This document guides carers of people living with dementia through the process of making difficult decisions during the Covid-19 pandemic whilst taking into consideration wishes and preferences of those they care for and the legal aspects of making decisions. The guide covers a number of decisions carers may need to make if the person they are caring for has or is suspected to have Covid-19. These include decisions such as how to care for them if they are unable to visit them, whether they should go to hospital if they become unwell and what it means to have a do not attempt cardiopulmonary resuscitation order. The guide also provides useful tips for carers such as the Covid-19 symptoms to watch out for which may differ to the commonly recognised symptoms, where to find help and support when making decisions and how to look after yourself as a carer. Topics covered include: thinking about any existing advance care plans; wishes and preferences; legal aspects of decision making; managing care at home; supporting someone in a care home; admitting them to hospital if they are very unwell; support for carers; and how carers can look after themselves during coronavirus and beyond.

The guidance outlines how the coronavirus (COVID-19) transmission risk can be minimised when support is provided so that people who need assistance can visit shops, socialise or exercise safely. Contents include: who can get support; what ‘getting support’ means; getting support while socially distancing; who should help you; what everyone should do when they provide support to you; getting support from someone in your household or support bubble or your normal carer; getting support from someone who is not in your household or support bubble, or is not your normal carer; getting support from volunteers or organisations; if you have symptoms. [Published 2 September 2020. Last updated 3 March 2022]

This is the fourth annual report of the National Mental Capacity Forum. Against the backdrop of the Covid-19 crisis, the report spans three main aspects of the Forum’s work: evaluation of the efficacy of the Forum over its first four years in changing awareness of the Mental Capacity Act (MCA) and its implementation; the legislative changes that resulted in the Mental Capacity (Amendment) Act 2019 to move from Deprivation of Liberty Safeguards (DoLS) to Liberty Protection Safeguards (LPS); and actions taken from the outset of the pandemic to meet the needs of those who are protected by the MCA and support those providing care and having responsibility for the wellbeing of people with impairments of mental capacity.

Brings together emergency guidance for health and social care staff in England and Wales who are caring for, or treating, a person who lacks the relevant mental capacity during the coronavirus outbreak. The guidance ensures that decision makers are clear about the steps they need to take during this period. It focuses on new scenarios and potential ‘deprivations of liberty’ created by the outbreak. During the outbreak, the principles of the Mental Capacity Act 2005 (MCA) and the safeguards provided by the deprivation of liberty safeguards (DoLS) still apply. The MCA provides protection for people who lack or may lack the relevant mental capacity to make decisions about different aspects of their life. The DoLS are an important part of this act and provide further safeguards for those who need to be deprived of their liberty in order to receive care or treatment in a care home or hospital, but do not have the capacity to consent to those arrangements. [Published 9 April 2020. Last updated 27 April 2021]

Emergency guidance for health and social care staff in England and Wales who are caring for adults who lack the relevant mental capacity to consent to their care and treatment during the coronavirus (COVID-19) Pandemic. This document provides additional guidance to supplement ‘The Mental Capacity Act (2005) (MCA) and deprivation of liberty safeguards (DoLS) during the coronavirus (COVID-19) pandemic’, which was published in April 2020. It includes guidance on: testing someone who lacks the relevant mental capacity; providing life-saving treatment to someone who lacks the capacity to consent; hospitals and care homes; and using emergency public health powers when someone who lacks relevant capacity needs to be isolated because they have symptoms and are not following public health advice. [First published 29 May 2020; last updated 12 January 2021]

This annual report on CQC monitoring of the Mental Health Act (MHA) puts a specific focus on the impact that the COVID-19 pandemic has had on patients detained under the MHA, and on the services that care for and treat them. The findings indicate that: planning for individuals’ discharge from hospital continues to be essential and is particularly important during the pandemic period due to the increased burden on all services, including those in the community; some services showed exemplary practice in the co-production of care with patients, including infection control measures; in many services the physical environment requires modernisation and doing so would have the added positive impact of making infection control easier; some services continued to uphold restrictions on patients’ movement, activities and leave for longer than seemed necessary; many services invested in software to help detained patients to stay connected with their family and other sources of support during the pandemic; detained patients’ access to advocacy services was made more difficult during the pandemic, but such services played an even more crucial role where patients’ lives were more limited by infection control measures; there needs to be careful evaluation of using remote technology should aspects of them continue after the pandemic abates.

Annual report on the use of the Mental Health Act (MHA), looking at how providers are caring for patients, and whether patients’ rights are being protected. The report sets out CQC’s activity and findings from our engagement with people subject to the MHA and review of services registered to assess, treat and care for people detained using the MHA during 2020/21. It is largely based on feedback letters on the 620 remote monitoring letters following reviews of 682 wards carried out during 2020/21. These involved private conversations with 1,895 patients and 1,111 carers. The report highlights three key findings. Firstly, the workforce is under extreme pressure; the pandemic has placed additional stresses on staff, patients and carers; staff are now exhausted, with high levels of anxiety, stress and burnout, and the workforce is experiencing high levels of vacancies. The negative impact of working under this sustained pressure poses a challenge to the safe, effective and caring management of inpatient services and to the delivery of care in a way that maintains people’s human rights. Secondly, community services are key to reducing levels of detention in hospital. Not getting the right help at the right time can lead to symptoms worsening and people needing inpatient care. During the pandemic this has been a particular concern for children and young people. We have seen an increase in the numbers of children and young people being cared for in inappropriate settings while they wait for an inpatient bed. Thirdly, urgent action is needed to address longstanding inequalities in mental health care. We remain concerned that Black or Black British people are more likely to be detained under the MHA, spend longer in hospital and have more subsequent readmissions than White people.

Guidance for care providers on how to apply the Mental Capacity Act during the Coronavirus (COVID-19) pandemic. The resource considers the issues that should be considered when thinking about care and treatment that might involve restrictions because of Coronavirus; the cases where DoLS authorisations have already been granted; and the impacts of the Coronavirus Act 2020.

A general discussion examining to the legal position in relation to testing for COVID-19, especially as testing (a) starts to be more generally available; and (b) is increasingly been rolled out as mandatory in certain settings. It primarily relates to the position in England in relation to those aged 18 and above; specific advice should be sought in respect of Wales and those under 18.

This note provides an overview of the Department of Health and Social Care (non-statutory) guidance ‘Adult social care: our COVID-19 winter plan 2020 to 2021’. It discusses the key issues for local authorities, and in particular the interplay with the wellbeing principles of the Care Act 2014, including managing a potential conflict in terms of the wellbeing of both care home residents and those in the community with care and support needs as regards prevention of C-19. It also looks at the implications of the winter plan for the right to respect for family and private life, addressing the tension between the imperative to protect the health of social care users (and the social care workforce) and the need to respect the family life and private life rights of those who might be subject to protective restrictions. Finally, it explores the impact of the winter plan on deprivation of liberty safeguards, in particular in relation to testing and 14-day isolation requirements.

An overview, signposting to relevant resources and guidance, on how an attorney or deputy can continue to fulfil their role during the Covid-19 pandemic and lockdown.

This study explores the experiences of professionals who worked with care home residents with impaired mental capacity in England and Wales during the COVID-19 pandemic. It explores (i) how competing risks were balanced and (ii) how the Mental Capacity Act (MCA) functioned in care homes under pandemic conditions, with particular focus on its associated Deprivations of Liberty Safeguards (DoLS) and Independent Mental Capacity Advocacy (IMCA) systems. Between March and May 2021, an online survey and five focus groups aimed at professionals who worked in or with care homes during the pandemic, were held. The study explored issues pertaining to residents with impaired mental capacity, alongside several other topics on which the authors report elsewhere. For this paper, the researchers filtered data to only include responses from ‘capacity professionals’. The resulting sample comprised 120 (out of 266) survey participants and 18 (out of 22) focus group participants. The researchers performed manifest content analysis on the filtered data and found that (1) participants reported a ‘massive discrepancy’ between the ways different care homes balanced the risk of COVID-19 infection with the risks associated with severe restrictions. (2) Some suggested this was due to vague guidance, as well as care home type and size. Participants told us the pandemic (3) obstructed smooth operation of statutory safeguards designed to protect residents’ human rights and (4) resulted in confusion about the remit of the MCA during a public health crisis. The findings raise concerns about the impact of pandemic-related measures upon care home residents with impaired mental capacity. The researchers urge further exploration and analysis of (a) the variability and inconsistency of restrictions applied at care homes, (b) the strain placed on key safeguards associated with the MCA, (c) uncertainty about the remit of the MCA during a public health crisis and (d) the human rights implications hereof.