Mental Capacity (Amendment) Bill [HL]

Written evidence submitted by Kings College Hospital NHS Foundation Trust, Adult Safeguarding Service (MCAB38)

Authors: Heather Payne, Head of Adult Safeguarding

Lynne Ramnanansingh, Clinical Nurse Specialist for Learning Disabilities

Submitted of behalf of: Kings College Hospital NHS Foundation Trust, Adult Safeguarding Service


Kings College Hospital NHS Trust (KCH) is one of London's largest and busiest teaching hospitals primarily serving the boroughs of Lambeth, Southwark, Lewisham and Bromley. Our specialist services are available to patients across a wider catchment area, providing nationally and internationally recognised work in liver disease and transplantation, neurosciences, haemato-oncology and foetal medicine. We have over 12000 employees and have over 6000 in-patient attendances a month.

The Deprivation of Liberty Safeguard ( DoLs ) applications/ authorisations are overseen by the Adult Safeguarding Service. We provide support and guidance to clinical staff considering making a DoLS application and work with approximately 16 DoLs Offices. In 2017/2018 we facilitated 270 applications. From the data gathered for the first half of this year 2018/2019 (226 applications), it appears that we will be almost doubling the applications made.

The Adult Safeguarding Service at KCH has been closely following the Liberty Protection Safeguards progress.

Consultation response

· Wishes and beliefs of the person; individual s wishes and beliefs should be documented and taken into consideration in every case. 

· The r ole of the AMCP ; additional safeguards should be required to involve an AMCP, eg , when family/friends are unhappy with the arrangement

· Advocacy; all persons under an LPS should have the right to advocacy at any stage of the process , t his would ensure that the LPS are aligned with the Mental Capacity Act process and ensures the placement is appropriate.  

· Pre-authorisation Review ; it is our view that all assessments and reviewers should be undertaken by professionals

· Renewals; maximum renewal length needs shortening. In an acute hospital setting an appropriate length of an application could well be as little as 3 weeks. Setting a long maximum length could mean that in patients are set an authorisation to cover the length of their hospital stay and running a risk of not being reviewed as their condition improves. This would also be helpful in the acute setting where patients are awaiting placement following rehabilitation.  This would be in keeping with Principle 5 of the MCA 2005 that is the least restrictive option.

· Funding ; t o bring to the attention of the MPs the importance of the correct level of funding / resourcing for the responsible bodies to allow them to discharge their new responsibilities in a timely manner. We want to avoid the significant back log created and ongoing (in some Local Authorities) nearly 5 years since the Cheshire West judgement was passed. With current huge financial pressures on the NHS it would be helpful to understand the funding plans and to also make MPs aware that in many hospitals a whole new LPS service/ team would need to be recruited and appropriately trained. The training estimate appears to exclude the cost of retraining all appropriate clinical staff in the LPS legislation. Currently KCH has approximately 8000 clinical staff who require DoLS / MCA training.

· Private hospitals; private hospital applications should have an independent assessor due to the conflict of interest of keeping patients in their own hospital.  It would appear beneficial to implement a measure to safeguard these individuals to avoid situations like Winterbourne view. 

January 2019



Prepared 15th January 2019