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We must put the best interests of patients first and end the crisis in social care

4 min read

Baroness Judith Jolly, Liberal Democrat Spokesperson for Health, writes about the Deprivation of Liberty Safeguards (DoLS) system, covered in the Mental Capacity Act Amendment Bill which is currently going through parliament.

You may not know it but there are currently over 100,000 people, many of them with dementia, who may be unlawfully having their freedom restricted and receiving inappropriate care. This is because of the broken Deprivation of Liberty Safeguards (DoLS) system, which has been made worse by the crisis in the social care system.

But who is impacted by DoLS? The answer is the most vulnerable in our society, including those who have had a stroke or individuals with learning disabilities. However, they are most often used to protect older people, as the likelihood of a person having a DoLS application made on their behalf increases significantly with age.

DoLS reforms are therefore the main focus of the Mental Capacity Act Amendment Bill, which had its second reading in the House of Lords in July. These new safeguards aim to make sure people in care homes, hospitals or those receiving care at home, who can’t consent to their care arrangements, do not have their freedoms unlawfully restricted. 

I am pleased to see support for these new safeguards building. Indeed, there has been much criticism of the current DoLS system across parliament. The Joint Committee on Human Rights has said the system is broken and urgent action is needed to fix it. The process is overly bureaucratic and lacks the clarity over how DoLS should be implemented and who is responsible for their implementation. 

The backlog of DoLS assessments means there are over 100,000 people who may be having their liberty unlawfully restricted, hundreds of care home managers and Mental Capacity Act (MCA) practitioners whose workloads are overwhelmed by process, and thousands of family members struggling to get the best care for their loved ones.

A key part of the reforms gives major responsibilities to care home managers. However, there are currently no provisions in place for how care home managers will manage this new responsibility or deal with any conflict of interests. What the amendments need to ensure is a focus on the resources and training that are necessary to implement a DoLS assessment and to ensure patients’ best interests are met. 

Older people with dementia who are going through a DoLS assessment are particularly vulnerable. The nature of the illness means that an assessment by someone with limited training or time can mean the wrong care plan is implemented and an individual’s freedom is restricted. For a DoLS assessment to be in the best interests of the patient, there needs to be a face to face assessment by a fully trained and approved practitioner. This person-centred care planning will be in the best interests of the individual and will ease the burden on care home managers who already have multiple and complex caring responsibilities.  

Whilst the bill has many positive features, the current crisis in the social care system will restrict how successfully the bill can be implemented. A fully funded and integrated health and social care system needs to be guaranteed to ensure the success of the bill. Without support and funding for our local authorities and the right training and resources for care home managers and MCA practitioners, the most vulnerable in our society will continue to have their rights restricted and not receive the appropriate care.

With 100,000 people waiting for their DoLS assessments to take place, urgent action is needed to put the best interests of patients first and end the crisis in social care.

Baroness Jolly is the Liberal Democrat Spokesperson for Health


PoliticsHome member, Alzheimer's Society have responded to Baroness Jolly. Sally Copley, Director of Policy, Campaigns and Partnership said "Deprivation of Liberty Safeguards (DoLS) are an essential part of protecting the rights of people with dementia, and the system in which they operate must be given the resources it needs to do that". Read the full response here.

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