SWANSEA Council is reducing its backlog of assessments of care home residents who lack mental decision-making capacity partly by re-authorising previous assessments, a meeting heard.
Councils have to approve what are called deprivation of liberty safeguard (DoLS) assessments for care home residents; health boards do the same for hospital patients lacking decision-making capacity.
Councillors in Swansea heard that doctors with training under the Mental Health Act and social workers carry out DoLS assessments on behalf of the authority. These are then scrutinised and authorised by managers in the council’s DoLS team.
Swansea Council had a backlog of 259 DoLS referrals in February this year but it dropped to 73 in October. A council adult services scrutiny panel heard a new “streamlined” process was behind the drop.
Explaining this streamlined process at a panel meeting, Ffion Larsen, the council’s principal officer for safeguarding and practice lead, said: “After somebody has been in a care home for a while and they have got something like dementia, we will have done assessments on them for many years, so we are trusting previous assessments, not asking for the same assessment to be done time and time again.”
This speeded up the process, she said, and saved the council money because it didn’t have to pay a doctor with the mental health training – known as a Section 12 doctor – to do a new assessment.
Panel convenor, Cllr Susan Jones, asked if Ms Larsen was happy with this and whether a different approach would sometimes be taken.
Ms Larsen said the streamlined process applied to some cases and did not apply when somebody previously assessed showed a substantial change in their presentation. In these cases, she said, a new assessment would be carried out.
She said DoLS assessments were required every three to 12 months for a care home resident, depending on the individual, and that although the council kept records care homes were meant to inform the authority when someone’s DoLS assessment was due to expire.
She said the council was being proactive in reminding care homes about this as it wanted to avoid situations where somebody’s assessment had expired.
A report before the panel said Swansea received 1,475 DoLS applications in 2024-25 compared to 978 three years previously.
Assessments have to be completed within 21 days of an assessor being instructed but this is a big challenge for councils although Swansea is doing better than some.
Cllr Jones asked if council was able to meet the DoLS assessment demand. Ms Larsen replied: “At the moment we are meeting demand.”
The report said the council was increasing the number of trained professionals it used called “best interests assessors” to provide additional support, and that the DoLS team had a screening tool to help prioritise urgent and high supervision cases.
Local authorities and health boards began to get a lot more deprivation of liberty safeguard (DoLS) applications following a ruling by the UK’s Supreme Court in 2014. The panel report referred to an ongoing Supreme Court case in which the 2014 ruling was being challenged. If the challenge was successful, it said, the number of people who legally required a DoLS authorisation “will significantly decrease”.
Meanwhile an entirely new system, called liberty protection safeguards, had been proposed by the previous UK Government but didn’t come into force. The panel report said the current UK Government is planning a liberty protection safeguards consultation next year.
Speaking after the meeting, the council said the streamlined process discussed at the meeting applied when someone had been in a care home for two or more years or was on their third DoLS authorisation.
“It can only be used where there are no concerning issues, the care home placement is settled, and no new restrictions have been introduced,” said a council spokesman.
“The person must have a long-standing impairment or disturbance and be unlikely to regain capacity. Court cases will always require a full assessment, even if these criteria are met.”
He said suitability for the streamlined process was screened by DoLS team managers.
“If suitable for the streamline process, the best interests assessor will visit the person in the care home, speak to the relevant person’s representative, the managing authority (care home), review care home documentation, and check the last Section 12 doctor’s mental health and mental capacity assessments,” he said.
“Where there are no changes, restrictions, concerns, or new information, the best interests assessor will complete the assessment, including the mental capacity assessment normally undertaken by the Section 12 doctor.”
He said the person subject to the DoLS assessment would always be spoken to face-to-face at the care home, and that their wishes and feelings remained paramount.
He added: “If any concerns arise, the full assessment process will be followed.”
