Mental Capacity Act

1. Care and support plans and MCA recording Mental Capacity Act

2. Think about recorded information? • If you go in to assess care plans, do the plans clarify exactly what care they provide to a person and the reasons why they are doing this? • If you manage a service and you employed a new worker, do your plans clarify what the worker should do and on what basis they are doing this? • If you looked at the documentation, would there be evidence of the persons ability to make decisions or not? • Would it clarify for you whether the person agreed and consented to those actions in the care plan or that you are providing that care in their best interests?

3. The care planning cycle

4. Revised care planning cycle

5. Good Practice around recording and care planning • How do we build the MCA into our recording and care planning processes? • How do we know what might constitute good practice? • MCA Code of Practice • Care Quality Commission Guidance • Good Practice guidance

6. MCA Code of Practice Expectation that there will be recording evidence of: • Assessments – use of the two stage test • Best interests checklist being applied and how the best interests decision was reached • Integration into care planning processes

7. Code of Practice - Care Planning • Care plans should include an assessment of the persons capacity to consent to the actions. • A record of why that action is believed to be in their best interest if they are unable to consent • What is in best interests may change over time and therefore these need to be reviewed regularly. MCA Code of Practice 6.25

8. Regulations for Service Providers and Managers: https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulations-service-providers-managers Regulations 9 (person centred care) and 11 (need for consent) “Providers must make sure that they take into account people's capacity and ability to consent, and that either they, or a person lawfully acting on their behalf, must be involved in the planning, management and review of their care and treatment”. Regulation 9 Care Quality Commission

9. Good Practice Guidance - SCIE • https://www.scie.org.uk/mca/practice/care-planning/ • Contains breakdown of each principle and what to look for in care/support plans and other records • Covers quality standards and a monitoring checklist

10. SCIE Care and support plans can and should: • consider questions of autonomy and liberty • reflect the efforts staff have made to maximise people’s capacity to be involved and to make decisions • reflect the right of people, who have capacity, to make unwise decisions.

11. Good Practice – using the test and recording • Where you use the test you should record it – what your evidence is and the outcome. • If your decision does not follow something a person has put in writing, you must record the reasons why • It is also good practice for healthcare and social care staff to record at the end of the process why they think a specific decision is in the person’s best interests. MCA Code 4.61, 5.43 & 5.52

12. Good practice reminder – Best Interests and recording • “staff involved in the care of a person who lacks capacity should make sure a record is kept of the process of working out the best interests of that person for each relevant decision, setting out: • how the decision about the person’s best interests was reached • what the reasons for reaching the decision were • who was consulted to help work out best interests, and • what particular factors were taken into account. This record should remain on the person’s file”. MCA Code 5.15

13. MCA and care planning The preparation of a care plan should confirm that: either the person HAS capacity and consents to particular actions/ interventions Or the person lacks capacity and those actions/interventions are being carried out in their best interests. • This will allow staff to carry out actions contained within the plan in a ‘reasonable belief’ that the person lacks capacity and that their actions are in the person best interests. Some points taken from MCA Code 6.25

14. Person centred planning Care plans written in the first person – when is this appropriate? “I like to have a bath every morning and to have my hair washed.” “Joan will have a bath every morning and have her hair washed”.

15. A person with capacity has the right to make their own decisions about having their hair washed, how often, with what products, etc. Their care plan could be written in the first person and have their signature. A person who lacks capacity should have a care plan that demonstrates that the two stage test has been used and the best interests checklist. Their family may have signed to say that they have been consulted and the plan will be in the third person. Acts of care like hair washing can then be carried by care workers under a ‘reasonable belief’ that they lack capacity and the care outlined is in their best interests. Examples: