Mental Capacity Act 2005 (Select Committee Report)

Lord Brown of Eaton-under-Heywood Excerpts

Tuesday 10th March 2015 Lords Chamber

[Lord Brown of Eaton-under-Heywood (CB)]

My Lords, this is a most distinguished and impressive report and I respectfully congratulate my noble and learned friend Lord Hardie and others who contributed, many of whom are speaking in this debate. I confine myself, as did the noble Baroness, Lady Browning, to the second of the key recommendations, which concerns deprivation of liberty. More particularly, I want to deal with this in the context of last year’s Supreme Court judgment in the two cases that came to it on appeal.

As my noble and learned friend Lord Hardie has noted, the Select Committee’s report was published just six days before the Supreme Court judgment came out in March. The judgment, therefore, was not considered by the committee but is referred to in the Government’s response of June last year, although—I shall come back to this—it should be regarded as giving altogether greater impetus and urgency to the committee’s report than the Government seem to have recognised.

It may be helpful if I make one or two preliminary observations about the Supreme Court’s judgment. I am conscious of next Monday’s QSD on this from the noble Baroness, Lady Finlay, but—alas—I shall probably not be able to take part in that debate. The judgment, however, is also highly relevant to today’s debate. The court consisted of seven justices and split four to three. The two cases before it both arose out of community care orders for mentally incapacitated persons placed variously with a foster mother, in a specialist home for adolescents, and in a house with live-in carers. The question in each case was whether the various restrictions on their movements involved a deprivation of liberty within the meaning of Article 5 of the European Convention on Human Rights, because the MCA provides that the deprivation of liberty under the Act has the same meaning as in Article 5.1.

The question, therefore, necessarily fell to be determined by reference to the jurisprudence of the Strasbourg court. It being agreed by all seven justices that the Strasbourg court had never yet had to deal with the particular situation arising in those two cases, the critical question was which way the justices felt Strasbourg would decide it. The 4:3 split was on the answer to that question. I decline to say which way I might have resolved it—it is irrelevant, and I did not hear all the arguments—but suffice to say that it was, in any view, a borderline decision. There was a large measure of agreement between all seven justices.

It can fairly be said that the facts of those three cases represent about the furthermost examples of what the English courts—and the Strasbourg court—would conclude involves a deprivation of liberty. Not only were the dissenting judgments themselves powerful but their approach agreed with that of the six judges in the two courts of appeal to which the appeals came, who included Lord Justice Wilson, now a Supreme Court justice, and Lord Justice Munby, now President of the Family Division. That said, the Supreme Court judgment clearly establishes that very many more authorisations of deprivation of liberty are required under the MCA than had previously been appreciated.

Of course, these authorisations are in two distinct categories. There are those concerning people detained in hospitals and care homes requiring DoL authorisation under Schedule A1 procedures; and there are those for people before the Supreme Court detained in community settings, such as supported living and shared lives schemes, whose placements require authorisation under Section 16 by the Court of Protection. The DoL system has no present application at all to the second category.

The leading judgment for the majority in the Supreme Court was given by the noble and learned Baroness, Lady Hale, who herself observed that the safeguards for these cases appear “of bewildering complexity”. She recognised that those responsible for deciding whether a case indeed involves deprivation of liberty may,

“baulk at the bureaucracy of the procedures and the time they take”.

The BMA has said:

“The primary concern with the DOLs is their complexity and bureaucracy”.

In an earlier case, Mr Justice Charles, experienced in this field, described writing a judgment about these schedules as feeling,

“as if you have been in a washing machine and spin dryer”.

The Care Quality Commission report of 2 February this year, while welcoming the clarity provided by the Supreme Court’s decision, points to the huge increase in the number of requests for authorisation: in the case of requests from hospitals and care homes, eight times the number—my noble and learned friend Lord Hardie mentioned an increase from 13,000 to 90,000—and a climb also in respect of requests for community settings. The CQC report notes that at the end of September last year there were more than 19,000 applications outstanding compared with 359 at the end of 2013-14.

Against that background, the Select Committee’s recommendations surely assume yet greater importance and urgency, and one wonders whether the response has been sufficiently positive. It is true that the response at paragraph 7.21 states that by the end of November 2014 a new set of DoLS forms would be created. I simply do not know whether they have or have not been. It is true, too, that in the next paragraph the response states that there is a commitment to publish legal guidance on this topic by the end of 2014. Again, I do not know whether that did or did not happen but, frankly, it would not have been very difficult.

The Supreme Court judgment makes it clear that the essential test is whether the person is under continuous supervision and control and not free to leave, although that is always to be regarded as a question of fact and degree, depending on the person’s actual situation. As I have already said, I believe that the judgment marks the extreme limits of what is to be regarded as deprivation of liberty. It seems to me important, too, to recognise that the judgments are focused on long-term placements and not, as I suggest, on a terminal or emergency situation. After all, the policy that underlay the court’s decision was as follows, and I quote from paragraph 57 of the judgment from the noble and learned Baroness, Lady Hale. She said that these people,

“need a periodic independent check on whether the arrangements made for them are in their best interests. Such checks need not be as elaborate as those currently provided for in the Court of Protection or in the Deprivation of Liberty safeguards (which could in due course be simplified and extended to placements outside hospitals and care homes)”.

That said, recognising that the most pressing problem now appears to be community care arrangements, including supported living, the Government have, as we have heard, asked the Law Commission to draft a new legal framework for authorising those cases as well as for DoLS. However, that, they acknowledge, will not be complete “for a few years”. I think that we were told by my noble and learned friend Lord Hardie that it would be the summer of 2017. In the mean time, all that is offered is possible minor adjustments to the DoLS code of practice, if that is suggested by a task group led by ADASS, the Association of Directors of Adult Social Services. But as the passage that I have just cited from the judgment of the noble and learned Baroness, Lady Hale, suggests, is not perhaps the better approach that, as soon as possible, the DoLS,

“be simplified and extended to placements outside hospitals and care homes”?

I urge the Minister to address these urgent questions.