Are women and ethnic minorities getting protection against deprivation of their liberty in hospital and social care?

Older people should be interested in the Deprivation of Liberty Safeguards (DOLS), because most of the people affected by official decisions to deprive them of their liberty under the Mental Capacity Act 2005 are older people affected by dementia, as you can see from this chart, published in the annual report on DOLs by the Health and Social Care Information Centre.

What this bar chart also tells you is that the rates of application are the same for men and women (the rates are per 100,000 in the population), but I think they shouldn't be because most applications are about older people and most older people are women: are men getting a disproportionate amount of protection from being deprived of their liberty?

And if you look at ethnicity a lower rate of white people are  affected by applications than the total rate of all other ethnicities, when white people are massively predominant in the population. Are agencies more prepared to make applications for the depriving non-white people of their liberty?

The law on DOLS is a bit hazy and the procedures are confusing, so it's not surprising that DOLS applications are still not hitting the expected rates, even after several years of the Safeguards being in operation. Numbers of applications are going up every year, although the rate of increase has slowed. That suggests that there are probably quite a lot of people who are being deprived of their liberty (although restriction of liberty is OK, so long as it's not continuous and heavy - that's one of the confusing thing about the law), and who are not getting the protection of the assessments that the Safeguards require. You can get some clue to this, by looking at the reasons applications were not granted. By far the most common reason was that nobody had done an adequate best interests assessment, so health and social care agencies weren't really looking too carefully at the best interests of the people they are supposed to be caring for.

Most of the people affected will be in hospitals and care homes. The Safeguards require health and social care organisations, that are depriving people of their liberty as part of caring for them, to carry out an assessment of the decision (or lack of decision) to do this. Mostly this is hospitals and care homes preventing people from leaving or pursuing their normal lives, mainly because there are fears for their safety where people cannot make decisions for themselves. The Safeguards require a 'best interests' assessment to be made by the professionals involved (is it in someone's best interests to be derived of their liberty?) and an independent element in the decision-making.

It's obviously still not working too well, and I'd be worried about the covert reasons why a decision is made or not made to apply for a DOLS authorisation. On the one hand, I think care homes and hospitals get themselves into deprivation of liberty situations trying to do their best in caring for people without thinking too clearly about people's rights and liberty. The affects mainly older people often without a lot of support from friends and relatives. On the other hand, I think they may be choosing to make applications when they are worried about being criticised or gong through a bad time with a particular resident or patient, rather than consistently thinking through whether their care for someone actually deprives them of their liberty.

Link to the HSCIC Annual Report on DOLS.

Big care services can be human, even if they are not small and local

I I'm always irritated by articles by top people in commercial organisations, when the main purpose of publishing it seems to be to promote how enlightened they and their organisations are without of course doing anything vulgar (and expensive) like actually advertising (the puff for the writer's organisation is about halfway down this one). However, this recent article on The Guardian's website makes an interesting point. It suggests that social services departments in commissioning services find it too easy to contract with big providers, rather than smaller, local services that might be a bit more human-sized and responsive to local circumstances. I actually think that it's possible to over-egg the argument about local is best. Expertise, flexibility and responsiveness is best, and professional services can do that if they're well-run, big or small. 

 Link to Guardian social care article