DoLS assessments – how much time are they really taking?
Emma Goodall is a registered Social Worker working in Cornwall and specialising as an Approved Mental Health Professional, Best Interests Assessor and Practice Educator. She is the co-author of a new research study published by Cornwall Council in December 2015. The research focuses on the time it takes Best Interests Assessors (BIAs) to complete their assessments and here she introduces the study, explains why they asked a research question and discusses what they found.
In March 2014 the Supreme Court handed down its decision in the conjoined case of P v Cheshire West and Chester Council and another (Respondents); P and Q v Surrey County Council  UKSC 19, known more commonly as ‘Cheshire West’. The decision in this case has brought with it a momentous change in practice, introducing a new ‘acid test’ to determine a deprivation of liberty. The decision in Cheshire West effectively lowered the thresholds of what factors had previously been considered a deprivation of liberty and saw an appreciable broadening which has resulted in many more individuals falling within the scope of the Deprivation of Liberty Safeguards (DoLS).
Following Cheshire West, my colleagues and I witnessed surge in applications for the DoLS. Nationally, new figures (1) suggest there has been a reported ten-fold increase in referrals in England and Wales. Many Local Authorities are struggling to cope with the demand for assessments and with a growing number of outstanding DoLS authorisations, the question of how services manage, often in the face of limited staffing and resources, has become a hot topic for debate.
With local authorities intent on restructuring their DoLS teams to cope with these demands one question we kept hearing was ‘well how long does it take BIAs to complete their assessments?’
Whilst the Department of Health had suggested a figure of eight hours, this didn’t appear to be based on any real test or research. Keen to learn more about this, my co-author Paul Wilkins (DoLS Lead) and I decided to undertake a small survey to find out. We had no aspirations at this point of any large scale study; with access to an online survey tool band applying suitable research methods we anticipated we might reach 50 maybe 70 responses in the South West, perhaps giving us enough data to be useful locally and to inform our own service at the very least.
Between July and September 2015 we opened an online survey of BIAs, taking a primarily quantitative approach (‘time’ and ‘task’). We also incorporated a qualitative ‘free narrative’ space for additional comments, to add depth to the findings. We contacted the BIAs through the use of social media, either directly or via specialist interest sites.
The uptake for the survey was unexpected. Whilst we had anticipated only a very small response from BIAs, by the close of the survey we had received a total of 507! This amazing result is a real testament to the power of social media. This platform allowed us to reach a niche group of professionals and the response significantly changed the scope of the study. We gained a substantial amount of statistical data and a considerable amount of ‘free narrative’ data. Together this allowed us to consider the research question in much greater detail and depth.
Our study found that the average time taken by Best Interest Assessor’s to undertake DoLS assessments is 12.1 hours (726 minutes). We are clear that this is only an average and can never be entirely indicative of every DoLS assessment. Whilst the notion that we can somehow quantify the work of the BIA wholly in terms of ‘time’ is tantalising, particularly in the face of an overwhelming number of outstanding DoLS applications, in reality the study found too many ‘variables’ that can coalesce to extend (or indeed reduce) the time taken overall.
We need to recognise that:
- BIAs must grapple with the DoLS, a scheme known for its considerable bureaucracy, whilst negotiating its intricacies in the face of case law changes and ever shifting legal parameters.
- DoLS assessments can vary greatly in complexity, however in all cases the BIA must involve the relevant person in the assessment process, consult widely and gather information relevant to their decision-making and provide a report that explains their conclusion and their reasons for it.
- BIAs are independent in their decision-making, their assessments may well be subject to the scrutiny of the Court and they must always be prepared to face a legal challenge.
All three of these factors are likely to add time to any DoLS assessment.
In conducting this research study we quickly realised that it was much more than an exercise in measuring ‘time’ and ‘task’. The findings told us far more about BIAs and their work than we had anticipated. Whilst we learnt more about the time it takes BIAs to complete their assessments (including any ‘time standards’ they may have to work within) we also learnt about the difficulties of managing the DoLS scheme and the effect of the changes since Cheshire West. In terms of the application of the study’s findings to practice, BIAs told us that time pressures often add to the complexity of what they do.
Today the future of the DoLS is uncertain. The Law Commission have recently set out an alternative scheme, and whilst change has been welcomed by professionals, all be it with some caution, the Department of Health has cast some doubt about the viability of the Law Commission's proposals, suggesting the new scheme is elaborate and might replicate the duties found already in the Care Act 2014. So how long legislative change will realistically take is not yet clear. The question of how local authorities will deal with outstanding DoLS assessments remains a live issue for both local authorities and BIAs.
In the meantime services must continue to implement the DoLS and to do this they must develop strategies that will help them to cope with the demands of the current scheme. This may well include a careful consideration of their workforce and the question of the time it takes BIAs to assess may be a critical consideration. We hope our research study will enable those services to better understand the role of the BIA and its complexity in order to make sense of this question. To enable this we propose that the BIAs experience of the DoLS is critical if we are to anticipate the scope of their future role managing assessments under an alternative scheme and this experience should be central to informing any legislative changes that are to come.
As a final word (and slightly apart from the study itself), my colleagues and I here in Cornwall think it is important to try and make some sense of what we do and how we do it. Now more than ever it is possible for us to ask a question and then seek the answer though the application of simple research methods, on any scale. Social media affords us the ability to contact each other quickly, across agency and geographical boundaries; this gives us considerable power to connect and find out more from each other. Our study began simply - with a single question, an account with an online survey site and some links on Twitter. We hope our success inspires you to ask a question. We look forward to seeing where your question takes you.
Please find our full survey report under ‘research’ at: www.cornwall.gov.uk/dols.
1) Health & Social Care Information Centre (2015) Deprivation of Liberty Safeguards (England), Annual Report 2014-15.