Recording assessments and decisions

1. Recording assessments and decisions Esther Donald DoLS Manager Bournemouth Borough Council

2. Decisions decisions..... On your table there are a couple of cards. In your group, pick one and think about the following: • What information would you want or need to help you make this decision? • How would you want to get that information? • What personal traits would impact on your decision?

3. Back to basics “No decision about me without me”

4. 5 MCA Principles 1. A person must be assumed to have capacity unless it is established that they lack capacity. (every adult has a right to make their own decisions unless there is proof that they lack capacity when the decision needs to be made).

5. 5 MCA Principles 2. A person is not to be treated as unable to make a decision unless all practicable steps to help him have been taken without success.

6. 5 MCA Principles 3. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. Values, beliefs, preferences and attitudes are important factors.

7. 5 MCA Principles 4. An act done or decision made under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests. This is not the same as what people think is ‘best’ for the person!!

8. 5 MCA Principles 5. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action. This includes considering whether there is a need to act or make a decision at all.

9. Context: What is the context of the situation? Why is the decision required now? and What is the decision?

10. What led you to think the person might lack capacity? • The person’s behaviour, circumstances or content of communication has caused doubt about their capacity • Someone else has expressed concern about the person’s capacity • The person has recently been assessed as lacking capacity to make similarly complex decisions

11. Two Stage test Stage 1: Does the person have an impairment of, or a disturbance in the functioning of, their mind or brain? Stage 2: Does it mean the person is unable to make a specific decision when they need to?

12. How do we address Stage 2? • Understand information about the decision to be made • Retain that information in their mind • Use or weigh that information up • Communicate their decision

13. Understand? • The person was not able to use one or more of their senses to ‘receive’ the necessary information. • The person was able to receive the information but not able to appreciate it’s meaning

14. Understand continued • They were not able to concentrate long enough to ‘receive’ the information • They were able to receive the information but misinterpreted it

15. Retain How long is long enough? It depends on the decision, the complexity, the seriousness of the consequences, and the urgency.

16. Weigh up • Critical ideas and beliefs were not founded on the reality of the person’s particular circumstances or situation • The person could not utilise the information in any ordered way • The person’s cognitive functioning did not allow them to compare critical aspects of the information

17. Communicate • This is only when people are unable to communicate in any way, for instance people who are unconscious or in a coma. • It is very rare for people not to be able to communicate at all, and therefore principle 2 is engaged.

18. Best Interests • What I have done to try to help the person make the decision for themselves • Have I considered what the person would best like for themselves • What harm is going to occur

19. What options do I have? • Who (if anyone) I have discussed this with • What is the decision I have made in their best interest and is it a proportionate response to the situation?

20. Is there another option available that is less restrictive of their freedoms

21. Have a go!!! Using the resources looked at today, have a go at documenting an assessment! You could use the headings given, and write a short paragraph for each. Or use the ehealthtracker online tool.