E-Newsletter for Managing Authorities March 2016
Welcome to the March newsletter! Please share this newsletter with interested colleagues.
Firstlywe wish you, your residents and families a very Happy Easter
National Mental Capacity Act Action Day 2016
Since November 2015 the National MCA Forum has had a new chair Baroness Finlay. She has declared March 15th as National MCA Action Day. There will be an event in London on that day and thepurpose of the event is to:
- Profile Current Best Practice
- Identify MCA improvements for coming year
- Greater commitment from attendees for projects and work to improve MCA implementation at the front-line.
Organisations have been asked to submit examples of innovative projects around MCA workto be presented on the day, we have submitted a project. Our project is around attending the over fifties groups in North Yorkshire and highlighting to them the importance of planning for future care,putting in place lasting power of attorney and explaining the DoLS process, including the role of the RPR. To date we have spoken to 101 people face to face and a further 500 have received newsletters and minutes with the information. Also another innovation that is taking place countrywide is an ‘Unwise decision wall’ where we as staff etc. can post our unwise decisions! It can be done with flip charts, post it notes or electronicallyetc Maybe you would like to do this in your CareHome or Hospital? It raises awareness of MCA and can bring a smile to our lips!
Mental Capacity Act in DoLS authorisation requests.
The phrase ‘Mental Capacity’ used in the Act refers to our ability to make decisions.
The five statutory principles are:
- A person must be assumed to be able to make the decision unless it is established that they are unable to (from your evidence.)
If relevant what makes you consider that the person lacks capacity to make this particular decision? What is your evidence? It is acceptable to record that you have acknowledged the need to look at Mental Capacity Act but you have no reason to explore whether the person lacks capacity for the decision at this time.
- A person is not to be treated as unable to make a decision unless all appropriate steps to help him have been taken without success.
What steps have been taken? Have you provided the individual with the information they need in a format that they understand? Have you ensured that this is the best time to assess their capacity? Do they need additional support from an advocate or speech and language therapist? Has the decision been made as simple as possible? (There can be more than one decision to make at a time).
- A person is not to be treated as unable to make a decision merely because they make an unwise decision.
On the basis that it must first be assumed the person has capacity, the actions or decisions taken by an individual must not be the sole reason that a Mental Capacity assessment was undertaken, (see below). Has this person been supported to understand the risks? Have they been supported to undertake the risk?
- An action taken or decision made on behalf of a person who lacks capacity must be done, or made in their best interests.
Have you taken into account the views and wishes of the person, the views of relevant others? Any previous wishes?
- Is it the least restrictive option?
Any ‘best interests’ decision taken on behalf of an adult should interfere as little as possible with their rights and freedoms. Each decision has to take account of all the circumstances, and take the least restrictive course of action available.
In order for someone to be deemed to lack capacity for a specific decision, it must first be determined whether there is an impairment of the mind or brain, or is there some sort of disturbance affecting the way their mind or brain works? (it doesn’t matter whether the impairment or disturbance is temporary or permanent.) The impairment could be a stroke or brain injury, a mental health problem, dementia, a learning disability, confusion, drowsiness or unconsciousness because of an illness or the treatment for it, substance misuse.What is it about this impairment that makes them unable to make the decision?
Question to ask when making a referral for DoLS authorisation
Does the individual understand that they are in a care home or hospital? Do they have a basic awareness of their needs? Do they have a basic awareness of the likely consequences of not receiving support with their needs? In considering this you should look at their ability to understand, retain, weigh up and communicate the decision.
If the individual in your care is able to consent to their stay for the purpose of receiving care and treatment, then a DoLS authorisation request should not be sent.
RPR Visits
As part of the DoLS process the Supervisory Body needs to appoint a representative for the relevant person .We look to family/friends in the first instance. Then if none are available or able to take on the role we then refer to an advocacy service. The role is very important, being the persons advocate also around instigating a 21a appeal.The RPR needs to visit at least every 6 weeks. If you are aware of someone who’s RPR does not visit could you please let us know then we can review the situation.
Section 21a Appeals
As previously mentioned the RPR is crucial in supporting the relevant person in the appeal process. Nationally there is anincrease in the number of DoLS 21A appeals that are being sent to the Court of Protection. Every person who is subject to a DoLS has the right to appeal, even if its felt that their package of care is in their Best Interest and that the appeal may fail .Therefore it needs to be stated that if a patient or a resident is appealing against their DoLS, it does notnecessarilyreflect on the care they are currently receiving
Form 2 Further Authorisation Request
Just a reminder to Managing Authorities when submitting a form 2 please can you make it clear on page 2 whether there has been any change since the last authorisation, whether this is in the regime that is delivered, or the overall health and wellbeing of the individual. This will help us to prioritise the referral appropriately.
Emails
Please note when a member of staff uses their email on aDoLS referral formthis is the e-mail we will use as a team to communicate with the ManagingAuthority. Therefore if a nurse on the ward for example emails a referralthrough then goes away for a 2 weekholiday all DoLSinformation will be emailed back to that email address. Therefore some thought needs to be given to the best email address to be used in this circumstance.
Paperwork
A reminder of the current paperwork.
Forms 1 and 4, urgent and standard are now combined and form 2 is much shorter please find templates below.
Usual Reminders!
When someone is subject to a DoLS dies please let the DoLS office and Coroner’s office know immediately.
Currently there is a private members bill going through parliament, which has already had its second reading, proposing changes as to whether a death under DoLs should be regarded as a death in state detention. Clearly this may be a significant change, and we’ll keep you up to date re any changes. In the meantime, you must continue to inform your local coroner.
Also the DoLS team need to know when someone is discharged from hospital or moved from one Care Home to another any changes in Residency has an impact on the DoLS.
Also please note if a person needs an interpreter to support them in the DoLS assessment process please enter this on the referral form, to enable the DoLS team to arrange for an interpreter to be present during the assessments.
If you give us an email address to contact you, please make sure it’s an address that is checked regularly
Thank you very much for your cooperation in these matters
If you aware of any good practice around MCA or DoLS we would be very interested to share in the future newsletter
Website
Please visit our website,all the forms and supporting information is on the site If you feel we could improve the content in any way please let us know. Shortcut to the site is
Contact Us
The NYCC MCA/DoLS Office is open:
Monday –Thursday 8:30am- 5:00pm and Friday 8:30am- 4:30pm
DoLS helpline number 01609 536829. Calls will be monitored and returned between 10am-2pm. Please note that this number is for follow up/queries only. We have a general email address which is monitored for queries but not referrals –
If you require DoLS authorisation outside of these times or during a bank holiday period please process the application in the usual way and it will be acted on upon our return.
Sending Referrals
All completed forms should be faxed to our Customer Service Centre on: 01609 532009 or emailed to: .
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