Mental Capacity Act 2005, Deprivation of Liberty Safeguards - 2020-21

This publication provides statistics from the Mental Capacity Act 2005, Deprivation of Liberty Safeguards data collection for the most recent financial year. DoLS are a legal framework applying to individuals who lack the mental capacity to consent to the arrangements for their care. Where such care may amount to a "deprivation of liberty"  the arrangements are independently assessed to ensure they are in the best interests of the individual concerned, and to give those subject to a deprivation of liberty the means to challenge this.

This publication covers DoLS applications made to local authorities by care homes and hospitals. Data were provided by 150 out of 151 Councils with Adult Social Services Responsibility (CASSRs) - for ease of reading and consistency ‘local authority’ will be used subsequently to refer to CASSRs. One CASSR was unable to provide data, and consequently the England totals have been estimated – more information on this can be found in the Data Quality Key Information section. Statistics on challenges to DoLS authorisations are published by the Ministry of Justice

This publication provides analysis of all DoLS applications that were active at any stage during the period, and concentrates on six main areas of DoLS activity:

• the demographic profile of people for whom a DoLS application was submitted, analysing data on the applications received for individuals during the period rather than the total number of applications received
• applications received during the year, regardless of the status of the application at the end of the period
• applications completed (i.e. signed off) during the year, regardless of when the application was received
• applications not completed as at year end
• analysis of the length of the application process, including compliance with the 21 day standard outlined in the Code of Practice
• analysis of the duration (proposed and actual) of granted authorisations and the proportion of authorisations that ended early

The publication consists of:

• tables providing data at local authority level
• machine readable open data (csv files)
• a data quality assessment, including data completeness and integrity measures
• supporting information
• the Adult Social Care Analytical Hub, an interactive business intelligence tool

In order to prevent the disclosure of individuals, figures 0, 1, 2, 3 and 4 are displayed as [c] in the data tables, in accordance with Government Statistical Service guidelines on best practice for accessible spreadsheets. All other figures have been rounded to the nearest multiple of 5. Proportions (percentages) are calculated on the unrounded figures.

During the coronavirus (COVID-19) pandemic period, which this publication covers, some aspects of the DoLS process have changed due to new Government guidance. This includes greater use of remote assessments and shortened forms. In addition, Local Authorities have described the additional pressures the pandemic period has placed on them in relation to DoLS, with staffing, redeployment and capacity being common themes, as well as increases in applications. The impact of COVID-19 on DoLS has not explicitly been measured, but these differences may be reflected in the data.

Data quality is measured on submission of annual data by local authorities, and processes are followed to try and improve quality of data submitted. The Data Quality Statement gives further information, and presented below is an overview of the key data quality issues impacting on the 2020-21 DoLS data.

Summary measures indicate that the data submitted was valid and complete to a high degree, with the final returns yielding a very high national completeness and validity score (99.85%). The annex tables that accompany this publication also includes some data integrity checks. There are 11 data integrity checks that are carried out across each record in each local authority return. In 2020-21 there were approximately 15,500 data cells with validation breaches, which is comparable to previous years.

Missing Data

Due to a serious cyber-attack, Hackney Council (called London Borough of Hackney in the data tables) has been unable to submit 2020-21 DoLS data to NHS Digital.

In order to present England level statistics that can be compared to previous years, NHS Digital have calculated a range of estimates based on different scenarios to account for the missing data. These can be summarised as:

• add 2019-20 Hackney data to 2020-21 totals
• uplift 2019-20 Hackney data by a factor equal to the national percentage increase between 2019-20 and 2020-21, and add to 2020-21 totals
• uplift 2019-20 Hackney data by a factor equal to the regional percentage increase between 2019-20 and 2020-21, and add to 2020-21 totals
• uplift 2019-20 Hackney data by a factor equal to the nearest neighbour* percentage increase between 2019-20 and 2020-21, and add to 2020-21 totals

These estimates have been applied to the key measures only, giving a range of:

• between 256,580 and 256,610 total DoLS applications received
• between 245,995 and 246,045 total DoLS applications completed
• between 119,735 and 119,745 total DoLS applications not completed

Because these ranges of estimates are very narrow we have chosen to only present the first scenario (add 2019-20 Hackney data to 2020-21 totals) in the web page Key Facts and Key Measures data table.

For all other DoLS detailed data tables or the Adult Social Care Analytical Hub, the missing data has not been included and therefore England totals do not match those presented in the Key Facts or Key Measures. Where age-standardised population rates have been presented, the numerator (activity) does not include Hackney but the denominator (population) does include Hackney in order to maintain the same approach to standardisation. This means care must be taken when comparing figures over time.

The detailed data tables display London Borough of Hackney data as [x], denoting missing data. 

* nearest neighbour is a statistical model developed by the Chartered Institute of Public Finance and Accountancy to facilitate benchmarking of local authorities.

Not completed applications

As in previous years, NHS Digital has used the data available to calculate the estimated volumes of applications not completed at year end. An estimated number of applications not completed can be created by taking last year’s reported number of applications not completed, adding the number of applications received and then subtracting the number of applications completed.

This calculation produces an estimated figure different to the equivalent figure reported by local authorities. NHS Digital has worked with local authorities to try to understand the reasons for this. From the local authorities who provided explanations for their variation in previous years one common theme was that this variation could be explained by the figures from the previous reporting period being higher than they should have been. This was due to several reasons, such as the previous return including applications that should have had a status of Not Granted but the application was still showing as in progress, or data quality issues caused by migrating data from older reporting systems, or through duplicate recording of applications. This year the pandemic is also cited as having an impact on local authorities’ ability to complete assessments and also to resolve inconsistencies in the data.

Variance in active authorisations

The DoLS data collection should include all applications that were active at any point in the year. During the analysis of the data, it was noticed that a number of local authorities had once again not submitted data for authorisations that had been started in the previous year but had finished in the current year. During the data validation process, many local authorities resolved this issue and included the missing authorisations for their final data return. This year some local authorities reported to NHS Digital that the variance was a result of the pandemic, and that the cases should have been closed with a retrospective date before April 2020 but the local authorities were not notified of the change in circumstances until later. This situation will always exist to some degree regardless of the pandemic and can help to explain some of the variance.

As a result, 17 local authorities are showing significantly lower numbers of active authorisations on 1 April 2020, the opening date of the 2020-21 collection, compared with the previous day, 31 March 2020, the closing date of 2019-20 collection. Having these data allows us to accurately measure the actual duration of granted authorisations and also measure the number of authorisations in place throughout the year. NHS Digital will continue to provide the guidance document and encourage all local authorities to review this document each year to ensure they are including the correct records.

Incomplete Actual End Dates

During the data validation process, NHS Digital identify where the Planned End Date of the authorisation was during the current reporting period however the Actual End Date had been left blank, indicating the unlikely scenario that the authorisation was still in place. This year NHS Digital embedded this check into the automated data validation tool used by local authorities. This has reduced the number of these cases by half from approximately 3,300 last year to 1,200 this year. In some cases local authorities told us this is a deliberate approach to allow ongoing monitoring via case management systems. The issue has the effect of inflating the figure reported in Table 6 in the Time Frames data tables, which is the number of authorisations in place on 31^st March 2021.

Start Date of Authorisation recorded earlier than Application Sign-off Date

There were approximately 5,100 authorisations across 16 local authorities where the Start Date of Authorisation had been recorded earlier than the Application Sign-off Date.  Some local authorities provided the explanation that this was an accurate reflection of local practice.

Some local authorities gave comments in their data return to explain errors, changes or issues with their data. NHS Digital would like to thank these local authorities for their transparency. The table below summarises specific key issues explained by local authorities that are not covered by the general comments above.

DoLS data are collated and processed by NHS Digital from an annual mandatory data collection from all local authorities in England. The collection requires one record per DoLS application with information on; the dates that applications were received and processed, details of the key decisions made and demographic information about the individuals involved. No person identifiable data is collected.

Between April 2009 and March 2013, DoLS applications were processed by both local authorities and Primary Care Trusts (PCTs). Local authorities processed applications from care homes and PCTs processed those from hospitals. During this time, NHS Digital collected data on a quarterly basis from both local authorities and PCTs in an aggregated form. Following the abolishment of PCTs in 2013, all applications from both health and care settings have been processed by local authorities and the returns are submitted at a case level on a yearly basis. The DoLS collection has remained mandatory for all local authorities.

The collection methodology changed for the 2013-14 DoLS collection onward, following a “zero-based review” of adult social care data collections. The review considered changes in the delivery of social care and looked into what information should be provided to monitor the most important current and future priorities. The key changes introduced were to move to collecting the data annually and at a case level, rather than quarterly and in aggregate. The 2013-14 DoLS collection was developed following consideration of this feedback and was approved by the Department of Health and Social Care (DHSC), the Department of Communities and Local Government (DCLG) and other key stakeholder organisations including the Association of the Directors of Adult Social Services (ADASS).

The data collection has evolved since then in fairly minor ways, with any changes being signed-off by the appropriate governance boards, which involves a process of approval consisting of the DoLS Working Group (comprising a cohort of local authority DoLS leads and performance leads to advise on the data collection), the Adult Social Care Data Delivery Action Group (a national group overseeing adult social care data collections, publications and the working groups, and which consists of NHS Digital, ADASS, Local Government Association, Care Quality Commission and DHSC) and the Adult Social Care Data Outcomes Board (a strategic national group setting the priorities for adult social care national data collections, publications and associated developments).

Any changes to the collection are communicated to local authorities via a Data Provision Notice are also detailed in the annual ‘September Letter’ and the associated social care collection materials. For 2020-21 there were no changes to the DoLS data collection.

Prior to 2019-20 there were 152 local authorities. However, on the 1st April 2019 Bournemouth and Poole merged to form the new Bournemouth, Christchurch and Poole (BCP) local authority. The inclusion of Christchurch has also reduced the size of the Dorset local authority. Therefore, care should be taken when making comparisons over time for Dorset due to such changes.

This publication may be of interest to members of the public, policy officials and other stakeholders to make local and national comparisons and to monitor the quality and effectiveness of services.

In particular, local authorities may find this data helpful in shaping services and making improvements, especially in terms of benchmarking their services and comparing them with previous years or to share best practice with colleagues in other authorities.

DoLS teams across England are working to bring improvements to the DoLS processes and to service users’ quality of life and may use the data presented here to focus their efforts.

Officials in DHSC can use the data contained within this DoLS publication to make decisions about national policy and practice.

Members of the public and other stakeholders, such as charity organisations, can also use this DoLS publication to help satisfy themselves that processes are followed and that officials are acting in service users’ best interests.

In previous years, prior to the publication of 2018-19 data, an annual report has formed part of this publication. This provided a broad range of in-depth analysis and commentary around the data. This is again not included this year - the publication follows the same format as last year and the data released remains the same.

Instead of providing in-depth analysis upfront, NHS Digital encourages any users wanting bespoke additional analysis to request this directly and we can work with you to understand your requirements and provide the data. We hope this will provide a more responsive and valuable service to meet your needs. Please send any such requests to [email protected]. Where this happened last year the resulting analysis was released alongside the publication.

Please note that although the data released remains the same, the data tables were reformatted last year. The table below shows previous years’ annex tables and where they map to in the publication from 2018-19 onwards.