1. The MCA project The Mental Capacity Act Mental Capacity Act Project Team Stef Lunn Martin Watson Michelle Moore

2. The MCA project Rights, rights, rights What ways are you able to exercise your rights in ways that the people who lack capacity may be unable to?

3. The MCA project Rights, rights, rights The MCA is built on a foundation of Human Rights That we all have the right to make our own choices in accordance with our own unique values, wishes and beliefs The MCA is about empowering choice and personal autonomy Giving control to individuals

4. The MCA project Our messages

5. The MCA project Our messages We’re your resource

6. The MCA project Please contact the project team on 0121 255 0777 or on the following emails with any questions, queries, examples of best practice or initiatives that you would like to share or for any requests for partnership working: stephanie.lunn@nhs.netstephanie.lunn@nhs.net07525 247598 michelle.moore15@nhs.netmichelle.moore15@nhs.net07525 247606 martin.watson3@nhs.net07525 247609 martin.watson3@nhs.net We’re your resource

7. The MCA project Our messages We’re your resourceThe MCA is everyday

8. The MCA project The MCA is everyday We’re often doing it already – we might call it different things: choice, control, making decisions The MCA isn’t just life changing decisions It’s about a change in culture, where the power lies and who holds that power It’s about empowering people and enabling choice It’s something we do with people, not to people

9. The MCA project Reflection What choices have you made today?

10. The MCA project Our messages We’re your resourceThe MCA is everyday Little things… Big differences

11. The MCA project Little things… Big differences It’s the little things in life…. Best practice isn’t Earth shattering, it’s little changes and initiatives People being given information, in their preferred way to support them in making informed choices People having choice and control over their lives, as well as their care and treatment Involving people in the decisions made about their care and treatment Involving people who the person wants involved in decisions about their care and treatment

12. The MCA project Our messages We’re your resourceThe MCA is everyday Little things… Big differences Autonomy

13. The MCA project Autonomy A process of elimination 1.Having capacity & making your own choices, supported decision making, retaining choice and control for the future (Powers of Attorney / Advanced Decisions) 2.Delaying the decision until the person can regain or be supported to have capacity in the future 3.Making no decision at all or acting in accordance with the person’s views 4.Least restrictive options 5.More restrictive options 6.Deprivation of Liberty Border Control Increasing autonomy Increasing protection Capacity Assessment Authorisation DoLS / CoP Best Interests

14. The MCA project Our messages We’re your resourceThe MCA is everyday Little things… Big differences Autonomy Crossing the border

15. The MCA project Crossing the border If you’re crossing the border into best interests: Remember when you assess someone to lack capacity, a decision will be made on their behalf and they will lose a small part of their personal autonomy Best interests is restrictive Have you got a time and decision specific capacity assessment? Have you got evidence for stages 1 & 2? How have you maximised the person’s ability to make the decision for themselves?

16. The MCA project Crossing the border Start with a ‘blank canvas’ and an assumption that the person has capacity to make the specific decision required The burden of proof is on the assessor to prove the person lacks capacity and not upon the person to prove they have capacity Different people give different weight to different options, some people are risk adverse some people relish taking risks Don’t confuse the assessment of capacity with an assessment of what’s in the person’s best interests

17. The MCA project Crossing the border Supported decision making / maximising the person’s capacity Remember to always attempt to maximise the person’s potential to make the decision for themselves or to participate in the decision making process: Give information in the persons preferred communication method, i.e. verbally, using pictures, symbols or photographs, using an interpreter when the patient’s first language isn’t English Use specialist support when required and appropriate: SLT etc Think about the ‘Set’ and ‘Setting’ Is it about education?

18. The MCA project Reflection How would you feel if someone else was making your decisions? What would you want that person to consider and / or take into account?

19. The MCA project Crossing the border If you’re crossing the border into a deprivation of liberty you will need an authorisation for this to be lawful: Deprivation of Liberty Safeguards in hospitals and care homes Court of Protection application in community settings Must be a proportionate response to the likelihood of harm and the seriousness of that harm Must be in the person’s best interests There must be no lesser restrictive option to achieve the aim

20. The MCA project Our messages We’re your resourceThe MCA is everyday Little things… Big differences Autonomy Crossing the border It’s all good!

21. The MCA project It’s all good! The Act provides you with protection from liability if you can demonstrate: That you have a ‘reasonable belief’ the person lacks capacity That you have ‘reasonable grounds’ for believing the action you are taking is in the person’s best interests That you’ve applied the Statutory Principles of the Act That you’ve followed the guidance in the code of Practice Whole Chapter in the Code of Practice about Protecting you from liability Have a Go!

22. The MCA project It’s all good! Remember: There’s nothing in the Act that says we all have to agree about whether someone has capacity or not, or what is in someone’s best interests It’s how we work together and enable people to make their own choices and meaningfully involve them when they lack capacity to make their own decisions Don’t be afraid of risk Don’t be afraid to say that you don’t know whether someone has capacity or not

23. The MCA project Our messages We’re your resourceThe MCA is everyday Little things… Big differences Autonomy Crossing the border It’s all good!

24. The MCA project Powers of Attorney (LPA / EPA) Property and Affairs EPAs can only make property and financial affair decisions (different laws for EPAs) Buying or selling property Managing all aspects of the donor’s finances Receiving benefits Personal Welfare The donor’s day-to-day care, including diet and dress Consenting to or refusing medical examination and treatment on the donor’s behalf Arrangements needed for the donor to be given medical, dental or optical treatment

25. The MCA project Powers of Attorney (LPA / EPA) LPAs have to be registered with the Office of the Public Guardian to be valid, concerns about LPAs may be a safeguarding issue and an alert may need to be raised with the Local Authority, the OPG will investigate concerns regarding a Power of Attorney Information leaflet from Empowerment Matters: http://www.empowermentmatters.co.uk/Wordpress/wp- content/uploads/2012/10/Lasting-Power-of-Attorney-Information-Sheet-pdf.pdf LPA Forms and registration: https://www.gov.uk/government/collections/lasting-power-of-attorney-forms

26. The MCA project Powers of Attorney (LPA / EPA) You can verify whether there is any registered Powers of Attorney through the Office of the Public Guardian, however do bear in mind this can take several days https://www.gov.uk/find-someones-attorney-or-deputy

27. The MCA project Authority to manage finances AppointeePower of AttorneyDeputy Registered with DWPRegistered with OPGAppointed by the Court of Protection Manages the receipt of state benefits Can manage state benefits Cannot manage savings and equity Can manage savings and equity Birmingham City Council have an Appointee and Court Deputy Dept. Nominated by the person themselves when they lack capacity to decide to have an attorney Birmingham City Council have an Appointee and Court Deputy Dept. Appointed by the Court once the person has lost capacity to decide upon an attorney

28. The MCA project Assessing capacity for finances and Powers of Attorney In your groups please discuss: a)What things (inc. risks & benefits) would you want someone to know in order to have capacity to nominate a Power of Attorney b)What things (inc. risks & benefits) would you want someone to know in order to have capacity to manage their own finances c)Is there anything else you should consider?

29. The MCA project Assessing capacity for finances and Powers of Attorney Useful guide for assessing financial decisions by Empowerment Matters http://www.empowermentmatters.co.uk/Wordpress/wp- content/uploads/2014/09/Assessing-Capacity-Financial- Decisions-Guidance-Final.pdf http://www.empowermentmatters.co.uk/Wordpress/wp- content/uploads/2014/09/Assessing-Capacity-Financial- Decisions-Guidance-Final.pdf

30. The MCA project Assessing capacity for finances and Powers of Attorney Consider the following: Does the person know that their capacity is being assessed? Have they consented to the assessment? What support does the person needs? Who (if appropriate) is supporting them during the assessment? Have you given them information about the decision? In what format? Is this their preferred method of communication? Consider the person’s executive functioning (to plan and organise as well as being able to initiate a task) Remember: The burden of proof lies with the assessor to prove the individual lacks capacity for the specific decision, at the time it needs to be made and not with the individual to prove that they have capacity

31. The MCA project Assessing capacity for finances and Powers of Attorney Break down the decision into components (not all stages would be relevant to each person that is being assessed): 1.Recognition and awareness of money 2.Relative values of things 3.Management/control of money at the current time. 4.Does the person know their approximate income/value of benefits? 5.Balancing responsibilities 6.Budgeting and planning 7.Security and a PIN 8.Banking 9.Does the person have capacity to make a Lasting Power of Attorney for Property and Affairs? 10.Investments, savings, ISAs and shares

32. The MCA project Break

33. The MCA project The Answers Picture round: 1.Coatimundi 2.Tapir 3.Capybara Rulers round: 1.King of Brunei -Hassanal Bolkiah 2.President of Banglaedesh - Abdul Hamid 3.Prime Minister of Jamaica - Portia Simpson-Miller 4.The Prime Minister of Pakistan - Nawaz Sharif

34. The MCA project The Answers Some words beginning with Z.. zip, zap, zit, zoo zing, zinc, zoom, zone, zest, zeal, zero zombi, zebra, zygote, zodiac

35. The MCA project The Answers ‘If you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.’ - Albert Einstein

36. The MCA project Ms. Manuela Sykes Case Study Who am I? What Is Important to Me? Who Knows Me Well? What Would I have Decided Before I Became Unwell? What Is The Point In Making Me Safe If You Don’t Consider What Makes Me Unhappy?

37. The MCA project Advanced Decisions Healthcare professionals must follow an advance decision if it is valid and applies to the particular circumstances. People can only make advance decisions to refuse treatment, nobody has the legal right to demand specific treatment. The person must be 18 or over at the time of making the advance decision The person must have capacity to make that decision, when making the advance decision There are no particular formalities about the format of an advance decision it can be written or verbal, unless it deals with life sustaining treatment (in which case it must be written)

38. The MCA project Advanced Decisions to refuse life sustaining treatment The Act imposes particular legal requirements and safeguards on the making of an advance decision to refuse life sustaining treatment: They must be put in writing The person must sign the advance decision The person making the decision must sign in the presence of a witness The advance decision must include a clear, specific written statement from the person that the advance decision is to apply to the specific treatment even if life is at risk An advance decision cannot refuse basic or essential care (such as warmth, shelter etc.), section 5 of the Act allows these actions to be carried out in the person’s best interests Information leaflet from Empowerment Matters: http://www.empowermentmatters.co.uk/Wordpress/wp- content/uploads/2012/10/Advance-Decision-to-Refuse-Treatment-Information-Sheet- pdf.pdf

39. The MCA project Questions

40. The MCA project Further reading / information www.scie.org www.empowermentmatters.co.uk www.39essex.com Mental Capacity Act code of practice: https://www.gov.uk/government/publications/mental-capacity-act-code-of- practice Deprivation of Liberty Safeguards code of practice http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.go v.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_085476

41. The MCA project Please contact the project team on 0121 255 0777 or on the following emails with any questions, queries, examples of best practice or initiatives that you would like to share or for any requests for partnership working: stephanie.lunn@nhs.netstephanie.lunn@nhs.net07525 247598 michelle.moore15@nhs.netmichelle.moore15@nhs.net07525 247606 martin.watson3@nhs.net07525 247609 martin.watson3@nhs.net We’re your resource