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A / Please enter the referred person’s full nameB / Current Place of Residence; this is where the referred person resides at the time of referral.
C / Insert telephone number and date of birth
D / Tick which type of Best Interest Decision and outline the details of the decision; the decision must be one of these options to quality for an IMCA. You need to refer to your Local Authority guidelines for reviews/FORMAL Adult protection proceeding referrals.
For Long Term Accommodation, please indicate a date for the projected discharge.
E / The decision should be made after consultation with the IMCA. Please indicate a date the decision needs to be made by. This is important to help us prioritise how quickly we need to provide an IMCA.
Please list dates such as operations, Best Interest meetings. This is important to help us prioritise how quickly we need to provide an IMCA. It also helps us plan the IMCA’s time more effectively.
F / Capacity Assessment; Please insert the name and position of the professional responsible for the capacity assessment and tick whether a 2 stage functional assessment has been carried out.
It is the decision maker’s responsibility to follow the capacity test in the Mental Capacity Act. The decision maker must assess the person’s capacity to make the decision to which they are referring. A capacity assessment by a doctor is not needed for a referral to IMCA.
G / Family and Friends: please indicate whether the referred person has family, whether they are “appropriate” to consult with and any reasons why they may not be appropriate.
An IMCA can only be provided in serious medical treatment/long term moves/care reviews if there are no “appropriate” friends and family to consult with. It is the decision-maker’s decision as to whether the family or friends are appropriate to consult with. Please read the VoiceAbility “Appropriate to Consult” guidance if you are unsure.
You need to have justifiable reasons for deciding the person’s family or friends are not appropriate to consult with. In adult protection circumstances, you need to follow your Local Authority guidelines.
In most circumstances, friends and family should be informed of IMCA Involvement. Our “FAQs for Family and Friends’ guidance is available, and should be forwarded to those involved.
H / Please indicate any support needs the IMCA may need to be aware of to undertake the advocacy. Please indicate whether an interpreter / signer is needed.
I / If there are any safety issues regarding health or behaviour which may put the advocate or the referred person at risk, please list them here. Include risks posed by other family members if appropriate.
J / The referrer details should be the decision-maker. The decision-maker is the person employed by the Local Authority or NHS body to action a decision. This is usually a care manager or a doctor. In some Local Authorities, there are “gate keepers”, usually team leaders who you may need to approach to authorise your referral. Please check this with your manager.
We may accept an alert from some-one other than the decision-maker where the referrer has been unsuccessful in persuading the decision-maker to refer and it seems likely that the person meets the criteria for an IMCA. Also, if the decision maker is not readily available to complete the referral form, we can take a referral form from another professional in the same team. However, in both situations, decision maker details need to be given and we will then contact them to confirm referral authorisation. If you are the referrer but not the decision maker, please insert your details in this section.
Please include all your contact details as this helps speed up communication. Please include the Local Authority or NHS body that employs you.
K / Please list contact details of people that the IMCA will need to speak to. This should include where relevant G.P., consultant, care manager, key worker, care workers, day centre, employer, friends, family, colleagues. Providing this information enables the IMCA to respond faster.
L / Please indicate whether the referred person has been made aware of the referral
M / If you are the referrer but not the decision maker, please ensure you sign and date this section.
N / If you are the decision maker, please ensure you sign and date this section
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