The rights of patients with dementia are changing. When it comes to patient-centred care, it’s always been a tricky one: on the one hand, you have to be sure your patients don’t put themselves or others at risk. But on the other, those patients need to be protected from having their liberties unjustly taken away from them.
And this balancing act is often made trickier when (as is so often the case) you’re dealing with someone whose behaviour isn’t consistent: on some days they’re fine; on others not.
Up to now you’ll have been relying on the Mental Capacity Act of 2005, which sets out the legal framework. But it’s long been known to have some significant flaws and gaps. So amendments to the act are currently making their way through Parliament. This will have potentially significant implications for anyone involved in providing care to Dementia sufferers – particularly when it comes to those patients’ liberties.
The bulk of the amendments contained in the new bill focus on Deprivation of Liberty Safeguards (DoLS). And these new safeguards aim to make sure people in care homes, hospitals, or receiving care at home, who can’t consent to their care arrangements, do not have their freedoms unlawfully restricted.
The Parliamentary Joint Committee on Human Rights has said the system for assessing these patients hasn’t been working: the process is overly bureaucratic and is unclear about how DoLS should be implemented and who should be doing it.
These flaws have contributed to a huge backlog of DoLS assessments which, in turn have had a number of negative consequences:
- over 100,000 people may be having their liberty unlawfully restricted.
- hundreds of care home managers and Mental Capacity Act (MCA) practitioners’ workloads are overwhelmed by process.
- thousands of family members are struggling to get the best care for their loved ones.
The Amendment Bill seeks to address this. In their current form, the reforms will give major responsibilities to care home managers and MCAs. But of course legislation can’t solve the problems on its own. It can work only if there’s a fully funded and integrated health and social care system in place to support it.
However, as Baroness Judith Jolly, Liberal Democrat Spokesperson for Health points out: “There are currently no provisions to enable care home managers and MCAs to manage their new responsibilities or deal with conflicts of interests. In particular, these people need adequate training to implement a DoLS assessment and to ensure patients’ best interests are met, and Person Centred Care is not just a piece of terminology to which we default, but a reality for each individual.”