Notes from the Department of Health, DoLS Consultation
London, 28 October 2014
MCA/DOLS are, on the whole, still seen as a force for good within the sector. However, the Cheshire West ruling has thrown the cat amongst the pigeons, and some anxieties about the practical outcomes were expressed at the CPA consultation in London. The massive increase in applications (from 13,000 to over 100,000 in a year) has overwhelmed the system leading to a huge backlog in referral approvals.
Three issues dominated the meeting:
1) Delays in authorisations
People at the consultation were very happy to receive assurances from DH and CQC representatives that Cheshire West was, to an extent, not the problem of service providers. Rachel Griffiths (MCA/DOLS lead, CQC) told the meeting that inspectors would be sympathetic towards providers not having received approvals, as long as they are aware of the Cheshire West ruling and can demonstrate they are doing their best to obtain authorisations. A CQC briefing can be found at:
However, the message has clearly not got through to all inspectors, and some providers have been threatened with enforcement action owing to authorisation delays. Another was told by an inspector that they should be ringing their local authority every day to check on progress! If this happens to you, it would be a good time to contact ARC.
There were also some accounts of local authorities not playing fair, with a couple of reports of providers being told not to submit any more referrals, in one case for six months! Again, this is the time to contact ARC. The Local Authority representative on the panel (Henry Gilfillan, Bexley) was quite clear in saying that local authorities CANNOT tell providers not to make applications, even though they will not meet their time targets.
Henry from Bexley estimated that Cheshire West would cost his local authority an extra £4m this year, that’s one London borough. England has c.152 local authorities (depending on your definition). It’s difficult to extrapolate, but you can see the scale of the issue. One delegate pointed out that these extra costs are unlikely to be funded either centrally or with new money, so where is this all coming from? The obvious answer is the Health & Social Care budget. Every penny spent of Cheshire West is one less penny for care and support.
3) Sledgehammer to crack a nut?
To repeat, the sector approves of the MCA, sees it as a powerful force for progressive change, and has welcomed the opportunities offered by the Cheshire West ruling to review how services are offered to people with the greatest needs. Niall Fry (MCA/DOLS lead, Dept of Health) pointed out that Best Interests assessments following Cheshire West have often lead to more freedom for individuals.
However, one delegate argued (with some support) that DOLS was unnecessary and a poor tool to meet its intentions. She suggested that so long as a provider is implementing a solid and challenging care planning system DoLS is redundant. This does beg the question as to how Social Care would meet its obligations under section 5 of the Human Rights Convention. Please discuss, and show your workings!
The sector needs to be involved in these discussions, with as much front line experience as possible entered into the equation. Please use ARC, and keep us in the loop with what you are doing, including any interactions with CQC and local authorities.
We should be seeking joint training with CQC and LA staff, and possibly the Police so we all have a common understanding and understand each other’s issues. ARC will press for this.
Short and medium term solutions need to be found, as the long-term solution (legislation following a Law Commission review) is unlikely for at least 5 years!
Association for Real Change