Mental Health Act and Mental Capacity Act

1. Mental Health Act and Mental Capacity Act

2. Agenda • Mental Capacity Act – Deprivation of Liberty Safeguards • Modernising Mental Health Act function • Current position in relation to Second Opinion Appointed Doctors (SOADs) and Community Treatment Orders (CTOs) • Mental Health Act Annual Report

3. The Mental Capacity Act (2005) (MCA) and Deprivation of Liberty (amendments) requirements • The MCA is designed to protect people who are unable to make decisions for themselves. • The Act was amended to include the deprivation of liberty safeguards (safeguards) that came into force on 1 April 2009. • The Act requires that everyone working in health and social care who takes decisions for people who lack capacity has a duty to know about and follow the associated codes of practice. • The deprivation of liberty safeguards are about making sure that decisions that deprive people of their most basic liberties are taken carefully, properly, individually, and with due regard for each person’s human rights.

4. The role of health and social care providers and commissioners under the MCA • Local authorities with social services responsibilities and NHS primary care trusts that receive, assess and decide on applications to deprive a person of their liberty are described as ‘supervisory bodies’. • The person registered in independent hospitals and care homes, or the body responsible for an NHS hospital, a ‘managing authority’ for the safeguards purposes.

5. CQC’s responsibilities for the safeguards • CQC has been given a duty to monitor practice under the safeguards from 1 April 2009, and is required publicly report the findings from this monitoring function • We monitor the practice in ‘managing authorities’ (care homes and hospitals), and in ‘supervisory bodies’ (local councils and PCTs). • CQC has no powers to enforce compliance with MCA requirements, and therefore, monitoring is not regulatory inspection and enforcement, as we normally understand it, but the code of practice and safeguards are fairly well aligned with Care Standards Act and the new Health and Social Care Act regulations, standards and guidance. • Our reporting function and duties relate to reporting on this practice in our service, commissioning and national reports and to advise the government about changes that might be needed.

6. Modernising our Mental Health Act monitoring 1. Ensuring care is centred on people’s needs Strong commitment to working together with people who use services as we believe this is fundamental to improving the care people receive (e.g. as part of inspection teams and as part of specialist groups such as the service user reference panel) 2. Championing joined up care Ensue that the monitoring role is integral to the wider assessment of services and that the expertise is used to comments on pathways of care across the health and social care system. Develop a skill set that will lend itself to assessing health and social care across different parts of the system e.g criminal justice system 3. Acting swiftly to eliminate poor quality care Mental health act monitoring information will feed directly into our safeguarding and risk profile processes to ensure issues are swiftly acted upon 4. Ensuring & promoting high quality care A key opportunity is for the findings from our mental health act monitoring to have greater impact in our regulatory assessments and the judgments we make about the quality service provision and commissioning By reviewing the lines of enquiry/questions asked by visiting commissioners and improving the way in which we code information we can make it more amenable to being used in our checks on compliance with registration, other assessments and for indicating risk. 5. Regulating effectively in partnership Ensure that our monitoring of the MHA takes account of the findings of other regulators to help reduce unnecessary burden and duplication Ensure that our findings inform policy developments by keeping under review the evidence of our impact and highlight any key issues e.g. community treatment orders and the effect on Second Opinion Doctor service.

7. Update on SOADs and CTOs • CTO SOAD requests continue to average 350 per month • > 40% of requests beyond 28 days • % seen within 28 days low but trend is upwards from Q1 to Q3 • Continue to appoint additional SOADs to the panel numbers now at 116, further appointment panels planned for March • Increased the number of day sessions to target CTO backlog • Additional guidance in relation to referrals, visit co-ordination and patient non-attendance • Continue to work collaboratively with DH, NHS Confed, RCPsych and sector to address this • Quality of our performance data

8. Mental Health Act Annual Report • MHA Section 120D Annual reports • (1) The regulatory authority must publish an annual report on its activities in the exercise of its functions under this Act. • (2) The report must be published as soon as possible after the end of each financial year. • (3) The Care Quality Commission must send a copy of its annual report to the Secretary of State who must lay the copy before Parliament. • (4) The Welsh Ministers must lay a copy of their annual report before the National Assembly for Wales. • (5) In this section “financial year” means— (a) the period beginning with the date on which section 52 of the Health and Social Care Act 2008 comes into force and ending with the next 31 March following that date, and (b) each successive period of 12 months ending with 31 March.

9. Mental Health Act 1983Annual Report • Governance for the report • Owned by Engagement directorate – lead Jill Finney • Written by Regulation and Strategy – lead Mat Kinton • Stakeholder reference group – lead Jill Finney To include • Anthony Deery • Nicola Vick • Mental health operations manager • Service User Reference panel member