Adult Social Care 2017 LocalGovernmentLawyer 14 kickstart the process and help them to build the capacity that you need to do it. He was very clear that it is very difficult to achieve the integration required without that funding.” However, he added, there appears to be no quick fix. One of the issues identified in Manchester (as in many places elsewhere) is the lack of clarity over who should take the lead in improving integration. Resources are scarce which means that inevitably there will be discussions about how limited funds should be allocated between health and local authorities whether that be from the Better Care Fund or, more recently, funds allocated to help with the implementation of Sustainability and Transformation Plans (STPs). The latter, Goacher added, were sometimes viewed by local authorities as being NHS-driven, leading to unenthusiastic engagement from local authorities in some areas. STPs have also not been accompanied by significant structural reform and, although early days, there remains some doubt as to whether they will make much progress in integrating health and social care. “When you’ve come, as I have, from a local authority background and now working for a firm that does a lot of health and local government work, I think there’s still quite a journey to go on to get the integration agenda working effectively,” Goacher concluded. Deprivations of liberty Perhaps the biggest single issue facing social services departments is dealing with the DoLS regime after the 2014 Supreme Court decision in Cheshire West, which significantly widened the range of people considered to be potentially deprived of their liberty in health and social care settings. Since then, the Law Commission estimates that hospitals and care homes in England made 195,840 DoLS applications in 2015-16 compared with 13,700 in 2013-14, the year before the Cheshire West decision, costing £250m a year and putting staff and budgets under severe strain. In response, the Law Commission published its proposals to replace the DoLS with a new scheme, to be called the Liberty Protection Safeguards. Amongst other measures, these would extend the safeguards to settings other than hospitals and care homes, allow safeguards to apply to 16 and 17 year olds, and make changes to the best interests assessor role (For full details, see Tim Spencer-Lane’s article on p16). Perhaps most significantly for local authorities, they would no longer automatically be (in the new terminology) the “responsible” authority; instead in cases where treatment is primarily in hospital or carried out primarily through the provision of NHS continuing health care, then the responsible body would be either the hospital (or the trust that runs its) in the former case, or the Clinical Commissioning Group (or Health Board in Wales) in the latter. “We are now faced with a huge cohort of people who are legally defined as being deprived of their liberty,” the Law Commission’s Tim Spencer-Lane told the roundtable. “We have a system in place, that just doesn’t work in the sort of world we’re in where you know we’ve got something like 200,000 people, 220,000 people deprived of liberty every year and needing authorisations - the DoLS aren’t designed to cover that number of people. On the other hand, we must guarantee human rights as well.” The Law Commission’s proposals were broadly welcomed by the roundtable. However, even under a new system, the willingness of the healthcare sector to authorise deprivations of liberty would still be subject of some concern and some participants said that they faced problems with persuading healthcare partners of the importance of making an application. One said: “We just can’t seem to get them [healthcare providers] to make the appropriate applications. They just do not seem to want to deal with it at all.” The clearer definition of responsibility between health providers and local authorities for gaining authorisations and the implied front-loading of the process were also seen generally seen as an improvement on the status quo. “I like the proposal in relation to getting things on a “We have a system in place, that just doesn’t work in the sort of world we’re in where you know we’ve got something like 200,000 people, 220,000 people deprived of liberty every year and needing authorisations - the DoLS aren’t designed to cover that number of people. On the other hand, we must guarantee human rights as well.” Tim Spencer-Lane, Law Commission