Agenda item

To discuss the Council’s ability to implement the Deprivation of Liberty Safeguards.

To accept the report and note the following observations:

a)    To declare genuine concern about the situation and the Care Scrutiny Committee's unwillingness to accept the risk highlighted in the report.

b)    To request that the Cabinet Member for Adults discusses further with the Adults, Health and Well-being Department and create an action plan.

c)    To request that the Department provides a Progress report within six months.

d)    To note a wish to receive further information from an expert.

 

The report was submitted by the Cabinet Member for Adults, Health and Well-being as well as the Assistant Manager for Safeguarding, Quality Assurance, Mental Health and Community Safety.

 

It was explained that Deprivation of Liberty Safeguards (DoLS) arrangements was the procedure prescribed in the law when a resident or patient must be deprived of their freedom when they did not have the capacity to agree on their care or their treatment, in order to keep them safe from harm. It was explained that conditions such as dementia or brain injury could lead to this lack of capacity. Emphasis was placed on the fact that each case was considered on its merits.

 

Members of the Committee were guided through the report, noting that DoLS was a statutory duty and that it was a requirement for Local Authorities to lead on DoLS matters within their communities and care homes, with the Health Board leading the field within hospitals. It was reiterated that every application for DoLS Standard Authorisation was expected to be completed within 21 days, with emergency applications being completed within 7 days. It was acknowledged that there was currently a waiting list of 340 in Gwynedd. It was emphasised that this meant that 340 individuals were being deprived of their liberty without authorisation. It was reiterated that 20 of those individuals had been waiting for Standard Authorisation for over three years because of changes to the waiting list as a result of priority.

 

The fact that the Council did not comply with the relevant legislations and that there were clear corporate risks here was highlighted. Reassurance was given that this matter had been escalated within the Adults, Health and Well-being Department's performance challenging meetings. It was explained that the report was a way to share information with the members regarding the situation, whilst trying to obtain the Committee's feedback and support. It was emphasised that this situation was not unique to Gwynedd, confirming that Local Authorities across North Wales and nationally had a waiting list for DoLS provision.

 

It was stated that the Council received 67 applications, on average, for Standard Authorisation Assessments every month. It was noted that 16 of those applications could be authorised in a timely manner. It was reiterated that a Standard Assessment was valid for a year, explaining that the individuals who had received a DoLS assessment must receive an additional assessment at the end of that period. It was ensured that the Department had a process to prioritise the individuals who were on the waiting list in accordance with urgent needs and the need to renew the Standard Authorisation.

 

It was reported that 18 employees within the Adults, Health and Well-being Department had qualified as Best Interests Assessors. It was noted that the Department had attempted to encourage these individuals in the past to conduct assessments for DoLS, but this was not sustainable because each assessment took a minimum of 10 hours to complete.

 

Reference was made to the resources available to get to grips with this challenge, noting that the Department had one DoLS Coordinator employed four days a week and one Best Interests Assessor employed for two days a week. It was reiterated that the Council had managed to receive £114,000 worth of grant money from the Welsh Government over the last three years to address the requirements of the waiting list in Gwynedd. It was explained that the Council had experienced recruitment challenges when trying to appoint individuals to conduct the assessments, as it was a short-term post as a result of the fact that the funding was provided annually. It was reiterated that this funding had been used to commission an agency and pay doctors to complete the assessments on behalf of the Council.

 

During the discussion, the following observations were noted:- 

An enquiry was made about the difference between the lack of capacity ruling and DoLS standard authorisation assessment. It was explained that individuals must receive a lack of capacity ruling before applying for a DoLS assessment. In response to a question about who was allowed to apply for a DoLS assessment, it was confirmed that this was usually done through the professional workers.

 

In response to a question about whether the essential requirement to be able to communicate in Welsh had led to less people applying for posts, the Senior Language and Scrutiny Advisor confirmed that the Council's Language Policy made it a requirement that posts were always advertised noting Welsh language skills as essential. It was reiterated, when posts were advertised for a third time and there was a lack of applicants with the eligible language skills, then it could be considered to appoint an individual who did not fulfil the necessary language skills if they were committed to learn and improve their Welsh skills. The Council could provide suitable training for them. The Cabinet Member added that the Adults Department had been offering Welsh lessons and driving lessons to those who fulfilled the other requirements and tried to be flexible to attract workers.

 

An enquiry was made as to whether the Department had considered the possibility of advertising a permanent post jointly with a nearby County, as it was believed that a permanent post would attract more applications. In response, it was noted that this would be challenging to administrate because the numbers and requirements of DoLS provision varied between the region's Local Authorities. It was also noted that other counties in north Wales had had more success recruiting officers to complete the assessments than Cyngor Gwynedd. Other challenges were also highlighted, namely how the work would be prioritised if it would be administered by one officer working across two Counties.

 

In response to a question about the financial penalty, reference was made to the internal inspection to the arrangements completed in 2022. It was confirmed that a follow-up inspection had been completed in March this year, where it was noted that there was a high risk for the Council to be penalised for lack of compliance with DoLS statutory arrangements. Details were given on the fact that it was a financial penalty of approximately £3,000-£4,000 per individual, monthly for the period in which the individual had been deprived of their liberty without authorisation was the highest cost that could have been given. The Department acknowledged that it was not possible to mitigate the risk with the resources available to the department currently and therefore, they believed that they must continue to try and find processes to comply with the legislation. It was noted that a second option was to earmark additional resources to resolve the situation. A wish to employ a full-time officer was expressed to undertake these assessments, acknowledging that the total cost of employing them would approximately be £90,000 a year. Frustration was expressed that employing one full-time officer would not manage to achieve the same workload as the agencies currently used for the same amount of money. The fact that financial bids within this field had not been successful in the past was reported. It was acknowledged that there were no alternative options to consider at this point in time.

 

In response to an enquiry, it was reported that the Council had received a fine in the past and was likely to receive another fine soon for an individual who had been deprived of their liberty without authorisation for a six-month period.

 

Members of the Committee were reminded of training received by a legal specialist on a similar matter in the past. As a result of changes in the membership of this Committee, it was proposed to send an invite to receive a presentation from a specialist once again to ensure that Committee members made informed decisions considering the way forward to the provision in Gwynedd.

 

The Cabinet Member noted that he was not expecting a solution today, but instead to escalate the risk to the Council. He highlighted the fact that plans were underway but he was eager for the whole Council to understand the risk. They took the opportunity to praise the staff of the Department for their work and for prioritising the safeguarding field.

 

The members expressed their unwillingness to accept the risk and to accept the report in its current form and they noted their desire to receive more information. It was stated that the Care Scrutiny Committee would not commit to making a decision on this financial risk without receiving further specialist information. Instead, there was a consensus to express genuine concern for the situation and the Cabinet Member was asked to collaborate with the Department to develop an effective action plan, as well as provide more detail on the financial options of recruitment.

 

The Department was asked to provide a progress report in six months to present an update. The officers were thanked for a comprehensive and clear report.

 

RESOLVED

 

To accept the report and note the following observations:

a)    To express genuine concern about the situation and the Care Scrutiny Committee's unwillingness to accept the risk highlighted in the report.

b)    To request the Cabinet Member for Adults to discuss further with the Adults, Health and Well-being Department and create an action plan.

c)    To request that the Department provides a Progress report within six months.

d)    To note a wish to receive further information from an expert.