Spiral Skills Independent Mental Capacity Advocate (IMCA) Service.

The decision to refer must be approved by the Decision Maker, e.g. the Doctor or the Social Worker/Care Manager responsible for making the final decision.  This is the person to whom the IMCA will present their findings and report.  The referral must be made by an authorised person, this may be the Decision Maker, or a person authorised to act on their behalf such as a site or team manager. We strongly encourage decision makers to make the referral directly where possible to save time gaining instruction from the decision maker. When making a referral, please also provide contact details for the person with whom we can make arrangements for an initial meeting with the individual who is subject to the decision.

Anyone referring to the Service for the first time should read Chapter 10 of the Mental Capacity Act Code of Practice.  A useful synopsis is also contained in Booklet No. 6 Making Decisions. The Independent Mental Capacity Advocate (IMCA) Service. Both are available to download or visit the Social Care Institute of Excellence website for further information on the Mental Capacity Act http://www.scie.org.uk/mca

The Mental Capacity Act 2005 places an obligation on Local Authorities and / or NHS bodies to instruct and consult an IMCA when someone lacks capacity to make a particular decision at a particular time regarding the following areas:

  Serious medical treatment (Section 37).

  The Local Authority is proposing to arrange accommodation for someone for longer than 8 weeks
     (Section 38).

  The NHS body is proposing to arrange accommodation for someone for longer than 28 days
     (Section 39).

The Mental Capacity Act 2005 gives POWERS to Local Authorities and the NHS to appoint an IMCA where they consider that the appointment would be of particular benefits to the person concerned in cases of:

  Care Reviews (in relation to accommodation only);

        and

  Safeguarding Adult Cases, (the criteria of friends and family does not apply in Safeguarding Adult
      Cases).

It is important that we know which decision needs to be made, if the decision is not on the referral criteria list (for example someone requires support with financial issues) then it is not appropriate for IMCA. 

Additionally Spiral Skills also needs to know if there are a number of decisions to be made for the person, for example there may be a decision around moving a person and also Safeguarding Adult Proceedings might have been instigated.  IMCA referrals are decision specific, therefore Spiral Skills will view this as two referrals and require two referral forms with the necessary information regarding each decision.  It is the duty of the decision maker to instruct the IMCA in clear terms regarding the proposed decision.

The Mental Capacity Act criteria for initiating referral to an IMCA service is clear in stating that the person must lack capacity to make the particular decision.  Please outline that an assessment of capacity has been completed, the date the assessment was carried out, the method of assessment and the outcome of the assessment.  This is the gateway to the IMCA service and we request assessment of capacity information for this reason.

Spiral Skills is commissioned to deliver the IMCA service within Northumberland.  All eligible people living in Northumberland, whether on a permanent or temporary basis must be referred to Spiral Skills IMCA Service.  Please click here for a link to the Department of Health web site where you will find a full list of IMCA providers and contact details. 

To be eligible for the IMCA service, the person must meet all the criteria as outlined on the referral form. Please click here to download a referral form. 

If you are not using the on-line referral system please type out the information on the referral form. If you do hand write the referral form please could you write clearly and extend the boxes (on your pc before printing) so we can view the information easily.

What is serious medical treatment?
NHS bodies must instruct and then take into account information from an IMCA where decisions are proposed about ‘serious medical treatment’ where the person lacks capacity to make the decision and there are no family or friends who are willing and able to support the person.

Serious medical treatment is:

  Giving new treatment

  Stopping treatment that has already started

  Withholding treatment that could be offered

And where there is either:

  A fine balance between the benefits and the burdens and risks of a single treatment

  A choice of treatments which are finely balanced

  What is proposed would likely involved serious consequences

What is meant by serious consequences?
Serious consequences refers to those which could have a serious impact on the person.  It could include treatments which:

  Cause serious and prolonged pain, distress or side-effects

  Have potential major consequences for the patient (for example, major surgery or life-sustaining treatment)

  Have a serious impact on the patient's future life choices (for example interventions for ovarian cancer)

The IMCA Service and Changes to Accommodation.
The right to an IMCA applies to decision about long-term accommodation moves to or from hospital or care home or a move between such accommodation if:

  It is provided or arranged by the NHS

  It is provided under section 21 or 29 of the National Assistance Act

  It is part of the after-care services provided under section 117 of the Mental Health Act 1983 -
      following a decision made under section 47 of the National Health Service and Community Care Act
      1990

Accommodation Review

Areas to be considered by the decision maker in each individual case when deciding if an eligible individual having an accommodation review would benefit from having the safeguard of an IMCA.

Regime change:
Is there likely to be a substantial change in the service user’s experience within the accommodation setting? For example, significant change in staffing levels; significant change in the quality of life experienced by the individual or significant change in his/her involvement or non-involvement in activities.

Non-compliance:

Is there a recommendation to change the placement to a more restrictive regime, on the basis of non-compliance with the current regime?

Professional disagreement:
Are there significant differences of view between professionals regarding the appropriate care regime to be arranged in relation to the plan of care?

Risk:

Authority:
Access to relevant records is being restricted or denied, therefore the statutory authority of the IMCA is required.

Any other significant factor:

However:

If the accommodation review is triggered because of a need to consider a change of accommodation the decision maker must appoint an IMCA for a qualifying individual.

The role of an Independent Mental Capacity Advocate is to:

  Establish the referred person's preferred method of communication.

  Meet with the referred person, and use a variety of methods, as appropriate, to ascertain their views.
      Supporting the person to have as much say as possible in deciding what happens to them.

  Consult with staff, professionals and anyone else who knows the person well who are involved in
      delivering care support, and treatment.

  Gather any relevant written documents and other information.

  Attend meetings to represent the person raising issues and questions where appropriate.

  Support the person and respect their interests.

  Make sure the person's wishes, beliefs, religion and culture are respected.

  Make sure that everyone involved in making a decision about the person acts in the persons' best
     interests.

  Present the information to the Decision Maker verbally and via a written report.

  Remain involved until the decision has been made and be aware that the proposed action has been
      taken.

  Audit the best interests decision making process.

  Challenge a decision if necessary.

Considering alternative courses of action
The IMCA will check that the Decision Maker has considered all possible options and that the proposed option is, according to the Mental Capacity Act, the least restrictive or the person's future choices or would allow him or her the most freedom.  The IMCA may suggest alternatives where there is evidence that these are more consistent with the wishes and feelings of the person.

Representing and supporting the person who lacks capacity
The IMCA will find out if the person has been given the appropriate support to enable them to be as involved as possible in the decision making process.  They will attend meetings to represent the person and will use non-directed advocacy approaches to ask questions about the proposed decision.  The IMCA will make sure that the views, feelings, values, wishes or the person and any other relevant information such as religious and cultural factors are made known to the decision maker.

Advance Decisions
If you work with people who may lose capacity at some future time over health care decisions the legislation, through advance decisions, allows a means of stating any treatment they would not wish to receive in the future should they lack capacity to give or refuse consent to that treatment.  The Act provides a clear statutory basis advance decisions and sets out what is required to make a valid on.  For some mental health service users although they can make an advance decision to refuse treatment for mental health problems (such as electro convulsive therapy (ECT) this can be overridden if they are placed under a Section of the Mental Health Act 1983.

Lasting Powers of Attorney
Lasting powers of attorney also provide a means of planning ahead.  They are more flexible than advance decisions because they can apply to all health, social care and financial decisions. People can appoint a person, or persons, they choose to make these decisions on their behalf in the event they lack capacity to do so themselves in the future.

Further sources of information:

Or visit the Downloads section of our website

Deprivation of Liberty Safeguards
People who lack capacity in hospitals and care homes are protected by a new law known as the 'Mental Capacity Act Deprivation of Liberty Safeguards'.  The new law introduces new safeguards, so that, if a care home or hospital needs to deprive someone of their liberty for their own safety or wellbeing, they must apply for permission.  The law only applies to people in hospital and care home settings who are unable to make decisions on their own care or treatment and who need to be deprived of their liberty in their own best interests to protect them from harm

These safeguards mean that, if a hospital or care home wants to deprive someone of their liberty to keep them safe from harm, they must apply to the local health trust or council for permission. This triggers a series of six assessments carried out by trained assessors.  These are:

The deprivation of liberty is in the person's best interests to protect them from harm and is a reasonable response to the likelihood of the person suffering harm and the likely seriousness of that harm.

The person must be over 18 years of age.

The person must have a mental disorder.

The person must not be subject to a requirement of the Mental Health Act.

The person must lack the capacity to consent to their own care or treatment.

The authorisation must not conflict with an advance decision made by the person; or valid decision made on the person's behalf by a donee of a lasting power of attorney or a deputy appointed by the court.

Only if all these criteria are met will an authorisation be granted. At any stage, the person or their representative will be able to appeal against their deprivation of liberty to the Court of Protection. In an emergency, the hospital or care home can issue an urgent authorisation, for seven days, which speeds up the normal process of authorisation.

At all times Spiral Skills works to the Advocacy Code of Practice.
Extract from the Code of Practice: "People are entitled to be in control of their own lives but sometimes, whether through frailty, disability, financial circumstances or social attitudes, they may find themselves in a position where their ability to exercise choice or present their own interests is limited.  In these circumstances advocates can help ensure that an individual's views and needs are heard, respected and acted upon. Advocacy is taking action to help people say what they want, secure their rights, represent their interests and obtain services they need. Advocates and advocacy schemes work in partnership with the people they support and take their side. Advocacy promotes social inclusion, equality and social justice.”

Please click here to download a full copy of the Advocacy Code of Practice. This is a PDF file if you don't already have Adobe Reader click here to download free.

Confidentiality.
Spiral Skills Advocacy Service has a confidentiality policy and guidelines.  We will keep the things you tells us confidential unless it would be dangerous to you or someone else not to.  Please visit our downloads page to read the Spiral Skills confidentiality policy, your advocate will be happy to discuss this with you.

Complaints.
If you have a complaint about Spiral Skills Advocacy service, you can be reassured that the appropriate procedure is in operation. If you would like to discuss making a complaint, or you would like a copy of the complaints procedure please contact Spiral Skills or alternatively you can download a copy of the procedure from our web site.

How to get in touch.
Please visit the contact us page for ways to get in touch and visit the downloads page for referral forms, leaflets, policies, guides and feedback forms. Thank you.