There has been a rise in the number of approvals for measures that allow hospital and care home staff to deprive people of their liberty.
Councils and primary care trusts can approve placing restraints or restrictions on people who are deemed to lack the mental capacity to consent to their care or treatment. They include those with dementia or a learning disability.
A report from the Care Quality Commission found awareness of the Deprivation of Liberty Safeguards grew in 2010-11 but were not always applied consistently.
This meant staff were sometimes unaware they were depriving people of the liberty by locking doors, using bed rails and keeping people indoors.
Overall, the number of applications in England rose in the year to the end of March 2011 to 8,982, compared with 7,157 the previous year.
In total, 55 per cent were authorised compared to 46 per cent previously.
The proportion of applications that were approved varied from 49 per cent in the North West to 83 per cent in London.
From an in-depth sample of more than 1,200 inspection reports, the CQC found “considerable variation” in practice in care homes - the institutions that make the most applications to deprive people.
About one in 10 care homes mentioned the use of restrictions or restraints, mostly locked doors or the use of bed rails.
“In some care homes these practices were in operation without any consideration of whether they might constitute a deprivation of liberty,” the report said.
“The use of bed rails was a particular example of where some care homes did not consider possible deprivation of liberty issues, others decided it did not constitute a deprivation of liberty, and others made applications to supervisory bodies.
“This will, of course, vary appropriately from case to case, but the impression is that there is a lack of consistency and confusion about what constitutes a deprivation of liberty.”
A sample of NHS hospitals also found variations in practice.
The study found the provision of staff training varied.
Between a third and a quarter of care homes had not done any staff training on the safeguards, and in some cases, only the manager had received training.
Most hospitals had held some training but the proportion of staff involved ranged between 20 per cent and 100 per cent.
When care homes and hospitals make an application for authorisation, they are legally required to also notify CQC. But today’s report found only one in three are doing so.
Cynthia Bower, chief executive of the CQC, said: “The safeguards are vital to ensure that a person’s best interests are carefully considered, their needs fully understood, their wishes taken into account and their human rights properly respected.
“The safeguards are no longer new and care homes and hospitals have had time to train their staff and develop their internal procedures.
“We expect them to embed this as a routine, but essential, element of their operation.”