Welsh inspectorates announce national review into Dols that will examine significant local variations in caseloads
Inspectors are to conduct a national review into the use of the Deprivation of Liberty Safeguards (Dols) in Wales over concerns that significant local variations in caseloads entail a ‘neglect of human rights’.
The review, which will be based on inspections of councils, health boards and care homes and will report this summer, will examine why the number of Dols cases varies so significantly between areas.
In 2012-13 seven councils – Isle of Anglesey, Gwnyedd, Conwy, Ceredigion, Blaenau Gwent, Wrexham and Neath Port Talbot – received fewer than 10 applications from care homes to authorise the deprivation of a person’s liberty for every 100,000 people in their populations. By contrast, Rhonda Cynon Taff and Carmathenshire received over 50 applications from care homes per 100,000 population, revealed today’s annual report on the operation of the Dols from the Care and Social Services Inspectorate Wales and the Health Inspectorate Wales. Conwy and Ceredigion did not authorise any of the applications they received whereas Rhonda Cynon Taff and Carmathenshire authorised most of theirs.
While today’s report said part of the variation can be accounted for by demography and the geographical distribution of care services – Carmathenshire has almost four times as many care homes as neighbouring Ceredigion – the inspectorates said this only explained part of the variation.
‘Neglect of human rights’
They said the figures suggested that some people were being detained in care settings without the capacity to consent or the protection of the safeguards.
“Taken at face value this represents inconsistency in the meeting of people’s legal entitlements,” said today’s report. “Put plainly, it may point to a neglect of the human rights of some of the most vulnerable citizens in Wales. It is for this reason that will be undertaking a national review of the use of the safeguards in 2014.”
Similar variations in the number of Dols cases have prompted concerns in England, with the House of Commons health select committee calling for an immediate government review into the safeguards last year, saying there was “no excuse for the extreme variation in their use across the country”.
This recommendation was not taken up though the Department of Health said it would use its recently-created Mental Capacity Act steering group to “examine the evidence to understand the progress which has been made so far in implementing the Deprivation of Liberty Safeguards”.
Unlike the CSSIW, the Care Quality Commission in England does not inspect local authorities, making the CQC more reliant on its regulatory oversight care homes and hospitals to fulfil its role in monitoring the Dols. It has sought to fill this gap by voluntarily surveying council staff and gathering information through structured interviews for its annual reports on teh Dols.
Sharp fall in reviews of Dols cases
Today’s report from the CSSIW and HIW also identified a sharp fall in the number of reviews carried out of Dols authorisations, from 30 in 2011-12 to 17 in 2012-13 – just 7% of the 254 authorisations granted last year.
Councils or health boards, known as “supervisory bodies” under the Dols, must review an authorisation when requested by the person subjected to the safeguards, their representative or the “managing authority” – the care home or hospital providing their care. Supervisory bodies can also initiate a review into whether the authorisation or conditions placed on its use remain valid.
The fall in the number of reviews in Wales was accounted for chiefly by a drop in the number initiated by councils, from 18 to six.
The absence of timely reviews raises questions about the proper consideration of any change in a person’s capacity or circumstances,” said the report. “An effective review process is central to the safeguarding of individual liberty and human rights.”
This issue will also be considered as part of the national review, the report said.