1. National Mental Capacity Forum The Mental Capacity Act and supporting people
Baroness Ilora Finlay
Working together to promote and uphold the principles of the Mental Capacity Act
2016

2. What is the purpose of the Forum?
The forum works with people from health and social care and other areas such as finance, legal, police, housing to find out actions that organisations can take, especially at a local level, to make sure the Mental Capacity Act works for people.

3. “A movement, not a committee”
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)
27 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”

4. Laws - Mental Capacity Act
More than regulatory instruments
Send social messages
Can have unintended consequences

5. 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

6. DoLS
Is it the illness or the attitude of people around that is depriving a person of their liberty?
Has DoLS improved their outcomes?
How many?
Majority
Half
Quarter
Les than 10%

7. Mental Capacity Act 2005 – 5 principles
A presumption of capacity
I can make a decision
Individuals supported to make their own decisions
Do all you can to help me make a decision
Unwise decisions
Don't assume I lack capacity
Best interests
Changing clinical scenarios
Consulting those important to P
Less restrictive option
Liberty and security 3 4 2 1 5
After Shropshire Council

8. Decision specific capacity

9. Disorder of the mind or brain?

10. Disorder of the mind or brain?
Interfere?

11. Understand the information

12. Retain information

13. Weigh up information

14. Communicate their decision

15. And conflicts …… Time conflicts: acute care v capacity needs
?Validity of
LPA H&W
Advance care plan
ADRT / DNACPR
Least restrictive option versus safety of others
In acute
out of hours
Confidentiality v discussing best interests decision
Financial fraud / grooming is very difficult to detect

16. Liberty and security Human rights – in balance?
Where is keeping people safe?
Autonomy
Do no harm / do good
Justice – to individual and to others

17. Helping people speak up by listening
The Forum has lots of members – they are people who are using the Act well in the work they are doing to help other people make decisions. I want the Forum to make sure people can learn from each other about how to use the Act well in their job. I want the Forum to keep listening to people using services. I have set up a ‘voice of the person’ group so we keep hearing what people have to say about how the Act can work better for them. We also ran a big ‘Action Day’ in March where people who are using the Act to help them do their job better came together and shared good ideas

18. Listening
You
Ear
Eyes
Undivided attention
Heart

19. Is elephant in the room money?
Financial duty of attorneys?
Does fiduciary duty trump health or vice versa?
What if different attorneys: F / H&W?
Do ‘wishes and feelings’ trump ‘weigh up and understand’?
Does safety of P override safety of others?

20. Overall – tensions and solutions
A presumption of capacity
Fluctuating
Assessing capacity
understanding, retention, weighing up, communication
Individuals supported to make their own decisions
Time for the person v allocation of resources
Unwise decisions
But what if front page of the papers
Best interests
Changing clinical scenarios
Consulting those important to P
Less restrictive option
Danger to themselves and others 3 4 2 1 5

21. Other big pieces of work for the Forum?
I think there are two big things the Forum should also do this year. We should make sure there are easy to understand messages for people who need to know about the Act to do their job well.
Some staff like social workers often know more about the Act than people working in other areas, like banks.
We should make sure that carers are involved in the right way in helping to make decisions. Sometimes carers know a lot about what someone would want but they aren’t always asked for their view

22. Next of kin
Should consult the people closest to a person who lacks capacity to understand that person’s wishes and feelings to help them make a decision in that person’s best interests.
‘Next of kin’ should not be asked to sign and/ or consent to certain interventions - not legally valid.
ADRT
LPA Health and welfare (enhanced)

23. Carers guides

24. 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