Endemic poor practice. Confusion over the legal rights of adults with incapacity and disregard for power of attorney.
That is how Scotland’s Mental Welfare Commission has described the transfer of hundreds of people with dementia and learning disabilities into care homes during COVID-19.
In a new Authority To Discharge report, the Commission says hundreds of people were moved from hospitals to care homes without due consent. Poor practice described as “endemic” includes: lack of understanding of the law, and of good practice, confusion over the nature of placements, and misunderstanding over power of attorney. “These findings… may mean that many more moves were made without valid legal authority,” says chief executive Julie Paterson.
In the report, the MWC sampled around 10 per cent of all care home discharges of people reported as lacking capacity. It found a number of short-comings in discharge practices, including situations where incapacity had just “been assumed”, where there was focus on beds rather than people, or where the existence of Power of Attorney was used to evidence incapacity.
The report makes 11 recommendations which include training to support safe and lawful hospital discharge planning, a renewed focus on person-centred care and more consistent administration. There are also recommendations for additional scrutiny by government and the regulator.
In response, Minister for Mental Wellbeing and Social Care Kevin Stewart said he would be writing to health board and local authority chief executives and to health and social care partnership chief officers to ensure “that such transfers do not happen again”.
By way of explanation he said: “Transfers took place at a point when we were seeing horrific pictures from Italy of the coronavirus going rampant. At the time, clinicians believed that the best possible outcome for patients was their being moved out of hospital settings, and that should have been done following legal process.”
He repeated the Government’s pledge to hold a public inquiry into COVID-19 in care homes.
Scottish Care has also responded to the report. It said: “We have long argued that it is critical that we reform our processes around discharge from hospital, especially for those who may have diminished or fluctuating capacity. A ‘professional knows best attitude’ has no place in modern care and support.”