National Mental Capacity Forum Mental Capacity Act in action Baroness Ilora Finlay Working together to promote and uphold the principles of the Mental Capacity Act 2016
What is the purpose of the Forum?
NMCF: first year 1) “Voice of the Person” 2) Leading change Leadership Group Engagement with MCA Implementation Group 3) Action Day NMCF National Action Day: 15 March 2016 (RCAnaes) 29 Feb 2017 (RCP) 4) Thematic work plan Financial sector Office of public guardian ‐ LPAs Clear messages – GMC toolkit Care planning – NCPC Listening “A movement, not a committee”
Laws ‐ Mental Capacity Act • More than regulatory instruments • Send social messages • Can have unintended consequences
Unintended consequences? • Carers feel excluded • Confidentiality can be used as a barrier to communication • Assessments take priority over listening • Deprivation of liberty safeguards bureaucracy • Advance Decisions to Refuse Treatment are not understood
Mental Capacity Act 2005 – 5 principles 1. A presumption of capacity • I can make a decision 2. Individuals supported to make their own decisions • Do all you can to help me make a decision 3 4 3. Unwise decisions 2 • Don't assume I lack capacity 4. Best interests 1 • Changing clinical scenarios • Consulting those important to P 5. Less restrictive option 5 • Liberty and security After Shropshire Council
Decision specific capacity
Disorder of the mind or brain?
Disorder of the mind or brain? Interfere?
Understand the information
Retain information
Weigh up information
Communicate their decision
And conflicts …… Time conflicts: acute care v capacity needs ?Validity of Least restrictive LPA H&W option versus Advance care plan safety of others In acute ADRT / DNACPR out of hours Confidentiality v Financial fraud / discussing best grooming is very interests decision difficult to detect
Liberty and security • Human rights – in balance? • Where is keeping people safe? • Autonomy • Do no harm / do good • Justice – to individual and to others
How is the Forum making a difference?
Is elephant in the room money? Elderly woman, dementia, fall, fractured femur. Husband frail, exhausted, Adamant she wants to go home Assessed as self funding Care home = £4k pcm Home care = £8k pcm Capacity assessment – ‘wishes and feeling’
Is elephant in the room money? Elderly woman, dementia, fall, fractured femur. . Husband frail, exhausted, adamant she wants to go home Assessed as self funding Care home = £4k pcm Home care = £8k pcm Capacity assessment – ‘wishes and feeling’ 1. Financial duty of attorneys to her, or to both despite his capacity? 2. Does fiduciary duty trump health or vice versa? 3. What if different attorneys: F / H&W? 4. Do ‘wishes and feelings’ trump ‘weigh up and understand’? 5. Does safety of P override safety of husband?
Overall – tensions and solutions 1. A presumption of capacity • Fluctuating • Assessing capacity • understanding, retention, weighing up, communication 2. Individuals supported to make their own decisions 3 4 • Time for the person v allocation of resources 2 3. Unwise decisions • But what if front page of the papers 1 4. Best interests • Changing clinical scenarios • Consulting those important to P 5 5. Less restrictive option • Danger to themselves and others
Other big pieces of work for the Forum?
Priorities : Easy to understand messages: Supported decision making Neglected sectors – prisons, utilities, Awareness of LPAs Awareness of principles Carers – exclusion, vulnerability, source of information Voice of the user Forum members knowledge and best practice, SCIE website Dementias Transition & learning difficulties
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