Agenda item

Report of the Deputy Chief Executive (People)

The Cabinet Member considered a report of the Deputy Chief Executive (People) regarding Deprivation of Liberty Safeguards (DoLS) and meeting the Challenges.

Deprivation of Liberty Safeguarding was a statutory function for the Local Authority and supported the most vulnerable individuals.  Deprivation of Liberty Safeguards (DoLS) were introduced in 2009.  Initial demand on resources was lower than expected and only rose marginally until a Supreme Court Judgement in 2014 which resulted in a 10 fold increase in activity across all Local Authorities.

DoLS applied from 18 years and outlined the process by which an individual could be deprived of their liberty.  It applied to individuals who lacked capacity (as defined by the Mental Capacity Act and following formal assessment) to make decisions relating to their residence, their wellbeing and care and treatment.  They aim to make sure that people in care homes and hospitals would be looked after in a way that did not inappropriately restrict their freedom.  The safeguards should ensure that a care home or hospital only deprives someone of their liberty in a safe and correct way, and that this was only done when it was in the best interests of the person and there was no other way to look after them.  If all alternatives had been explored and a hospital or care home believed it was necessary to deprive a person of their liberty in order to care for them safely, then they must get permission to do this by following strict processes.  These processes were the Deprivation of Liberty Safeguards, which had been designed to ensure that a person’s loss of liberty was lawful and that they were protected.

Coventry City Council had a statutory responsibility for Deprivation of Liberty Safeguarding (DoLS) assessments.  Due to the ongoing increases in the number of requests for DOLS being received it had been necessary to review the way the service was currently meeting demand.  This report identified a number of amendments to practice and processes in order to address the increasing pressure on the service and associated budget which would move away from a best practice approach but would ensure the Council remained compliant with statutory duties and available resources.

The report detailed options that had been considered that sought to address both resourcing and scope of the function based on a minimum legal compliance basis and not best practice.  Option 1 was the recommended option to continue to outsource 50 assessments per month and support operational changes detailed in the report.  It was recommended that the Council enter into a tendering process to secure agency assessment to a ceiling of 50 per month for a period of 12 months with a 12 month extension possible to account for the potential changes to DoLS currently being consulted on.  The existing pathways, authorisations and assurance process would remain in place. Implementing this option and continuing to utilise external agency support for 50 Best Interest Assessments per month would ensure that the authorisation process was more closely aligned to the proposed model currently being consulted on and assessment activity would be reduced significantly achieving proportionality.  Implementing this option alongside the operational changes to processes and practice described in the report would reduce costs and also benefit recipients and families by introducing simpler and condensed paperwork.  These changes comply with the Mental Capacity Act principles and legal framework set out in the Deprivation of Liberty.  However, revised processes were not aligned to the Association of Directors of Adult Services (ADASS) Guidance and was therefore below a best practice standard.  In taking the position of not providing a best practice standard the Council would be helping to ensure it was able to meet its statutory obligations to more people within the resources available than would be possible through a best practice approach which required more resource per person.

Option 2 detailed in the report was not recommended but was to increase the current number of assessments carried out by the external agency to 100 per month.  The assessments were carried out by an external agency and this would  significantly reduce waiting lists and would enable a best practice approach to continue.  This option would enable the City Council to maintain governance of the process.  An increase in costs would be incurred as a result of this option in order to maintain service delivery, increasing the current overspend.  This would be significant and not budgeted so would require a commensurate saving to be delivered elsewhere in order to fund the option.

Option 3 detailed in the report was also not recommended, to outsource all Best Interest Assessments to one agency via a tendering process.  The City Council could cease to provide this service in-house and outsource the entire process to an external agency.  This would involve a tendering process and would possibly lead to a TUPE transfer of staff who were currently either mainly or wholly engaged on Best Interest Assessment duties.  This approach would achieve an ongoing reduction in overheads for the City Council as posts would be deleted and headcount reduced, however, any potential cost reductions would be at least partially offset through increased external contract costs.  Through this option the City Council would continue to have oversight of the DoLs process from a commissioning and clinical perspective.  There were however, a number of other potential risks associated with this approach:

•  Approved Mental Health Practitioners (AMHP) would be included in the   group of staff for which TUPE would apply and this would create a   significant risk to the delivery of urgent mental health statutory provision.

•  Consultation, tendering and TUPE processes would be lengthy and   resource intensive and considering the impending legislative changes   little benefit may be achieved.

Consultation on the proposal was not required as recommendations did not include option 3.  Key partners had been made aware of the changes. University Hospital Coventry and Warwickshire had been engaged and were supportive of the operational changes.

Implementation on the revised review and assessment process would take effect from 1^st November 2018 whereas the implementation of the electronic based system was anticipated to be in place by April 2019.  Entering into a new contract for the provision of assessments was likely to be complete by April 2019.

The Cabinet Member and Shadow Cabinet Member discussed the following areas with the officers present:

·  The impact on service users

·  Whether the recommended option with 50 assessments per month would be enough

·  The tender process

The officers agreed to provide an informal briefing to the Cabinet Member and Shadow Cabinet Member when the recommendations had been operational for 6 months. 

RESOLVED that the Cabinet Member

1.  Procure external agency support to the value of 50 assessments   per month, subject to the outcome of a tendering process

2.  Support the measures being taken to improve our ability to respond   to demand associated with Deprivation of Liberty Safeguards