The document discusses the Care Quality Commission's (CQC) approach to monitoring compliance with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The CQC will assess providers on their understanding of the MCA and efforts to avoid unnecessary deprivation of liberty. They expect local authorities to address the backlog of DoLS requests and for providers to work within the MCA framework. The CQC incorporated the MCA into their new ratings system by including it as a key line of inquiry under the "Effective" domain. Common issues found in inspections include lack of capacity assessments and involvement of individuals in best interests decisions. Overall, the CQC aims to ensure people's liberty is only restricted in accordance with the

1. MCA DoLS
a view from the CQC
Rachel Griffiths

2. Ancient Chinese Curse…

3. Use of DoLS over first five
years

4. HSCIC data 2014/15

5. A “gilded cage” is still a cage…

6. CQC response in the short term
Acknowledging that supervisory bodies are under strain
Providers will be assessed on compliance with the MCA
where appropriate: re deprivation of liberty, we check that
• They understand the key points of the Supreme Court
ruling and they are doing their best to seek authorisation
• In discussion with supervisory bodies and commissioners
• Doing all they can to minimise the need for deprivation of
liberty – can care or treatment be given in a less restrictive
way?
• CQC concerned for the person at the heart of the process
and for providers
• Fear of DoLS being overwhelmed by bureaucracy.

7. CQC’s expectations
• Local authorities to do all they can to assess the backlog
of requests for authorisation and prevent its recurrence, for
example by using the triage tools created by the
Association of Directors of Adult Social Services (ADASS).
• Providers to work within the framework of the MCA and,
where relevant, the Supreme Court judgement, pending
the Law Commission review and any changes that arise
from it.
• Joint working, locally and nationally, to make sure that
commissioning, training and policies take into account the
need to avoid deprivation of liberty wherever possible.
CQC: Monitoring the use of the MCA DoLS 2013/14

8. House of Lords MCA committtee
Recommendation for CQC:
“The standards against which the CQC inspects should
explicitly incorporate compliance with the Mental Capacity
Act, as a core requirement that must be met by all health and
care providers”.

9. MCA Key Line of Enquiry
• The same over all sectors we regulate (adult social care,
acute hospitals, primary and community medicine)
• Five questions: is a service safe, effective, caring,
responsive and well led?
• MCA under the ‘Effective’ domain, linked to the new
regulation on consent
• MCA part of the descriptors in the new ratings system:
‘outstanding’, ‘good’, ‘requires improvement’ and
‘inadequate’.

10. New Regulation 11 (replacing
Reg. 18) on consent
11.—(1) Care and treatment of service users must only be
provided with the consent of the relevant person.
(2) Paragraph (1) is subject to paragraphs (3) and (4).
(3) If the service user is 16 or over and is unable to give
such consent because they lack capacity to do so, the
registered person must act in accordance with the
2005 Act.
(4) But if Part 4 or 4A of the 1983 Act applies to a service
user, the registered person must act in accordance
with the provisions of that Act.
(5) Nothing in this regulation affects the operation of
section 5 of the 2005 Act, as read with section 6 of that
Act (acts in connection with care or treatment).

11. Extracts from ‘what good looks
like’ (for ratings)
People are supported to make decisions and, where
appropriate, their mental capacity is assessed and
recorded.
The use of restraint is understood and monitored, and less
restrictive options are used where possible.
Deprivation of liberty is recognised and only occurs when it is
in a person’s best interests, is a proportionate response to
the risk and seriousness of harm to the person, and there
is no less restrictive option that can be used to ensure the
person gets the necessary care and treatment.
The Deprivation of Liberty Safeguards, and orders by the
Court of Protection authorising deprivation of a person’s
liberty, are used appropriately.
Provider Handbooks, on CQC website

12. Common issues from
inspections 2013/14
• People’s capacity to make a specific decision was not
being appropriately assessed.
• Decisions were being made on behalf of people without
following the best interests decision making process;
person not involved, relatives/friends not consulted.
• Relatives were asked to give consent without legal
authority.
• There were examples of unlawful use of restraint and
unauthorised deprivation of liberty.
• Lack of staff training in the MCA including the Deprivation
of Liberty Safeguards.
CQC: Monitoring the use of the MCA DoLS, 2013/14

13. Authorisation provides
protection
House of Lords found overwhelming evidence of
health services being paternalistic and social care
services risk-averse – probably both are both:
Deprivation of liberty (or restraint) often not even
recognised
The search for less restrictive options must be
continuous
Every effort must be made to enable people to make
their own decisions about how they live.

14. DoLS fit inside MCA which fits
inside human rights law

15. Now what…?
• a simple test?
• a streamlined procedure?
• a lot of claims?
• a change in the law?

16. 1. Mrs Smith just needs to be ‘Cheshired’ !
2. Mr Jones is being deprived of his liberty, as we are
putting eye drops in when he is not looking!
3. we are depriving P of his liberty, as we have had a new
front door fitted and it is heavier and much harder to
open.
4. we are depriving P because he is not allowed to open the
fridge in the communal kitchen-he loves chocolate!
5. we do not continually supervise P but we do follow her
wherever she goes!
Top Five Referrals from Managing
Authorities (Post Cheshire West)
4/28/2015 16

17. • DOL is far more widespread than previously recognised
• And is not necessarily a bad thing – but needs scrutiny /
authority – or will be unlawful DOL
• expect busy times – and huge resource implications and
potential liabilities
• need careful review of existing cases, training and support
• in the rush to protect rights and safeguard the most
vulnerable, don’t forget “empowerment”
• real “acid test” is how judgment is applied in practice
conclusion …