Best Interest Assessor Training Exercise
Cheshire West Acid Test: Impact Analysis
Supreme Court Case Reference: October 22-25, 2025
🎯 Learning Objectives
- ✓ Understand the implications of the Cheshire West acid test in DoLS assessments
- ✓ Analyse how the Supreme Court ruling could impact deprivation of liberty determinations
- ✓ Apply best interest assessment principles across both potential legal outcomes
- ✓ Critically evaluate conflicting information and stakeholder perspectives
- ✓ Complete a comprehensive balance sheet assessment
📋 Exercise Structure
This exercise presents a complex case scenario involving Mrs Bronwen Davies, a 78-year-old woman with dementia residing in a care home in Powys, Wales. You will analyse her situation under two alternative legal frameworks depending on the outcome of the pending Supreme Court case.
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📁 Case File: Mrs Bronwen Davies
📝 DoLS Form 1 Request Received
Date Submitted: 1st December 2025
Managing Authority: Glan Afon Care Home, Powys County Council
Reason for Request: The person is subject to continuous supervision and control and is not free to leave. The managing authority believes P lacks capacity to consent to care and treatment arrangements.
👤 Personal Details
Name: Mrs Bronwen Davies
Age: 78 years old
Date of Birth: 14th March 1947
NHS Number: 485 293 7651
Current Location: Glan Afon Care Home, Powys
Date of Admission: 15th September 2024
Primary Diagnosis: Mixed Dementia (Alzheimer's/Vascular)
Legal Status: Standard Authorisation pending
📖 Background History
Mrs Davies was a retired primary school headteacher who lived independently in her own home in Llandrindod Wells, Powys until February 2024. She was diagnosed with mixed dementia in 2021, and her condition has progressively deteriorated. Following a series of falls and incidents where she was found wandering in her nightclothes at night, her family became increasingly concerned about her safety.
Prior to her cognitive decline, Mrs Davies was known as a fiercely independent woman who served on the local council and was an active member of her chapel community. Her late husband, Gareth, passed away in 2019, and she has two adult children: Megan (52) who lives in Newtown, Powys, and Rhys (49) who emigrated to Australia in 2015.
Mrs Davies was admitted to Glan Afon Care Home initially as a respite placement, but due to her deteriorating condition and increased care needs, the placement became permanent. She did not participate in this decision and has on multiple occasions expressed a wish to return home.
📋 Form 1 Supporting Documentation
Mental Capacity Assessment (submitted with Form 1)
Assessor: Mrs Sian Hughes (Care Home Manager)
Date: 25th November 2025
Decision: Whether to reside at Glan Afon Care Home
Conclusion: "Mrs Davies lacks capacity to decide where to live. She cannot understand the risks of independent living and does not retain information about her care needs. She becomes confused when discussing her situation."
Note: No documentation of specific attempts to support understanding. Assessment conducted in English only, despite Welsh being Mrs Davies's first language.
Care and Support Plan (excerpt)
Care Objectives:
- Maintain physical health and prevent falls
- Provide 24-hour supervision to ensure safety
- Support with all activities of daily living
- Manage challenging behaviors through medication and redirection
- Maintain nutrition and hydration
Note: No mention of Mrs Davies's wishes, cultural needs, or community connections. No plan for supporting continued chapel attendance or Welsh language interaction.
Best Interests Decisions Documented (partial)
The Form 1 includes best interests documentation for:
- ✅ Locked doors: Documented consultation with daughter Megan (LPA holder) who agreed. Rationale: prevention of harm from unsupervised exit.
- ✅ Personal care supervision: Discussed with Mrs Davies who "seemed to accept help." Rationale: dignity and safety during washing/dressing.
- ✅ Bed rails at night: Discussed with Megan who consented. Risk assessment completed showing high fall risk.
NOT documented with best interests process:
- ❌ Covert medication: No record of best interests decision. Only notation: "Patient refuses tablets - given in food as per usual practice."
- ❌ Contact restrictions: No consultation documented. Implemented after "concerns raised by staff" about phone calls from someone claiming to be a friend.
- ❌ Activity restrictions: Blanket restriction policy - no individual assessment recorded.
⚠️ Critical Challenge
Mrs Davies's daughter Megan holds Lasting Power of Attorney for Health and Welfare, registered in 2022. However, Megan has stated she believes her mother "would want to stay safe" and has consented to the care home placement on her behalf. Mrs Davies herself frequently states she wants to go home and becomes distressed when this is not possible. Consider: Whose voice should carry more weight in this assessment?
⚠️ Conflicting Information
From GP Records (Dr Hefin Jones): "Mrs Davies has capacity to make day-to-day decisions and often articulates her wishes clearly. Her dementia affects her short-term memory but her long-term values and preferences remain consistent."
From Care Home Manager (Mrs Sian Hughes): "Mrs Davies lacks capacity to make any decisions about her care and accommodation. She doesn't understand the risks of living alone and cannot retain information about why she is here."
🔒 Current Restrictions in Place
| Restriction | Details | Rationale Given |
|---|---|---|
| Locked doors | Keypad entry/exit system on all external doors | Prevention of unsupervised egress; fall risk |
| Medication covert administration | Risperidone 0.5mg BD administered in food | Management of agitation; patient refuses tablets |
| Supervision | 1:1 supervision during personal care; general observation at all times | Safety during washing/dressing; fall prevention |
| Movement restriction | Sensor mat by bed; bedrails in use at night | Fall prevention during nocturnal wandering |
| Contact restrictions | Phone calls monitored; visitors screened | Safeguarding from potential financial abuse |
| Activity restrictions | Cannot access kitchen or laundry areas | Burns risk; confusion about appliance use |
📊 Cheshire West Acid Test Criteria
The acid test established in P v Cheshire West and Chester Council [2014] asks whether the person is:
- Under continuous supervision and control
- Not free to leave
- These conditions apply to someone who lacks capacity to consent to their care arrangements
The "relative normality" of the setting is irrelevant – the focus is on the concrete situation of the individual.
⚠️ Critical Challenge
The care home manager reports that Mrs Davies "rarely tries to leave" and "seems settled most of the time." Staff note she often sits contentedly in the lounge watching television. Does apparent contentment negate the deprivation of liberty? Consider the Supreme Court's emphasis on the objective nature of the test.
⚠️ Conflicting Information
Night staff observation records: "Mrs Davies frequently attempts to leave via fire exits between 2am-4am. Becomes very distressed when redirected. States she needs to 'get the children ready for school.' Requires significant reassurance and sometimes PRN medication."
Day staff observation records: "Bronwen is a delight to care for. Very cooperative with personal care. Enjoys activities and interacts well with other residents. No concerns."
✍️ Assessment Activity 1: Restrictions Analysis
For each restriction listed above, consider whether it contributes to a deprivation of liberty under the current Cheshire West test. Document your analysis below:
🧠 Mental Capacity Assessment
Decision in question: Whether to reside at Glan Afon Care Home
Understanding: Mrs Davies can describe what a care home is but cannot consistently explain why she is there. She recalls her home address and describes it in detail. She states "I don't need looking after, I've looked after myself for years."
Retaining: Information about risks of living alone is forgotten within minutes. She repeatedly asks "Why can't I go home?" despite explanations. However, she consistently retains her preference to live independently.
Using/Weighing: Struggles to weigh safety risks against her desire for independence. Dismisses concerns about falls stating "Everyone falls sometimes." Cannot engage with hypothetical scenarios about future deterioration.
Communicating: Articulates views clearly in Welsh and English. Becomes more lucid when speaking Welsh. No communication barriers identified.
👥 Stakeholder Consultations
"Mam would be horrified if she could see herself now. She was always so proud and independent. But I know she would want to be safe. She used to say to me 'promise you'll never let me end up a burden' – I think this is what she meant. Rhys doesn't understand, he's not here seeing it every day from Newtown. He keeps saying we should try home care again but we already tried that and it didn't work. I know this is hard for her but it's the right thing."
"I don't think Mam should be locked up in that place. She's always telling me she wants to come home when we speak. Megan's making decisions based on what's convenient for her, not what Mam actually wants. Have they even tried proper home care with Welsh-speaking carers? I'd contribute financially if that's the issue. I'm flying over next month and I want to discuss getting her out of there. She's not as bad as Megan makes out."
"I've known Bronwen for over 30 years. Her dementia is moderate – she's not at end stage by any means. I do have concerns about the level of antipsychotic medication she's on; I didn't initiate the risperidone and I'm not convinced it's necessary. Her 'agitation' might be a reasonable response to feeling trapped. I'd support a trial of reduced medication and reassessment of her placement. The care home approach seems quite risk-averse."
"Mrs Davies requires 24-hour care. She cannot safely manage any activities of daily living independently. She would be at extreme risk if she returned home – we've had incidents where she's tried to leave in her nightdress in freezing temperatures. The family don't see the reality of what we manage day-to-day. The DoLS authorisation is absolutely necessary and appropriate. Any reduction in restrictions would put her at unacceptable risk."
"In my meetings with Mrs Davies, she consistently expresses a wish to return home. She becomes visibly distressed when discussing the care home. Her sense of identity is strongly connected to her home and community in Llandrindod Wells. While I understand the safety concerns, I question whether sufficient exploration has been made of supported living options or enhanced home care packages. The current arrangement does not appear to reflect Mrs Davies's wishes and feelings."
"Bronwen was a pillar of our chapel community for decades. I visit her regularly and it breaks my heart. She knows me, she remembers hymns, she asks about people from chapel. But she always asks when she can come back to the service. Her faith and her community are so important to her. I worry that being cut off from these connections is making her worse, not better. Could she not attend chapel with support?"
🤝 Relevant Person's Representative (RPR) Assessment
Under Schedule A1 of the Mental Capacity Act 2005, if a Standard Authorisation is granted, Mrs Davies is entitled to have a Relevant Person's Representative appointed to maintain contact with her and support her rights.
Selection Criteria for RPR:
- Must be 18 or over
- Must be willing and able to carry out the role
- Would not have interests that conflict with Mrs Davies's interests
- Should be someone Mrs Davies would want in this role (her wishes and feelings)
- Must be capable of keeping in contact with Mrs Davies
- Must be available to represent Mrs Davies in matters relating to the deprivation of liberty
Potential RPR Candidates from Consultations:
Option 1: Megan Davies (Daughter/LPA Holder)
✓ Strengths: Family member, holds LPA, lives relatively locally in Newtown, visits regularly, understands care system
✗ Concerns: Strong advocate for care home placement - may conflict with Mrs Davies's expressed wishes to return home. Her views appear different from her mother's preferences.
Option 2: Rhys Davies (Son - Australia)
✓ Strengths: Family member, seems more aligned with Mrs Davies's wishes to return home, willing to contribute to alternative arrangements
✗ Concerns: Lives in Australia - cannot maintain regular face-to-face contact, time zone differences, may not understand full picture of care needs
Option 3: Reverend Elin Morris (Chapel Minister)
✓ Strengths: Long-standing relationship with Mrs Davies, visits regularly, understands her values and cultural identity, no apparent conflict of interest
✗ Concerns: Not a family member, may not be familiar with DoLS processes, professional demands on her time
Option 4: Professional/Paid Representative
✓ Strengths: Trained in DoLS, no conflicts of interest, objective perspective
✗ Concerns: No existing relationship with Mrs Davies, may not understand her cultural/linguistic needs, less personal connection
🔀 Key Consideration
There is a conflict between family members about what is in Mrs Davies's best interests. Megan (who holds LPA) supports the care home placement, while Rhys opposes it. Mrs Davies herself consistently expresses a wish to go home. How does this conflict affect the RPR selection? Should the RPR be someone who supports Mrs Davies's expressed wishes, or someone who prioritizes her safety?
⚠️ Critical Challenge
Megan holds LPA for Health and Welfare and has consented to the placement. However, an LPA holder must make decisions in the person's best interests, not substitute their own judgement. Is Megan's consent valid? What weight should be given to Mrs Davies's own expressed wishes?
✍️ Assessment Activity 2: Stakeholder Analysis
Consider the perspectives gathered. Identify areas of agreement and conflict. What further information would you seek?
✍️ Assessment Activity 3: RPR Recommendation
Based on the information provided, who would you recommend as Mrs Davies's Relevant Person's Representative? Provide your rationale.
⚖️ Alternative Futures: Supreme Court Outcomes
The Supreme Court case in October 2025 will determine the future of the Cheshire West acid test. Analyse Mrs Davies's situation under both potential outcomes:
🟢 Scenario A: Cheshire West MAINTAINED
The acid test remains the legal standard. "Continuous supervision and control" + "not free to leave" = deprivation of liberty requiring authorisation.
Implications: Mrs Davies's situation clearly meets the acid test criteria. DoLS authorisation is legally required. Focus shifts to whether the deprivation is in her best interests and proportionate.
🟠 Scenario B: Cheshire West OVERTURNED
A new, potentially narrower test is established. Greater weight may be given to the person's circumstances, comparators, or subjective experience.
Implications: Mrs Davies's situation may not constitute a deprivation of liberty if she appears "content" or her living situation is considered "normal" for someone with her care needs. Safeguards may not automatically apply.
⚠️ Critical Challenge
If Cheshire West is overturned and Mrs Davies no longer meets the threshold for DoLS, what human rights protections remain? Consider Article 5 ECHR (right to liberty) and Article 8 ECHR (right to private and family life). Does the removal of DoLS safeguards leave Mrs Davies more or less protected?
✍️ Assessment Activity 3: Scenario Comparison
📋 Best Interests Balance Sheet
Complete the balance sheet below, weighing factors for and against the current care arrangements being in Mrs Davies's best interests:
✅ Factors Supporting Current Placement
❌ Factors Against Current Placement
⏱️ Duration of Authorisation
If you are recommending authorisation, specify the duration and provide your rationale. Standard authorisations can be granted for up to 12 months.
💡 Reflection Points
- • How does the legal framework affect your professional judgement?
- • What is the impact on Mrs Davies's autonomy and dignity under each scenario?
- • How would you ensure ongoing review and least restrictive practice regardless of the legal outcome?
- • What role should Welsh language and cultural identity play in the best interests assessment?
📝 Final Reflections
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📄 Assessment Summary Report
© DCC-i, 2026. All rights reserved.