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.

This report looks at some of the common issues and complaints investigated by the Local Government and Social Care Ombudsman concerning people who lack mental capacity and the Deprivation of Liberty Safeguards (DoLS) system. The report includes individual case studies to show the impact on people when things go wrong. It estimates that 20 per cent of the 1,212 adult social care complaints investigated by the Ombudsman in the year 2016/17 concerned mental capacity or DoLS. Common issues included: not completing, or delays in carrying out, mental capacity assessments; poor ‘best interests’ decision making; disagreements with the process and failure to involving families; delay in obtaining DoLS authorisations; and failure to carry out full assessments before applying for DoLS. Drawing on the results of investigations, the report provides good practice points to help social care professionals get it right firs time when working with people who may lack mental capacity. It also provides a list of questions to help councillors scrutinise their own authorities.