Eleanor Roosevelt, 1958

'Where, after all, do universal human rights begin? In small places, close to home -- so close and so small that they cannot be seen on any map of the world. Yet they are the world of the individual person... Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.' Eleanor Roosevelt, 1958

The Small Places has moved...

The Small Places has moved to a new home here, including all the old posts. Any posts after 6th March 2014 will appear on the new website, but old posts are preserved here so that URLs linking here continue to work. Please check out the new site.

Friday, 28 September 2012

A serendipitous judgment

If a judgment can be serendipitous, then this was. Last week I gave a case law update to the fantastic Yorkshire and Humber Best Interests Assessors conference. In that update I talked about Article 8 and issues where an older person wanted to return home, but it was felt they were safer in residential care.   I described case law where the focus had been on a person’s desire to be reuinited with a loved one (in particular, DJ Eldergill’s judgment in A London Local Authority v JH & Anor [2011]), but grumbled that no judgments had yet been published about a person’s desire to be reunited with their home. This surprised me, as there are surely large numbers of older people in care homes who want to return to their homes, but where the ‘family life’ pull isn’t a factor. I then spent the best part of this week complaining about how fuzzy the concept of 'capacity' is, how little detailed guidance (as opposed to equivocal platitudes) the courts have given on how capacity should be assessed, and how much potential for arbitrariness there is in capacity assessments...  So, it was with a great deal of pleasure that Baker J’s judgment in CC v KK and STCC (2012) arrived in my inbox this morning. In the first place, it’s a much needed case about an older person who wants to return home. In the second place, it goes into considerable detail about what a good capacity assessment looks like. This case will not only shore up people’s rights to self-determination, it should also place capacity assessors on a much surer footing about what is expected of them by the law.  (By the by it also talks about the meaning of deprivation of liberty, and - with a few sideswipes at Cheshire - finds that a person who is objecting and 'has somewhere else to go and wants to live there' - see Cheshire [58] - isn't deprived of their liberty because their objections aren't causing enough conflict. But we'll let discussion of the parlous state of DOLS case law pass for now...).

Sunday, 16 September 2012

The problem of domination in social care

On his blog today, parent carer Mark Neary described a series of occasions over the past couple of years where some element of support he and his son Steven receive from his local authority has suddenly been withdrawn, and then eventually reinstated without any real explanation. These are decisions with potentially huge repercussions for them, the most recent of which was to stop their housing benefit, which would potentially have had the effect of splitting the family up (again) and rendering Mark himself homeless. Within a month. Horrified, bloggers and journalists including Anna Raccoon, Billy Kenber at the Times and the Radio London breakfast show covered this latest sting in the tail of a story that began with Hillingdon unlawfully depriving Steven of his liberty for almost a year. Mark’s fab solicitor got in touch. And then suddenly, whilst describing what had happened on the Radio London breakfast show, the local authority’s director of social care and housing stated (on air) that they had personally intervened and reinstated the housing benefit pending further discussions. Mark writes:
In less than 48 hours, I swung from terrible despair and fear to triumphant relief and for what? If anyone from the social care field is reading this post, I would genuinely be interested in your theories of how things can change so dramatically, and so suddenly.
I don’t have a theory which can account for what happened in Mark’s particular case, but I do have a theory of why these types of scenarios occur in social care with greater frequency than one might hope. It’s called the problem of domination. [Edit: 14/11/2012: see Mark's response to this post here]

Friday, 14 September 2012

Mental capacity and voting rights

A discussion about care homes refusing to enter residents on the electoral register on grounds that they lack mental capacity to vote on the (brilliant) Mental Health Law Online discussion list prompted me to jot down a few reminders about mental capacity and voting rights.

Is mental incapacity a reason not to put a person on the electoral register?

No.  And failure to provide information to registration officers about a person who is eligible to be on the electoral register may be an offence.

Monday, 10 September 2012

CQC, strategy and inspection frequency

There have been a lot of changes over the last year at CQC.  Chief Executive Cynthia Bower has been replaced by former social worker David Behan, and Chair of the Board Jo Williams resigned last week.  Although there are likely to be bumps in the road in the near future - notably the registration of 8,500 GP practices and the findings of the Mid Staffordshire NHS Foundation Trust Public Inquiry in October - some detect change in the air, a regulator turning over a new leaf.  CQC are currently consulting on their strategy for 2013-16, and one source of contention is likely to be the tricky matter of inspection frequency.  I have previously written about the shift towards 'risk responsive regulation', an idea emerging from the Hampton Report and which resulted in the removal of a requirement for biannual inspections in care services in around 2007.  Under CQC there is no statutory inspection frequency, but last year in interviews amid the fallout from Winterbourne View and uncomfortable witness testimony at the Mid Staffordshire Inquiry Cynthia Bower appeared to commit the CQC to doubling inspection frequency, perhaps to annual inspections (e.g. Community Care, HSJ).  In 2010/11, inspection frequencies sank to an all time low - including, according to data CQC shared with me, an inspection rate of only 6% for learning disability services.  However, CQC recently shared with me updated, data, shown in the graphs below, which shows that in 2011/12 they have worked extremely hard to increase inspection frequencies, with around 72% of all residential care services being inspected that year.  This is really encouraging, the charts below speak for themselves of the effort that must have gone into increasing the volume of inspections.  However, in CQC's recent strategy consultation and statements from David Behan, there are ominous signs of a U-Turn back towards risk based regulation - that is to say, removal or reduction of minimum inspection frequency targets, based on risk.

Thursday, 6 September 2012

The conference season

The conference season is upon us, and there are some great conferences coming up on the Mental Capacity Act 2005, the Mental Health Act and the deprivation of liberty safeguards.  Here's a selection, but if you know of others then please do send details my way and I'll post them here.  I am attending a few of these.  Where others drool over seeing their favourite bands in music festivals, I am quite beside myself with excitement about some of the talks, workshops and speakers that are lined up on the MCA and the DoLS... If you know of other conferences, seminars or events that might be of interest to readers, then drop me a line.