Back in October we travelled to Devizes, in Wiltshire to host another of our Together We Care Better round table events. This time the topic we were discussing was focused around Mental Capacity Assessments. This had been highlighted by Wiltshire Care Partnership (the local care association) as a hot topic for their care provider members. Along with a panel of mental capacity experts we engaged in a discussion related to the most up to date best practice, the pitfalls and issues of performing MCA and DoLs. The following article is formed from the round table’s minutes and includes a short montage style video we shot whilst in the event.
Mental capacity expert panel
- Alison Wood – Lester Aldrige Law
- Anne Weston – RHW Consultants
- Ian Bradford – Owner of Greenview Residential Care Home and pioneer of DemFest
- Nuno Almeida – Founder of Nourish
For the video highlights from the Mental Capacity Assessment roundtable event please see the video below. We’ve also included a handy breakdown of the issues raised, recommendations from the expert panel and a breakdown of the ‘easy hand technique for remembering the 5 key principles underpinning mental capacity assessments.
Issues raised and discussed
- Care providers felt that there was a lack of consistency, different people from different organisations with differing views and these were compounded by a local authority’s mixed advice.
- J. Hills a Wiltshire Council Lead for Mental Capacity, helped a provider develop their own template. This was then rebutted when another Social Worker said it was incorrect at a later visit. This gave rise to the following point.
- It was argued by many in the room that inspections and inspectors were inconsistent. The examples given were that a provider with 2 homes faced very different inspections. The first inspection took just 6 hours whereas the other took several days to complete.
- The room was against the blanket assumption that everyone living with dementia lacks capacity to make their own decisions.
- Some of the care providers felt that their training insufficient to give staff the confidence to carry out consistent assessments due to the inconsistencies in regulatory approaches.
- Because of the lack of standard MCA paperwork in Wiltshire, people used various templates designed from within their own organisations, with some even looking to other local authorities in order to find best practice examples and frameworks.
- Doing Deprivation of Liberty Safeguarding (DoLS) applications for someone who has capacity but is not free to leave, had a multi-agency meeting but professionals could not agree. This resulted in one participant having to go to the Court of Protection to secure a verdict.
- One inspector stated need to do a MCA for all residents of a certain home, however this was met with a question about frequency and pragmatism of this approach when residents only had minor needs.
Recommendations from the experts
- Care planning is about promoting ability and not focusing on frailties.
- In the Care Plan, providers should always try to include which areas people are able to make decisions on and those which they need assistance.
- The Mental Capacity Act states that providers need to have a MCA for each decision, but need to balance, recommend carrying out one MCA assessment for all day to day needs and anything outside this requires another assessment i.e. covert medicines, smoking, alcohol etc.
- Record the conversation, evidence that you have thought about and discussed each area in order to provide an audit trail for compliance reasons.
- Do not cut and paste standard text from one assessment to another as this will expose you to errors in the form entries.
- Care providers need to record and explain why the person in their care does not have capacity and why they are not able to fully understand the decision.
- Seek external advice and support i.e. GP, psychiatrist, safeguarding, Court of Protection etc.
- Doing an assessment for every resident is not required, the person has to have a mental impairment otherwise MCA is not relevant.
- Show that the assessment has been carried out at the best time of day and week to bet suit the person – choose their optimum time for this to be done and evidence why.
- Ensure the admission and care planning process covers Power of Attorney, a this means someone has got legal responsibility. Endeavour to discover what sort of powers are in place and for what decisions? This person is key, ensure you see proof such as their certificate before you act.
- With Best Interests it is crucial to show who is important to the person and that they have been consulted before any actions are taken.
- It is also very important to show that care providers always choose to use the least restrictive option.
- Allow positive risks to maintain good quality of life, it should be an empowering process not a restrictive one.
- Ensure staff procedures are clear that staff need to feedback immediately if they have any concerns about capacity of someone in their care.
- Develop templates specific to the care setting and ensure staff know the processes they have to follow in each setting they provide care in.
- Demonstrate how you have looked at and used Assisted Technology i.e. GPS trackers to enable freedom whilst being able to monitor a person’s whereabouts if they are prone to wandering.
- Have confidence with Inspectors, show that you know the person and their needs and that you know when MCA is required and when it is not.
- Give staff the responsibility for doing assessments to build their confidence in the process and with completing assessments
- Follow the 5 principles of the Mental Capacity Act and use the Code of Practice at all possible junctures.
- The Court of Protection is there to make the very difficult decisions i.e. when professionals have differing opinions, don’t be afraid to use their services.
- Owners being involved in the day to day running can be helpful, if not then the Registered Manager needs to take responsibility.
- Empowerment of registered Managers is vital, they have to feel empowered by the processes in place.
- The confidence and skills within the team comes from the top of the organisation.
- It is your responsibility to go out into the local community to offer support and advice where at all possible.
- Work in partnership with and network with the local community whenever possible.
- Ian gave examples of activities to encourage collaboration such as: exercise classes at local gym, puzzle club at local pub, arts and crafts at local theatre
- Table tennis is very good for the mind/memory, helps with focus as well as exercise, use a different coloured ball like orange when helping with Dementia.
- Use reminiscence tools and know the individual, their background, skills, work, history, find out what makes them tick and allow staff the time to get to know the individual
The easy hand technique to remember the 5 principles of Mental Capacity Assessments:
- Thumbs up, is the person OK, assume capacity
- Be mindful, take all practical steps and provide support
- Unwise decisions, allow people to make unwise decisions
- Commitment, make decisions in best interest, be faithful to the decisions you made
- Least restrictive, small decisions not big decisions.
For more information and to find out how Nourish can help your care provision
Nourish works tirelessly to empower care providers across the UK. You can find out more information regarding our upcoming events by visiting our Blog page or to speak to one of the team then email firstname.lastname@example.org