A significant number of care homes have still not yet trained their staff about the implications of the Deprivation of Liberty Safeguards (DoLS) more than 2 years after they were introduced, a review by care regulator the Care Quality Commission (CQC) has found.

The CQC’s second annual report on the operation of the Deprivation of Liberty Safeguards in England found that while many providers had developed good practice on the DoLS, between a third and a quarter of care homes had not done any training in them, and in some cases only the manager had received training. Most hospitals had held some training, but the proportion of staff involved ranged between 20% and 100%.

DoLS protect the rights of people in care homes and hospitals who lack the mental capacity to consent to their care or treatment. They include people with dementia or a learning disability. Authorisation must be sought to impose any restraint or restrictions on them that could breach their human rights. The CQC also found that some providers were confused about when restraints or restrictions on a person amounted to a deprivation of liberty. This was causing inconsistent practice and resulting in cases where people’s rights were not properly protected.  Additionally, the number of applications by care homes and hospitals across the country for authorisations under DoLS rose significantly in the year ended March 2011, to 8,982 compared to 7,157 the previous year. Of those, 55% were authorised, compared to 46% previously.

There continued to be considerable regional differences in the numbers of applications. Cynthia Bower, chief executive of the CQC, said: “The safeguards are vital to ensure that a person’s best interests are carefully considered, their needs fully understood, their wishes taken into account and their human rights properly respected. “The safeguards are no longer new, and care homes and hospitals have had time to train their staff and develop their internal procedures. We expect them to embed this as a routine, but essential, element of their operation. “We have integrated our monitoring of the safeguards into our mainstream regulatory work, so that it forms part of our assessments of how well care providers are complying with the essential standards of quality and safety. “But some aspects of the safeguards process can’t be reported on in the way that we want to. Information gaps are hindering us in getting a full picture, including important matters such as appeals and advocacy. We will be asking councils, PCTs, care providers and organisations representing people who use services to help us develop our monitoring role to ensure that it addresses the information gaps and becomes as effective as possible.“