A Report just published by the CQC The operation of the Deprivation of Liberty Safeguards in England, 2009/10 will be of great interest to everyone who has ever had cause for concern about the way in which these DoLS have been applied in their own particular circumstances.
“A number of cases concerning deprivation of liberty have come before the European Court of Human Rights and the UK courts. The following list is based on the judgements of several of these cases and indicates the circumstances that have led to courts deciding that patients have been deprived of their liberty:
• Restraint was used to admit a person to a hospital or care home when they were resisting admission.
• Medication was given forcibly, against a patient’s will.
• Staff exercised complete control over a person’s care and movements.
• Staff made all decisions on a person’s behalf, including choices relating to assessments, treatment, visitors and where they could live.
• Hospital or care home staff took responsibility for deciding if a person could be released into the care of others or allowed to live elsewhere.
• When carers requested that a person be discharged into their care, hospital, or care home staff refused.
• A person was prevented from seeing friends or family because the hospital or care home restricted access to them.
• A person was unable to make choices about what they wanted to do and how they wanted to live, because hospital or care home staff exercised continuous supervision and control over them.”
I don’t know anyone who has brought their case the the European Court of Human Rights or the UK courts. But I do know people who have had to fight hard to challenge decisions made by staff in hospitals, care homes and social services, as per each of the judgements listed above.
The relatives in question may have known little – or a lot – about the Deprivation of Liberty Safeguards.
Some of the relatives who were challenging these decisions had Lasting Power of Attorney (LPA) for Health and Welfare on behalf of their relatives, but still they were dismissed by the decision-makers as if they were just a thorn in the side of the authorities.
I do wish the supreme arrogance of those with the power to destroy lives could be trained out of existence.
The Report is not comfortable reading, especially for anyone who has encountered sub-standard care and neglect of their own relative in a care home. The examples given of the inappropriate deprivation of liberty that people with dementia have suffered are particularly gruesome.
“For example, during an inspection following a safeguarding alert, we found that a person in the care home who often suffered from confusion as a result of dementia was being locked in a room alone overnight and not checked by staff for periods of up to 10 hours. This person’s notes described their usual routine as being up at night and up early in the morning. However, because of their confusion and lack of mental capacity, they would be unable to use the call bell to summon assistance if necessary, and were therefore unable to follow their desired and usual routine. This practice was being carried out without any consideration that it may have been a deprivation of the person’s liberty. There was also no apparent consideration of any less restrictive practice and no thought given to alternatives such as increasing the number of staff overnight.”
Is this Care in the UK? Or Neglect in the UK?
CQC Reports will change nothing – unless there is also positive action. Today – not tomorrow.
If the DoLS regulations are “too difficult” for healthcare and social care staff to understand, they must be revised, reviewed and re-written so that they are easily understood by anyone and everyone. If the DoLS regs are to be a meaningful legal framework, there’s an absolute need for them to be understood and correctly applied.
Attitudes must change; training must change; dementia training must be made mandatory, not optional; staff-to-resident/patient ratios must be increased and enforced, not just left to chance; the postcode lottery of care and safety needs to change.
Will that be possible in the Big Society? Will that be possible with vicious cuts being applied without regard to care?
Who will care then?