Support for decisions ‘still not understood’ in parts of England

Professionals in parts of England still do not understand their duty to ensure that disabled people have the support they need to make “critical” decisions about their health and social care, according to a new government report.

The duty to refer people who do not have the capacity to make certain decisions to the Independent Mental Capacity Advocacy (IMCA) service is probably “still not well embedded” in some areas, seven years after the service was introduced, says the report.

The Mental Capacity Act 2005 introduced a legal duty on NHS bodies and local authorities to refer eligible disabled people – most commonly those with dementia, learning difficulties or mental health conditions – to the IMCA service, and to consider the subsequent views of the advocate before making any decisions.

The report on the sixth year of the IMCA service – which is run by 60 local providers – raises concerns that, despite a 16 per cent increase in 2012-13 in the number of care reviews assisted by IMCA, this area was still not being used widely enough.

Department of Health guidance says local authorities should carry out a care review within three months of a person moving to new accommodation or where there have been other major changes to a support plan, with at least one review every year.

But there are still far more referrals to IMCA for decisions about accommodation (5,353) than for care reviews (1,203).

The report also mentions one case in which a client was “tricked into going to a care home”.

Another IMCA advocate tells how a client was “deemed to have capacity yet still was not allowed home – and none of the professionals thought this was dishonest or wrong”.

The report says there were also concerns at a decline for the second consecutive year in the number of cases in which IMCA has acted where there were concerns about a disabled person’s safety.

Figures collected by local authorities show there were more than 173,000 safeguarding “alerts” during the year, but only 1,482 referrals to IMCA.

The report says: “This means fewer than one per cent of people who were referred to local authorities for safeguarding assistance received the help of an [IMCA advocate].

“This proportion is decreasing as safeguarding numbers increase and IMCA supported safeguarding decreases.”

The report adds: “It is recommended that supported decision making is adopted more widely within safeguarding practice, to assist more people to make their own decisions about their safeguarding plans.

“And before a care plan or a protection plan is made, the question should always be asked about whether any less restrictive safeguarding action which would interfere less with the person’s basic rights and freedoms may be possible.”

19 February 2014