Legal safeguards for vulnerable patients being 'ignored', warn MPs
Rules aimed at protecting the rights of people with dementia or severe learning difficulties are being ignored, MPs have warned.
Deprivation of liberty safeguards (Dols), designed to protect vulnerable people from abuse, are often used incorrectly, the Commons Health Committee said.
Dols aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.
They should ensure that a care home or hospital only deprives someone of their liberty in a safe way, and when there is no other way to look after them.
If a person is to be deprived of liberty, a care home must follow a strict process. This includes providing the person with a representative, giving the person or representative the right to challenge the order through the Court of Protection and a regular review of the situation.
In their report, MPs said the application of safeguards is “variable and, on many occasions, those responsible for ensuring patients are protected by them have failed to do so”.
They said: “There is considerable confusion around the scope of the safeguards and how and when to apply them in practice.
“The evidence the committee heard regarding the application of Dols revealed a profoundly depressing and complacent approach to the matter.
“There is extreme variation in their use and we are concerned that some of the most vulnerable members of society may be exposed to abuse because the legislation has failed to implement controls to properly protect them.”
The MPs called for an urgent review of the system.
Committee chair, Conservative MP Stephen Dorrell said: “Mental health legislation is designed to protect extremely vulnerable patients but our review has found that many vital safeguards are not working effectively. The provisions for Dols are not working well. We found that it is commonplace for Dols to be ignored, leaving many people at heightened risk of abuse.
“Dols are seen as complicated and difficult to implement, but this is no excuse for the extreme variation in their application across the country. The current approach to these vital safeguards is profoundly depressing and complacent and the government must immediately instigate a review which details an action plan for improvement.”
The report, which reviews the working of the 2007 Mental Health Act, also examined the way in which people with mental health problems are detained.
“The Department of Health does not appear to have clear understanding of the factors driving increased detention, particularly in relation to failures in community treatment and the readmission of patients,” it said.
There is “severe pressure” on beds with some wards running at over 100% occupancy.
“The most worrying consequence of this was the suggestion that voluntary admissions to psychiatric wards are now so difficult to access that patients are being sectioned to secure treatment in hospital.
“The committee is very concerned that clinicians would resort to a practice which represents a major infringement of a patient’s civil liberties.”
The MPs also expressed concern that pressure on hospital beds may be driving increased use of community treatment orders.
Mr Dorrell said: “Financial pressures should never distort clinical judgments, but the absence of clear guidelines for clinicians makes this all the more likely.”
Louise Lakey, policy manager at the Alzheimer’s Society, said: “It is essential that care homes and hospitals take the human rights of vulnerable people, such as people with dementia, seriously.
“However, the regional variation in how deprivation of liberty safeguards are being used and the fact that in some instances they are being ignored is very worrying.
“Vulnerable people must be treated with dignity and respect. Training in how to provide quality care and on how to use deprivation of liberty safeguards is vital to ensure that vulnerable people’s rights are being protected.”
A Department of Health spokesman said: “We have made it clear our goal is to make sure mental health has equal priority with physical health, which is why we have enshrined this principle in law for the first time.
“Making sure people with mental health problems get the right assessment, care and treatment they need as quickly as possible is vital and the local NHS must ensure acute beds and appropriate services are there for patients who need them.
“Vulnerable people deserve to be fully protected at all times, particularly when they need to be deprived of their liberty in their own best interests. However, there are still unacceptable variations across the country and we are working with the CQC, health services and local authorities to ensure that these protections are used whenever they are needed. “
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