Mental Capacity Act and Deprivation of
Liberty Safeguards
E-Newsletter for Managing Authorities March 2016
Welcome to the March newsletter! Please share this newsletter with
interested colleagues.
Firstly we wish you, your residents and families a very Happy Easter
National Mental Capacity Act Action Day 2016
Since November 2015 the National MCA Forum has had a new chair Baroness
Finlay. She has declared March 15th as National MCA Action Day. There will be an
event in London on that day and the purpose of the event is to:
 Profile Current Best Practice
 Identify MCA improvements for coming year
 Greater commitment from attendees for projects and work to improve MCA
implementation at the front-line.
Organisations have been asked to submit examples of innovative projects around
MCA work to be presented on the day, we have submitted a project. Our project is
around attending the over fifties groups in North Yorkshire and highlighting to them
the importance of planning for future care, putting in place lasting power of attorney
and explaining the DoLS process, including the role of the RPR. To date we have
spoken to 101 people face to face and a further 500 have received newsletters and
minutes with the information. Also another innovation that is taking place
countrywide is an ‘Unwise decision wall’ where we as staff etc. can post our unwise
decisions! It can be done with flip charts, post it notes or electronically etc Maybe
you would like to do this in your Care Home or Hospital? It raises awareness of MCA
and can bring a smile to our lips!
Mental Capacity Act in DoLS authorisation requests.
The phrase ‘Mental Capacity’ used in the Act refers to our ability to make decisions.
The five statutory principles are:
1. A person must be assumed to be able to make the decision unless it is
established that they are unable to (from your evidence.)
If relevant what makes you consider that the person lacks capacity to make this
particular decision? What is your evidence? It is acceptable to record that you have
acknowledged the need to look at Mental Capacity Act but you have no reason to
explore whether the person lacks capacity for the decision at this time.
2. A person is not to be treated as unable to make a decision unless all
appropriate steps to help him have been taken without success.
What steps have been taken? Have you provided the individual with the information
they need in a format that they understand? Have you ensured that this is the best
time to assess their capacity? Do they need additional support from an advocate or
speech and language therapist? Has the decision been made as simple as possible?
(There can be more than one decision to make at a time).
3. A person is not to be treated as unable to make a decision merely because
they make an unwise decision.
On the basis that it must first be assumed the person has capacity, the actions or
decisions taken by an individual must not be the sole reason that a Mental Capacity
assessment was undertaken, (see below). Has this person been supported to
understand the risks? Have they been supported to undertake the risk?
4. An action taken or decision made on behalf of a person who lacks capacity
must be done, or made in their best interests.
Have you taken into account the views and wishes of the person, the views of
relevant others? Any previous wishes?
5. Is it the least restrictive option?
Any ‘best interests’ decision taken on behalf of an adult should interfere as little as
possible with their rights and freedoms. Each decision has to take account of all the
circumstances, and take the least restrictive course of action available.
In order for someone to be deemed to lack capacity for a specific decision, it must
first be determined whether there is an impairment of the mind or brain, or is there
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some sort of disturbance affecting the way their mind or brain works? (it doesn’t
matter whether the impairment or disturbance is temporary or permanent.) The
impairment could be a stroke or brain injury, a mental health problem, dementia, a
learning disability, confusion, drowsiness or unconsciousness because of an illness
or the treatment for it, substance misuse. What is it about this impairment that
makes them unable to make the decision?
Question to ask when making a referral for DoLS authorisation
Does the individual understand that they are in a care home or hospital? Do they
have a basic awareness of their needs? Do they have a basic awareness of the likely
consequences of not receiving support with their needs? In considering this you
should look at their ability to understand, retain, weigh up and communicate the
decision.
If the individual in your care is able to consent to their stay for the purpose of
receiving care and treatment, then a DoLS authorisation request should not be sent.
RPR Visits
As part of the DoLS process the Supervisory Body needs to appoint a representative
for the relevant person .We look to family/friends in the first instance. Then if none
are available or able to take on the role we then refer to an advocacy service. The
role is very important, being the persons advocate also around instigating a 21a
appeal. The RPR needs to visit at least every 6 weeks. If you are aware of someone
who’s RPR does not visit could you please let us know then we can review the
situation.
Section 21a Appeals
As previously mentioned the RPR is crucial in supporting the relevant person in the
appeal process. Nationally there is an increase in the number of DoLS 21A appeals
that are being sent to the Court of Protection. Every person who is subject to a DoLS
has the right to appeal, even if its felt that their package of care is in their Best
Interest and that the appeal may fail .Therefore it needs to be stated that if a patient
or a resident is appealing against their DoLS, it does not necessarily reflect on the
care they are currently receiving
Form 2 Further Authorisation Request
Just a reminder to Managing Authorities when submitting a form 2 please can you
make it clear on page 2 whether there has been any change since the last
authorisation, whether this is in the regime that is delivered, or the overall health
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and wellbeing of the individual. This will help us to prioritise the referral
appropriately.
Emails
Please note when a member of staff uses their email on a DoLS referral form this is
the e-mail we will use as a team to communicate with the Managing Authority.
Therefore if a nurse on the ward for example emails a referral through then goes
away for a 2 week holiday all DoLS information will be emailed back to that email
address. Therefore some thought needs to be given to the best email address to be
used in this circumstance.
Paperwork
A reminder of the current paper work.
Forms 1 and 4, urgent and standard are now combined and form 2 is much shorter
please find templates below.
Form-2-Further-Auth Form-1-Standard-an Form-10-Review-Req Form-12-Notificationorisation-Request-Final.docx
d-Urgent-Request-Final.docx
uest-Final.docx
to-Coroner-Final.docx
Poster flowchart
2015.ppt
Usual Reminders!
When someone is subject to a DoLS dies please let the DoLS office and Coroner’s
office know immediately.
Currently there is a private members bill going through parliament, which has
already had its second reading, proposing changes as to whether a death under
DoLs should be regarded as a death in state detention. Clearly this may be a
significant change, and we’ll keep you up to date re any changes. In the meantime,
you must continue to inform your local coroner.
Also the DoLS team need to know when someone is discharged from hospital or
moved from one Care Home to another any changes in Residency has an impact on
the DoLS.
Also please note if a person needs an interpreter to support them in the DoLS
assessment process please enter this on the referral form, to enable the DoLS team
to arrange for an interpreter to be present during the assessments.
If you give us an email address to contact you, please make sure it’s an address that
is checked regularly
Thank you very much for your cooperation in these matters
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If you aware of any good practice around MCA or DoLS we would be very interested
to share in the future newsletter
Website
Please visit our website, all the forms and supporting information is on the site If
you feel we could improve the content in any way please let us know. Shortcut to the
site is www.northyorks.gov.uk/dols
Contact Us
The NYCC MCA/DoLS Office is open:
Monday –Thursday 8:30am- 5:00pm and Friday 8:30am- 4:30pm
DoLS helpline number 01609 536829. Calls will be monitored and
returned between 10am-2pm. Please note that this number is for
follow up/queries only. We have a general email address which is
monitored for queries but not referrals – [email protected]
If you require DoLS authorisation outside of these times or during a bank holiday
period please process the application in the usual way and it will be acted on upon
our return.
Sending Referrals
All completed forms should be faxed to our Customer Service Centre on: 01609
532009 or emailed to: [email protected].
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