Update on Deprivation of Liberty safeguards for Residential Care Homes
- Introduction
In 2014 the Supreme Court in 2014 issued a definition of ‘deprivation of liberty’ (known as the ‘acid test’) which extended the scope of the DoLS. as a result the Isle of Wight Council has a large backlog of unassessed requests under the Deprivation of Liberty Safeguards DoLS) – around 750. The majority of these are identified as low priority, although there are also around 125 that are medium and high priority.
A decision has previously been made to concentrate resources on assessment of medium and high priority requests. The Council is currently considering a business case to increase DoLS capacity to manage new demand and clear the backlog.In the meantime it is necessary to keep unassessed requests under review, to ensure that prioritisation correctly identifies the more urgent assessments.
- Acid Test – who is deprived of liberty?
The acid test extended the definition of deprivation of liberty to include many care home placements that previously would not have met the threshold – residents who are settled, not expressing any objection to the placement, not subject to specific restrictions and whose family agree with the placement. Such placements nevertheless meet the ‘acid test’.
Acid Test: A person is deprived of his/her liberty if s/he is under continuous supervision and control and not free to leave.
‘Under continuous supervision and control’ describes the day-to-day management of the resident, in particular restrictive actions taken without his/her consent. In many cases it is the need for supervision and control that triggers an admission into a residential setting and as such supervision can be said to be one of the core function of a care home.
’Not free to leave’ is about longer term decisions about residence and in many cases this simply means the person is unable to give consent to the placement, due to lacking mental capacity, rather than that s/he has to be prevented from leaving.
DoLS does not apply to anyone who has given capacitated consent to the placement.
- Prioritisation
In order to ensure that request can be correctly prioritised it is essential that Managing Authorities (Care homes and hospitals) understand what information the Supervisory Body needs and which aspects of a care regime will result in higher prioritisation.
ADASS Prioritisation
The Association of Directors of Adult Social Services has published a screening tool to prioritise DoLS requests at one of three levels. The criteria for each priority level are:
High Priority 1: 1:1 care, sedating medication, regular use of physical restraint, restriction on contacts, any objections by resident, family, friends or advocate, regular attempts / requests to leave;
Medium Priority 2: occasional attempts / requests to leave, unsettled at times, infrequent use of medication / physical restraint;
Low Priority 3: meets acid test, but no specific restrictive actions and no objections;
Further requests will be accorded the same priority as the original request.
- Information to be sent to the Supervisory Body
An initial request for DoLS authorisation is made on DoLS Form 1. This includes basic information (name, date of birth, care home etc.), standard demographic data and detailed information on the individual resident (the ‘relevant person’). The detailed information is recorded on page 2 in two separate sections:
The care plan: a description of the care and / or treatment the person is receiving, including personal care, mobility, medication, support with behavioural issues, types of choice the person has and any medical treatment they receive;
The restrictions the person is subject to: a descriptionof the restrictions put in place which are necessary to ensure the person receives care and treatment, their frequency and why they are necessary;
Further requests for authorisation: when an authorisation is due to expire a further request can be made on form 2, which includes just basic details and space to record anything that has changed since the original request. It should be completed and sent to the Supervisory Body 4-6 weeks before expiry of the current authorisation.
- Notifying the Supervisory Body of changes
Once a request has been made this will remain valid until fully assessed and there is no need to re-submit further requests at periodic intervals.
Any changes to the person’s circumstances can be notified to the Supervisory Body via email to
When a request remains un-assessed or when an authorisation has been granted, the Supervisory Body must be notified of any of the following changes:
- any significant changes to the care plan that increase or reduce the level of restrictions;
- any significant changes in medication, in particular the use of sedating medication or covert administration of medication;
- changes in behaviour, in particularly requiring an increase in the level or frequency of physical interventions;
- any objections to the placement;
- any change that may increase the priority of the request;
- a resident being discharged or dying.