The support and assessment social workers provide where someone may have mental capacity issues remains a vital and growing area of our practice in the 21st century.
We constantly strive to interpret and serve the needs and wishes of individuals who may be unable to make considered or rational choices about their own health and wellbeing.
In fact, it’s an issue we come across all the time. With awareness growing of our vital role in assessing, safeguarding and protecting the rights of our citizens in the most vulnerable circumstances, the proposed changes to the Mental Capacity Act (MCA) will help us make an even greater contribution.
In particular, the reframing of Deprivation of Liberty Safeguards (DoLS) as Liberty Protection Safeguards (LPS) is much more than a name change – it’s good news for social workers and the people who need our help the most.
I’m talking about individuals with learning disabilities, autism, mental illness, substance and alcohol misuse issues, and older people - including those in end of life care.
Considering a person’s needs, desires and how their care and support arrangements can help them achieve the best possible life is what social work is all about.
The principles of the MCA enshrine this purpose and are even more important when decisions are made which limit a person’s freedom in some way.
There has been a lot of debate and discussion around the proposals but everyone is keen to make sure that improvements are made to the system so that we can protect vulnerable people appropriately.
Time is arguably of the essence. There are currently 125,000 people in a backlog, waiting for their applications to be reviewed and their safeguards provided.
The Law Commission conducted four years of engagement with people who use services and also their carers, social workers, BIAs, providers and other local authority staff.
The government’s proposed reforms are based on their recommendations. The model aims to provide safeguards which are streamlined, proportionate and sustainable. Most importantly, they keep the person at the very heart of the process.
An individual’s human rights and unique voice must be at the centre of decision making and planning. In this context, social workers will have the authority to advocate on behalf of individuals and engage in meaningful consultation with them. These conversations will extend to family members and carers too and I welcome this explicit duty in the reforms.
It goes without saying that social workers have a comprehensive understanding of a person’s situation and should develop care plans with them.
It is entirely appropriate then that the responsible body (in this case, the local authority) should look to social workers to lead on LPS and provide counsel – and challenge if needed – on their use.
I firmly believe the outcome will be a system that is more flexible, responsive and compassionate. It’s another reason why I am so proud of this profession.
This will also mean that existing Best Interest Assessors will have opportunities to provide some additional resource which is so badly needed by the sector.
It is expected that existing BIAs will become Approved Mental Capacity Professionals (AMCPs), using their wealth of experience to review cases where there is objection or the person’s situation is very complex.
Many social workers could undertake this role, which would be an ideal use of their experience, knowledge and independent thinking.
As registered professionals with sufficient knowledge and experience, senior social workers may also conduct the pre-authorisation review, arranged by the responsible body. I am keen to raise the standards and profile of practice supervisors to make sure this is practice, not process led.
The review will consider the validity of the assessments and evidence of consultation and advocacy provision and decide whether the arrangements proposed should be authorised. The reviewer can if necessary meet with the person, make further enquiries or authorise arrangements with conditions.
Another example of social workers using their expertise would be conducting the ‘Necessary and Proportionate’ assessment, which checks that arrangements are in a person’s best interests.
This new model includes domestic settings, making sure people cared for at home are afforded the same rights and access to protections as in other settings. Previously, they may have had to apply through the Court of Protection, an often stressful and onerous process for all involved.
Social workers could play an important role here: identifying if restrictions are needed to keep someone safe at home, triggering the LPS process and informing the local authority.
Of course, we are not the only interested party in these proposed reforms. For example, there has been some controversy over the role of care home managers in the amended bill and any conflict of interest which might arise from their duties.
I know that officials have been working with stakeholders to understand concerns and provide clarification, as well as make changes to the bill in response. It’s important to note that the care home manager’s role is to arrange assessments only – they are not the final arbiters.
Amendments tabled by the government mean that arrangements and assessments are reviewed by the responsible body, who authorises them – it is not up to care homes to decide.
More broadly, it is important to me that social workers work in collaboration with care providers, giving them support and advice to make sure the person needing our care and support is able to achieve the best health and wellbeing outcome in whatever circumstances.
The Department of Health and Social Care has collaborated with stakeholders, listened to their concerns and made the necessary changes to improve the bill. I believe the proposals put our amazingly talented social work profession at the heart of good practice and can only enhance protection for the people who need it most.