Drowning in Paper

I was on the ward yesterday morning. For a substantial chunk of time. Our borough had a rush of applications for assessments for authorisations of deprivation of liberty in the last few days in April. Just in time to take advantage of the extended April deadlines.  They came from the wards in the psychiatric hospital that cater for over 65s.

Going from training roughly 30 Best Interests Assessors, the actual number able and willing to carry out assessments has fallen to single figures. Some teams are claiming that until there is any acknowledgement and workload relief, they will not accept any assessments, some people didn’t actually pass the training course and need to resubmit and some people are refusing to complete any assessments until that are actually paid the additional money that was promised.

I didn’t know that there was a reason to object so have got on with the assessments I was given. Yesterday was my third. Hardly overwhelming – but it’s all time that could be spent doing ‘other things’. Isn’t that always the case?

So as I wandered onto the ward to meet the Mental Health Assessor at the prearranged time, I saw another social worker in the office locked in conversation with the independent doctor.

She was just completing her second best interests assessment and  the doctor had doubled up  and  very sensibly arranged the two Mental Health parts of the assessment for the same morning.

The amount of paper was unbelievable. These forms while not as scary as they seem at first, they are long and they are wordy.  There are tick boxes that account for all possible outcomes. So there are lots of pieces of paper with lots of choices. We had reams of paper scattered around in an attempt to organise these forms into some kind of order.

image anomalous4 at Flickr

The doctor commented about the sad death of all these trees. It really was, with all the forms scattered and trying to organise them, a veritable paper mountain.

I can’t help but think there must be a better way to have organised this. Electronic forms and tablet PCs, perhaps. I wouldn’t be loved for sugggesting it to a those of my colleagues who suffer from technofear and of course, some kind of electronic signature arrangement needs to be in place but the amount of pieces of paper was just mindboggling.

My colleague had a bit of a crisis when the Mental Health, Mental Capacity and Eligibility Forms all got mixed up into a kind of mass mess of papers. We used my ‘stapled’ blueprints to unravel them.

So anyone who is involved in these assessments, another lesson learnt – always staple your forms together before you go because the pages can look remarkably similar!

As for my assessment – I didn’t actually think there that the situation amounted to a deprivation of liberty for the person in question. Restrictions, yes – but not a deprivation.

That seems to have been the conclusion for a number of these applications which were made en masse.

At some point, I may well return to the distinctions between restrictions and deprivations of liberty –  but my brain needs a bit of recovery time..

Actually later  today someone that I care co-ordinate is being assessed. I spoke to the Best Interests Assessor yesterday. I was amazed that application had been made as I hadn’t considered that she was being deprived of her liberty – again, I’d had definitely said there was a restriction but not a deprivation.

Seeing as these referrals (and there were, I think about six) have all emanated from the same source, I foresee some additional training running from the DoLs office who have been having a little panic.

9 thoughts on “Drowning in Paper

  1. We’ve not yet done any DoLS assessments in my corner.

    When it’s suggested, as I’ve said, we approach a band 7 Social Worker who considers if it’s restriction or deprivation. Only if she and we reckons it’s deprivation do we proceed to the formal process.

    6 weeks in and no paperwork. It’s not over I gloat. But sorry, I just can’t help it. Tee hee 🙂

  2. Can I come and work in your team please?! Seriously, it has been a bit of a mess. I did speak to the Borough lead on DoLs and she is organising some more training for the hospital. It’s an learning process though, I feel. And has led to the death of a great many trees…

    Your system is much better!

  3. The paper is frightening. Just done a couple which we haven’t authorised and I have spent a good deal of time in front of the photo-copier. And that’s before the appointment of the Representative. Interesting to hear about your experiences. We too haven’t had many referrals either but not sure about the legality of the Shrink’s approach.

    The DoH advised us not to say categorically whether it was DOLS or not without going through the assessment process and completing some of the paperwork to officially decline.

    Went on a training course last week when the lead of one London borough presented a case. All about restraint for personal care. Half the room thought it was DOLS, half didn’t and a few thought the patient should be in hospital. It’s all still very arbitrary.

    I miss the CMHT….It all seemed somewhat clearer

    • I haven’t actually had time to attend any of our DoLs support groups – and I was actually chastised for that yesterday but I have blocked out time to go next time! I have though had ‘informal’ discussions with a few other BIAs about referrals they’ve taken and there seems to be a little variance..
      I expect it’s the kind of thing that will only start to ‘bed down’ after a little more time and when feedback is shared more across borough lines.

      The BIA assessment form specifically asks for an explanation of why you don’t think it’s a deprivation of liberty (if you don’t) so that’s the way I was told to go too – although I did try the ‘phoning up and asking if I needed to’ but honestly, I haven’t found the forms too onerous. It’s just the quantity of actual physical paper that you have floating around and all the tick boxes.

      And if you have tried unravelling some forms that have been all mixed up together, you have to wonder if there would have been any more efficient way of doing this!

      I am booked on some update training though in a couple of weeks (As well as the running ‘support’ groups).

      I don’t know if you have been involved in any in May with urgent authorisations where you have the 7 calendar days, but I found that much more stressful than the nice, extended deadlines we had in April..

  4. We have to give a thorough explanation as to why we don’t authorise a DoLs. The trust seconded two and a half of us for six months as BIA’s on band 7 to meet the expected deluge. We have had thirty referrals so far and many enquiries. We are liaising with wards and homes in our capacity as a ‘resource’ and educators.
    However, it will take time to bed in and we expect a steady trickle of referrals as and when people realise what is required. What astonishes me is how much more important is the Mental Capacity Act and its impact upon care, yet the panic surrounds the possibility of deprivation of liberty.
    With regard to the forms: download to a dongle and print off as and when needed. Electric forms & tablet PC’s was our first request to management but their response was one desk PC which arrived at the end of April! Absolutely mind boggling.
    Mind you, 19 referrals from one home at once was a steep learning curve hence our keeness in liaising with homes but also loudly declaiming our independence and objectivity.

    • It’s always really interesting reading other people’s experiences. 30 referrals sounds like a lot! Our authority hasn’t got anyone working exclusively as BIAs but I know a few that do and at the moment, it seemed like it was probably a better idea.
      Dongle is a good idea definitely. I tend to type them up anyway, but write my initial thoughts/ideas etc on the hoof although to be honest, with some of the forms there really is no point. There is no reason at all I need to carry a paper copy of the no refusals assessment as I’d have had that information in the office anyway.
      I would LOVE electronic forms and tablets! THanks for sharing your experiences!

  5. Here is how we end up with mountains of (virtual – all online on internal systems) paperwork in the IT dept of the bank I work in.

    You start with 1 form that works for multiple tasks. Then a new task is added that doesn’t fit, so it gets a new form. Then, every so often a rare combo of circumstances comes up, or something goes wrong. Either way, a management arse needs quick covering. The solution? Add more paperwork, more signatures for approval, more documentation.

    Soon, you’re drowning in it.

  6. I’ve been involved in training BIAs in the South West and trying to get people to think about how to use the forms in a sensible fashion. It’s been hard work as I’m not sure that the person that designed them was always really clear about the answers that were needed on them. I do think that they’re thorough enough and lead the assessors by the hand through the processes required.

    Sadly, even though some of the social workers who have trained as BIAs in the area that I work have tablet PCs already they aren’t be allowed to use them and everything is being done on paper because of “security” thereby shooting in the foot the idea in the rest of the authority that they want us to be “paperless”!

    I’m also very concerned about this idea of screening out DoLS referrals before they get to the assessment process. This appears to have happened where I am based (out of concern that care homes haven’t written sufficient information to make a clear application) and they don’t seem to be following up to check whether someone is being deprived of their liberty illegally. I’m concerned that people aren’t using this system enough because of its complexity and bureaucracy, even though it has been put in place to protect essential human rights of very vulnerable people. I hope there will be more publicity and case law to really stimulate people to be more rigorous.

    • Thanks for that. For me, one of the issues is the quantity of pieces of paper that are floating around – I know they can be sent electronically and perhaps it says more about my way of working but I prefer to make notes on the forms before typing them out!

      I wonder if more consolidation of forms is needed.

      The discrepancy between paper forms and paperless offices is one we have as well in our authority. I try to ignore it – personally, I would be more than happy moving to a paperless system!

      We don’t really have much of a screening process (hence the wave of frankly inappropriate referrals). I know there are more substantial training courses being arranged for particular wards..

      Another concern of mine is the use in residential care. I’ve alerted one residential home that I think they should be applying for a DoL authorisation for a particular person but they responded ‘she’s ok, she’s happy here’ – which wasn’t exactly my point!
      I think it is just a bit of avoidance – I’m not sure how far to press it though as it isn’t someone I’m actively involved with..

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