Mental Health Act Committee - Deprivation of Liberty Safeguards, Recruitment of Best Interest Assessors in Health Boards in Wales

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1 Betsi Cadwaladr University Health Board Mental Health Act Committee Meeting 15 July 2014 Item 14/029.2 Subject: Situation Mental Health Act Committee - Deprivation of Liberty Safeguards, Recruitment of Best Interest Assessors in Health Boards in Wales The lack of Best Interest Assessors in the Health Board is on the Office of the Medical Directors risk register. A short-term and long-term plan has been put into place to increase the capacity of BIAs in order for the Health Board to continue to meet the legislative requirements for assessments. This will ensure appropriate patient safety, organisational governance, and clinical / operational effectiveness. The Chair of the Committee agreed to contact her Vice Chair colleagues across Wales to find out what the position is in other Health Boards. Background From 1st April 2009 new safeguards came into force to provide legal protection for those vulnerable people in care homes or in hospitals who are deprived of their liberty other than under the Mental Health Act From 1 st October 2009 Betsi Cadwaladr University Health Board was required to act as both a Supervisory Body and Managing Authority for the Deprivation of Liberty Safeguards. The Health Board is responsible for ensuring that systems and processes are in place for the Mental Capacity Act (MCA) (2005) and the Deprivation of Liberty Safeguards in order to discharge their functions as both the Supervisory Body (SB) and a Managing Authority (MA). As processes develop and legal precedent becomes clearer, existing evolved structures need to be reviewed. To date the Health Board has met legislative timeframes as reported to HIW. A response was received from Aneurin Bevan Health Board, Hywel Dda Health Board and Powys Health Board. Assessment Aneurin Bevan Health Board (ABHB) The five Local Authorities and ABHB have a consortium arrangement for DoLS, they pooled the DoLS funding received from Welsh Government. The Gwent Deprivation of Liberty Safeguards Team is hosted by ABHB in the Primary Care & Networks Division. The team supports the Supervisory Body functions for the six organisations and provides a team of Independent Best Interests Assessors (BIAs) The BIAs are fulltime and pooled from across the organisations.

2 This is an independent team from the Managing Authorities, whether they be Local Authority or ABHB employees. The team has a central point of contact for Managing Authorities across the Gwent Area. Following instruction from the Supervisory Body they carry out the independent assessments apart from the Mental Health Assessment and on occasion the Eligibility Assessment, which is carried out by GP (Section 12) doctor. The Supervisory Body function for ABHB is carried out by the Primary Care & Networks Division whereby the Divisional Director of Primary Care and the Assistant Medical Director have authority to authorise or decline a Deprivation of Liberty. The Managing Authority function for ABHB is carried out within the Nursing Division with the Director of Nursing as the lead, supported by Assistant Divisional Nurses. Hywel Dda Health Board Hywel Dda Health Board currently has 4 Best Interest Assessors (BIA S). 1 Learning Disability Nurse 1 Mental Health Nurse (RMN) 1 General Nurse who has experience of working with individuals who have a brain injury 1 Social Worker (AMHP) Each of the BIAs have completed the Bournemouth University accredited course for Best Interest Assessors. The BIAs work very closely with the Mental Health Assessors and the MCA Lead. BIAs work closely with each ward and will often visit the wards on numerous occasions and feedback to the Supervisory Body in relation to good practice and areas for improvement. This has led to a huge increase in DoLS referrals as the HDHB staff are beginning to understand the positive impact the BIAs can make to their every day decision making. All BIAs are on a rota system which means that every 3 weeks (usually sooner) they are completing an assessment which, ensures their skills are kept up to date. Powys Health Board Powys have taken a joint approach with the Local Authority (LA) in terms of BIAs (all of whom have undergone accredited training). Although they try to use the most appropriate BIA this is not always possible. There are currently 10 BIAs in Powys 3 from Health and 7 from LA, which more or less reflects the ratio of applications i.e. two thirds from Care Homes and one third from Hospitals. BCUHB current position Responsibility for the Supervisory Body (SB) function is held by the Medical Director, providing a separation between the SB and Managing Authority (MA) 2

3 responsibilities. MA is designated at ward manager level. There were 7 senior officers with a requisite knowledge of DoLS, available to sign off authorisations consisting of Nurse and Medical Directors and Assistant Directors. This has recently changed as the Nurse Director and Assistant Nurse Directors have informed the Supervisory Body that they are no longer able to fulfil this function. Accredited BIA training is provided by Manchester University. There is 5 staff trained to act as BIA s. This is in addition to their core substantive posts: Three (male) Learning Disability Nurses. One Social Worker. One (female) Learning Disability Nurse / AMHP. Since the Cheshire West Judgement, BCUHB has spot purchased an additional BIA for three days a week. Eligibility and Mental Health Assessments are carried out by section 12(2) Doctors arranged by Mental Health Act Administrators or the SB where the patient has a suitably qualified Doctor. The SB have a training and awareness raising programme that is available to all levels of staff. Part of this training is provided by National leaders in the field. BCUHB facilitate a quarterly BIA training / case discussion meeting open to all 6 Local Authorities. Additionally, a North Wales SB Group has met twice. Having merged the MCA and DoLS SB functions recently, BCUHB have funded three new posts to undertake Best Interest Assessments and MCA training and awareness raising. The posts are currently out for advert. BIA s and SB staff are available for advice. Conclusion The information received indicates that there is a varied approach across the Health Boards, as outlined above. Some key themes from the information are as follows: In the larger HB areas the BIA role is substantive. The most appropriate BIA is not always available due to capacity or availability. Two of the four HBs report a consortium arrangement with Local Authorities. In three HBs BIAs have received accredited Best Interest Assessor training. (This is not currently a requirement in Wales, although a practitioner acting as a BIA needs to be registered as a professional health or social care practitioner). Three of the four HBs have various systems of ongoing training and awareness raising within the BIA cohort. This information was received prior to the Cheshire West Judgement and therefore the position will have significantly changed due to the increase of applications all 3

4 SBs are currently receiving. Recommendation That the Committee receive and accept the report. Author(s) Presented by Sue Owen, Partnership Improvement and Development Manager and Lloyd Nelson, All Wales AC & s1292) and BCUHB DoLS Manager Sue Owen, Partnership Improvement and Development Manager Date of report 30 th June 2014 Date of meeting 15 th July

5 Appendix 3 Deprivation of Liberty Safeguards Training Plan 2013/14 SUBJECT TARGET GROUP CONTENT LOCATION FREQUENCY DoLS Level 3 Senior Nurses & Doctors staff responsible for making DoLS applications Awareness of process, Legal & ethical frameworks. East, Central & West 1 per region per year DoLS Level 4 Practitioner Refresher / Learning event. DoLS Awareness & Application Best Interest Assessor Training (Qualification) North Wales DoLS Peer Support Group Section 12(2) Doctors, Best Interest Assessors Authorised Signatories Consultants, Senior Nurses. Clinical Site Managers. Heads of Nursing. Heads of Service BCU Staff via Safeguarding Training Nominated practitioners BCUHB & LA BIA s & Supervisory Body representatives Emerging case law Inter-relationship between Mental Health Act & Mental Capacity Act Health Board responsibilities Care planning & reviews. Restriction/Deprivation. Best interest decision making Emerging case law Legal advice Understanding of legislation and process BIA roles & responsibilities and process. Legislation & case law Review practise, case studies, case law, legal advice and publications. Central Variable dependent upon target group As per safeguarding events & DoLS e-learning module (in development) Manchester University Central One half day per year TBC Annually As mandated Annually Quarterly 5