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Hospital Managing Authority: DoLS identification, application and compliance

Nick Rudling, Safeguarding Adults Lead at Northern Devon Healthcare Trust discussed Hospital Managing Authority: DoLS identification, application and compliance at today’s conference. In his presentation Nick looked at:

  • the implications of the recent Supreme Court ruling in healthcare
  • how to identify a potential DoLS in healthcare
  • how to remain compliant

Nick Rudling full presentation is available for download at the end of this page.

In his presentation Nick states:

“Supreme Court ruling implications and challenges for health

  • Substantially lowered the threshold for cases that would meet the requirement for DoLS
  • Lack of detailed guidance from anywhere which provides practical help in applying the ‘acid test’ in practice.
  • Large Local Authority backlogs of patients waiting an assessment – implications for DoLS in the long term - ‘buy-in’ and reputation”

“Added considerations for health

  • Flow of patients – large hospitals with a constant movement of patients
  • Length of stay – not permanent, may be days, weeks, possibly longer..
  • Patients in Intensive Care Unit (ICU) – ICU society paper contains some guidance
  • Palliative care – DoH letter provides some direction”

“The Supreme Court also held that a deprivation of liberty can occur in domestic settings where the State is responsible for imposing such arrangements. This includes placements in supported living in the community as well as domiciliary arrangements which may amount to a deprivation of liberty. Such placements must be authorised by the Court of Protection.”

“DoLS identification tool - A Tool to support ward staff identify a potential DoL. Firstly, checks mental capacity. Secondly, offers a number of prompts which could indicate a DoLS , Thirdly, if a potential DoLS has been identified, prompts next actions i.e. DoLS referral.”

“DoLS Checklist - Due to the number of considerations required pre, during and post a DoLS application the checklist acts as an aid and prompt sheet. It also acts as a quick summary of the stage in the DoLS process for anyone picking up the case notes.”

“Once a DoLS application has been made don’t assume your duties are over…Ensure staff are reviewing the need for DoLS, particularly if the patients situation/condition changes. Re-enforce the importance of the MCA, assessment and best interests will help protect you if challenged.”

“Registered persons must notify the CQC about a number of changes, events and incidents affecting their service or the people who use it. One such statutory notification: Application to deprive a person of their liberty and its outcome.”

“How to remain compliant…

Don’t... bury your head in the sand and hope the DoLS will just go away

Do…ensure your senior nurses and ward staff are well briefed of the Supreme Court ruling and its implications

Do…Update your polices, guidance and training

Do…Go back to MCA basics, are Mental Capacity assessments and best interest decision reviewed and is the DoL still necessary and proportionate?

Do…consider introducing tools to support front line staff identify a DoL.

Do…ensure you are making the statutory DoLS notifications to the CQC

Do…ensure you have processes in place for notifying the Coroner of any deaths under DoLS

Do…work closely with your local Authority DoLS leads to ensure consistency and understand their pressures and priorities.”

Nick Rudling Biography:

Having completed an undergraduate degree (BSc) in Psychology and Physiology in 2005 Nick went on complete a Master’s degree (MSc) in Abnormal and Clinical Psychology. In 2008 he worked for North Somerset PCT in a role implementing the Deprivation of Liberty Safeguards, whilst working in this role Nick also completed a Post Graduate Certificate in Leadership and Management (PGCert). In early 2010, Nick moved to Gloucestershire County Council as Operations and Development Manager for Safeguarding Adults Services. In this role he managed a multidisciplinary team and over-saw the County Councils Safeguarding Adults, Mental Capacity Act and Deprivation of Liberty Safeguard functions.

In late 2011 Nick moved to Northern Devon Healthcare Trust as Safeguarding Adult Lead, where he currently works. This role includes lead responsibilities for MCA and DoLS as well as Safeguarding Adults.  In addition to this role he chairs the local Safeguarding Adult Boards MCA sub-group. Nick also established and chairs a South West England Safeguarding Adult Network for Health leads.

The application and identification of deprivation of liberty as well as continued compliance is demonstrating to be of particular challenge post Supreme Court Judgement. However, there are a number of considerations and actions that can be taken in order to maximize compliance with the safeguards whilst minimising the risk to the patient, staff and organisation. The presentation will take you through some of those key areas in the context of an Acute and Community Health Provider.

Forthcoming events of interest:

Improving Mental Health Crisis Care
Thursday 30 April 2015, London

Masterclass: Mental Health Pathways
Monday 11 May 2015, London

Stronger Code: Better Care Implementing the Changes to the Mental Health Act Code of Practice
Tuesday 12 May 2015, London

Masterclass: The Mental Capacity Act and Advance Decisions
Wednesday 13 May 2015, London

Psychosis & Schizophrenia in Adults
Monday 8 June 2015, London

Implementing the national objective to end Prone/Face Down Restraint: Examining Restraint Positions in Practice
Tuesday 22 September 2015, London

Masterclass: Deprivation of Liberty Safeguards
Friday 13 November 2015, London

Download: Nick Rudlings Presentation

25 March 2015


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