Rise in number of dementia and learning disability patients being restrained in care homes

There has been a rise in the number of people with dementia or learning disabilities, being restrained in care homes and hospitals, according to the Care Quality Commission.

The commission has published its second annual report on the operation of the Deprivation of Liberty Safeguards in England (2010/11) which it has a duty to monitor in England.

Care homes and hospitals have to apply for authorisation if they want to deprive someone of their liberty by keeping them locked in or restricted by bed rails, physically restraining them, placing them under high-levels of supervision, forcibly giving them medication and preventing them from seeing relatives and friends.

This became law in April 2009 as part of the Mental Capacity Act 2005. Awareness of this law in care homes and hospitals grew in 2010-2011 but staff training on how to apply it was still patchy, leading to inconsistent practice, said the Care Quality Commission (CQC).

Cynthia Bower, CQC chief executive, said: “The safeguards are vital to ensure that a person’s best interests are carefully considered, their needs fully understood, their wishes taken into account and their human rights properly respected.

The safeguards are no longer new, and care homes and hospitals have had time to train their staff and develop their internal procedures. We expect them to embed this as a routine, but essential, element of their operation.”

The safeguards protect the rights of people in care homes and hospitals who lack the mental capacity to consent to their care or treatment. They include people with dementia or a learning disability.

Authorisation must be sought to impose any restraint or restrictions on them that could breach their human rights.

The report, Monitoring the use of the Mental Capacity Act Deprivation of Liberty Safeguards in England 2010/11, revealed that the total number of applications by care homes and hospitals across the country for authorisations under the safeguards rose in March 2011, to 8,982 compared to 7,157 the previous year.

Fifty-five per cent were authorised, compared to 46 per cent previously. There continued to be considerable regional differences in the numbers of applications.

The report revealed that many providers had developed good practice on the Deprivation of Liberty Safeguards, notably in involving people and their families in the decision-making process.

But they also showed that some providers were confused about when restraints or restrictions on a person amounted to a deprivation of liberty. This was causing inconsistent practice and resulting in cases where people’s rights were not properly protected. A significant proportion of providers had still not trained their staff in the safeguards, two years after their introduction. Between a third and a quarter of care homes had not done any training, and in some cases only the manager had received training.

Deprivation of Liberty Safeguards applications by care homes must be made to the council with responsibility for social services in their area, and hospitals must apply to their primary care trust (PCT). The council or PCT must carry out assessments of the person involved before deciding whether to authorise the proposed restraint or restrictions.

Authorisation is granted only if the proposed course of action is considered to be in their best interests and there is no other less restrictive way to care for them or safely provide treatment. The CQC analysed a sample of 1,212 reports of inspections that it had carried out at care homes, NHS hospitals and private (independent) hospitals.

Cynthia Bower, chief executive of the CQC is pictured