Mental Capacity Act: Progress & Priorities - National Conference Highlights
This content delves into the Mental Capacity Act (MCA) with insights from the IMCA National Conference in Derby. Niall Fry, the MCA Policy Lead at the Department of Health, discusses the progress made over the last year and outlines priorities for the future. Key topics covered include MCA principles, the value of the MCA, Deprivation of Liberty Safeguards, and the importance of embedding MCA principles in daily healthcare practices. The MCA Code of Practice is emphasized as a crucial element in ensuring professionals' compliance and protecting individuals' best interests.
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Mental Capacity Act - Progress & Priorities IMCA National Conference, Derby 12 November 2015 Niall Fry MCA Policy Lead, Department of Health Twitter - @NiallatDH Email - Niall.Fry@dh.gsi.gov.uk DH Leading the nation s health and care 1
Department of Health logo Overview MCA principles & the value of the MCA Progress over the last year Priorities for the next year National Mental Capacity Forum Deprivation of Liberty Safeguards Concluding thoughts DH Leading the nation s health and care DH Leading the nation s health and care 2
Department of Health logo The MCA: enshrining in law a person-centred approach to health & care 1. Assume each individual has capacity unless assessed otherwise 2. Support individual to make their own decision 3. Allow individuals the freedom to make unwise decisions 4. Decisions made in the individual s best interests 5. Finding the least restrictive option The principles of the MCA should be thoroughly embedded in the way all medical and social care professionals work every day. The MCA is not a piece of legislation removed from everyday front line work. It encapsulates and reflects best practice care. Compliance with the MCA cannot be achieved if it is approached as a tick box exercise. It is a cultural ethos of centring care around the individual. DH Leading the nation s health and care DH Leading the nation s health and care 3
Department of Health logo The MCA: Reassurance for professionals MCA Code of Practice: - - Section 5 of the Act provides protection from liability Section 5(1) provides possible protection for actions carried out in connection with care or treatment .. if the person is reasonably believed to lack capacity to give permission for the action. The action must be in the person s best interests and follow the Act s principles Recording rationale for decisions made is key, and evidence of capacity assessment In emergencies, it will almost always be in the person s best interests to give urgent treatment without delay - - The MCA is a fundamental legal foundation for health and care professionals. All should be aware of its principles and able to demonstrate how their practice complies with the Act. DH Leading the nation s health and care DH Leading the nation s health and care 4
Department of Health logo The Value of the MCA Practice based on MCA principles means improved well-being across multiple diagnostic groups dementia, learning disability, mental health. Get it right for these individuals, we can get it right for everyone. A smart investment of time and resource. DH Leading the nation s health and care DH Leading the nation s health and care 5
Department of Health logo Yet MCA implementation not what it should be House of Lords MCA Select Committee, March 2014: MCA: visionary piece of legislation: potential to transform the lives of many. However, its implementation has not met the expectations that it rightly raised. The Act has suffered from a lack of awareness and a lack of understanding. The empowering ethos has not been delivered. The rights conferred by the Act have not been realised. CQC State of Care Report, October 2015: We have seen variable staff understanding of the Mental Capacity Act 2005 (MCA). In a number of cases, staff did not understand how they should be applying the requirements of the MCA in their roles. In some cases, there was a lack of adequate training for staff in these areas. There was varied understanding, for example, of when an assessment of capacity needed to be made and how a decision was to be made in a patient s best interests under the MCA, when they did not have capacity to consent to treatment. DH Leading the nation s health and care DH Leading the nation s health and care 6
Department of Health logo Progress over the last year CQC hardwired MCA into inspections - clear link between those deemed inadequate and those failing to implement the MCA MCA element incorporated into foundation training for all doctors MCA a core part of new social work knowledge and skills statement New online resource and store of key practice-support materials: http://www.scie.org.uk/mca-directory/ New resources include: self-improvement/ audit tool, guide to commissioning for MCA compliance (NHS and social care), pocket sight MCA cards and more Our one year update contains links to all key documents: http://www.scie.org.uk/mca-directory/keygovernmentdocuments.asp DH Leading the nation s health and care DH Leading the nation s health and care 7
Department of Health logo Priorities for the next year Activating MCA leads e.g. in Clinical Commissioning Groups, Health & Wellbeing Board, GP Practices Translating MCA training to MCA practice Working through the new cross-Government MCA Implementation Group to build a more aligned and collaborative programme health and care but also financial, legal, police It is clear, that although national leadership and alignment of national levers is important, benefits for service-users will only be realised following local action and when practitioners embrace and practice MCA principles: some great local examples, but some areas far behind And so our major initiative for the next year and beyond DH Leading the nation s health and care DH Leading the nation s health and care 8
Department of Health logo National Mental Capacity Forum (NMCF) Independent Chair: Baroness Ilora Finlay (Ex-President British Medical Association, palliative care consultant , President Chartered Society of Physiotherapy) real improvements in MCA implementation and real benefits for service-users Key aim: identifying local practical actions that can realise Cross-sector: health and care, legal, financial, police How can encourage more of: - practice-based multi-sector training, information sessions for families and carers, outreach to GPs, third sector signposting to Lasting Powers of Attorney, pod-casts for hospital staff, MCA floor-walkers/ champions, calls for evidence of MCA-compliance during commissioning, engagement with local media Currently developing priorities, watch this space: @NiallatDH DH Leading the nation s health and care DH Leading the nation s health and care 9
Department of Health logo Deprivation of Liberty Safeguards (DoLS) March 2014 Cheshire West Judgment Acid test : Individual is deprived of their liberty if they - Lack capacity to consent to arrangements - Under continuous control & supervision - Not free to leave Lack of objection/ compliance, relative normality irrelevant: gilded cage still a cage Such a DoL must be authorised through DoLS or the Court of Protection (or through Mental Health Act if approriate) DH Leading the nation s health and care DH Leading the nation s health and care 10
Department of Health logo DoLS before and after the SC judgment Pre March 2014 Post March 2014 Overall DH Guidance: - Full compliance a journey - Do-nothing unacceptable - Must have a plan and be adhering to national guidance - Degree of prioritisation inevitable - If following national guidance and providing good, quality MCA- compliant care, should not be harshly treated DH Leading the nation s health and care DH Leading the nation s health and care 11
Department of Health logo National MCA Guidance Palliative Care In last few days/ weeks of life, consent before losing capacity can be taken to be consent to the conditions of care (providing no subsequent major change) Coroners DoLS This is not, for families, a death in state detention and so professionals should act appropriately . Working with police, providers, GPs to ensure families are kept informed before the event - good communication absolutely key All of this only applies to those who have a mental disorder, lack the specific capacity to consent the accommodation and who meet the acid test. [NB. Unconsciousness in itself not a mental disorder] Eligibility DH Leading the nation s health and care DH Leading the nation s health and care 12
Department of Health logo DoLS Spreading best practice important Lots of helpful guidance materials including from Law Society, ADASS and DH. Easily found: http://www.mentalcapacitylawandpolicy.org.uk/resources-2/cheshire-west- resources/ DH Leading the nation s health and care DH Leading the nation s health and care 13
Department of Health logo The future of DoLS the challenge Supreme Court judgment: ten- fold increase in cases. DoL no longer rare Severe criticisms from Parliament: complexity of legislation and variability in use Difficult fit in today s health and care system and with key priorities The challenge: a system that delivers real benefits for individuals and their families (encourages their engagement), best use of health and care system funding, complements (does not duplicate) other safeguards in the health and care system DH Leading the nation s health and care DH Leading the nation s health and care 14
Department of Health logo Law Commission review of DoLS Legislative Change? Determined legislation should be considered in the round quick and dirty changes may lead to more problems. Law Commission engaged as experts in law reform. Law Commission has completed its public consultation. Achieved enthusiastic engagement. Await their suggested reviews provisional report spring 2016. Final report and draft legislation end December 2016. Final decision lies with Government. If legislative change preferred, will need to identify Parliamentary time and subject it to debate and scrutiny. DH Leading the nation s health and care DH Leading the nation s health and care 15
Department of Health logo Conclusions MCA The principles of the MCA are basic good practice and should be embedded in the culture of all organisations providing care to vulnerable people. CQC want to see evidence of this practice in inspections: not just lip-service Keep a look out for developments on the new National Mental Capacity Forum DoLS They are about people, not paperwork. Good principles but the Law Commission s work is focussing on realising benefits for individuals and less bureaucracy for professionals. Keep in touch What to hear your best practice so we can disseminate And your key challenges, concerns DH Leading the nation s health and care DH Leading the nation s health and care 16
