Moves from hospitals to care homes during the pandemic – new report finds wider concerns over adherence to the law

A review of the legality of moves of patients from hospitals to care homes in Scotland at the height of the pandemic has raised significant concerns that are not exclusively the result of the pandemic.

The Mental Welfare Commission’s new report – Authority to discharge – report into decision making for people in hospital who lack capacity – is a study of a sample of all discharges from hospitals to care homes from March to May 2020.

The Commission studied the detail of 457 individual moves - representing around 10% of all such moves reported at the time by Public Health Scotland – looking at legal authority behind each decision to move a person who did not have capacity to decide for his or herself.

The data was supplied by every Health and Social Care Partnership in Scotland (HSCP) apart from Highland, who did not meet the timescale for the report.

Findings

Of the 457 cases, the Commission found unlawful moves of 20 people. For some of these moves, there had been specific pandemic related reasons, for example, a misinterpretation that easement of the Social Work Act had been enacted as a result of the Coronavirus (Scotland) Act 2020 when in fact this legislation was never activated and was removed in September 2020. One HSCP introduced an alternative to applications for guardianship orders, making decisions ‘internally’ rather than recourse to the courts, the critical safeguard for individuals. This particular practice started in response to the pandemic and ended in August 2020. 

The Commission analysed all of the 457 cases further to assure legal rights were respected and protected beyond the 20 clearly unlawful moves.  The Commission asked about the 338 moves said to have been authorised using a Welfare Power of Attorney or Adults with Incapacity legislation. They found that those working in hospital discharge were not always fully aware of the powers held by attorneys or guardians (this was the case in 78 out of 267 cases of power of attorney related moves) or indeed whether the attorney’s powers had been activated or guardianship orders granted. 

The Commission also found confusion in relation to the reported nature of the care home placement, with potential impact on rights to protection of property where the person was admitted to a care home but remained liable for their property.

Practice was not consistent within some HSCPs or across them. Some staff reported that moving from one HSCP to another brought differences in practice into sharp focus. This is despite a range of existing guidance and policy.

The Mental Welfare Commission made eight recommendations in the report for Health and Social Care Partnerships including asking for each of them to conduct a full training needs analysis and training programme for their staff to ensure they understand the law, capacity and assessment. 

There are two recommendations for the Care Inspectorate, including asking them to take account of this report in their inspection activity.

The final recommendation is for the Scottish Government to monitor the delivery of the recommendations and to ensure consistency across Health and Social Care Partnerships.

Julie Paterson, chief executive, Mental Welfare Commission, said:

“People who lack mental capacity and who are being cared for and treated in care homes and hospitals are among the most vulnerable in our society. The focus of this report was to examine the detail of a sample number of hospital to care home moves of people from across Scotland, to check that those moves were done in accordance with the law during the early stages of the pandemic. 
“Some of our concerns relate specifically to the significant pressures of the pandemic. 
But, worryingly, the report also finds more endemic examples of poor practice. Lack of understanding of the law, lack of understanding of good practice, confusion over the nature of placements, misunderstanding over power of attorney. These findings are very disappointing and may mean that many more moves were made without valid legal authority.
“This report also finds a lack of uniformity from one HSCP to another, with different approaches to national legislation and guidance adopted in different areas. 
“We call on Health and Social Care Partnerships across Scotland, the Care Inspectorate and the Scottish Government to read our report in detail and act swiftly on our recommendations”.

Note to editors
Whenever the term Health and Social Care Partnership or HSCP is referenced in the report, this refers to the joint operational arrangements that exist in a council area between the council social work services and the health care services of the local health board. All clinical, professional and support staff who work within a HSCP are employed by the health board or the council in the specific geographical area.