5. After authorisation
If a deprivation of liberty has been authorised by the local authority or local health board, there are still a number of safeguards to ensure that the person continues to be protected.
The ‘relevant person’s representative’
If a person’s care is authorised following a DoLS assessment, they must have a representative appointed, called the ‘relevant person’s representative’. Often this is a family member, friend or other carer. They are appointed during the best interests assessment.
If the person with dementia doesn’t have a relative or friend who is able to take on this role, or it is felt that that they may not be appropriate, the local authority must appoint a paid representative. The paid representative will be a professional who is trained and experienced in these matters and will act as the person’s representative.
The job of the representative is to stay in close contact with the person with dementia. They should look to see if the person’s care arrangements change, be given access to documents about decisions, and if necessary ask for a review of an assessment decision. The representative can also appeal against the DoLS authorisation, and should do so where the person under DoLS disagrees with it, even if they themselves do not.
The representative should be kept informed about the person’s care and treatment and any changes to it. The local authority or local health board should work together with the care home or hospital to make sure that both the person and their representative understand the DoLS process and know their rights.
If a representative requires support, they can ask to talk to an independent mental capacity advocate (IMCA). The local authority can put you in touch with your local IMCA service.
How long is the deprivation of liberty allowed for?
A DoLS authorisation should last for as little time as possible, and only up to a maximum of 12 months. Each individual DoLS authorisation will state the date it lasts until. However, during this time both the care provider and local authority (or health board) should:
- make regular checks to see if the authorisation is still needed
- remove the authorisation when it is no longer needed
- provide the person’s representative with information about their care and treatment.
A review of a deprivation of liberty authorisation is a formal process to decide whether the care that deprives someone of their liberty is still necessary. This can take place at any time, and doesn’t have to be at the end of the authorised period. It is up to the care home or hospital to make regular checks to see if the requirements for the authorisation are still needed, and they must inform the local authority or local health board if circumstances change.
This means that a review should take place if there is a change in circumstances, and also if it is felt that the criteria are no longer met. Therefore, if the deprivation is no longer in someone’s best interests, or if it is not managed in the least restrictive way, then this should be looked at again in a review.
The person under the authorisation, or their representative or IMCA, can request a review if the situation has changed. The local authority or local health board are responsible for carrying out the review and must ensure that all parties are kept informed and involved throughout the process.
If a person subject to DoLS dies
If a person with dementia who is subject to an authorised deprivation of liberty dies, there is one final safeguard. This is that their death will be reported to the coroner, as opposed to the GP. This means that the coroner can ensure that the reasons for the person’s death were not due to any abuse, or caused as a result of the deprivation of liberty. It is extremely rare that this would have been the case, but this check still must happen.
This will almost certainly be a very difficult time for the person’s family and friends, and the involvement of the coroner can increase anxiety and upset. The law in this area is currently being reviewed and it is hoped that there will be changes made to make this process less upsetting for families involved.