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The Mental Capacity Act 2005 was implemented in England and Wales in 2007. This article reports the findings of interviews with 15 adult safeguarding co‐ordinators in the London area about the operation of the Act and its impact upon adult safeguarding work, particularly in relation to people with dementia. The interviews covered participants' own training and understanding of the Act, their confidence in practice and capacity to be local sources of expertise about the Act and their perceptions of whether its existence is known among the public. The article concludes that adult safeguarding co‐ordinators are mostly well informed but would welcome specific updating, especially around the new offences introduced by the Act.

Monday 1 October sees the implementation of the majority of the Mental Capacity Act 2005 (the Act). Parts of the Act came into operation in April 2007, namely the creation of a new criminal offence of wilful neglect or ill treatment, the provision of Independent Mental Capacity Advocates (IMCAs) in England, and the Code of Practice governing the Act.The months leading up to October have been an exceptionally busy time for the Public Guardianship Office (PGO). The new legislation creates a new Office of the Public Guardian (OPG), which will replace the existing PGO. But there is more to this change than a simple re‐arrangement of words, as shown in this article.

The Mental Capacity Act 2005 comes into effect in England and Wales in 2007. The Act contains principles, procedures and safeguards to empower people to make decisions for themselves wherever possible, but also to ensure that decisions made on their behalf if they lack the mental capacity to make the decision themselves are done in their best interests. The Act will apply to anyone working in the supported housing field or residential care where residents may lack the capacity to make decisions as a result of illness, injury or disability. This article gives an overview of the Mental Capacity Act and its relevance to the field of supported housing.

2007 marks a major step forward in the history of adult protection with the implementation of the Mental Capacity Act in England and Wales. Understandably, debates about adult protection have usually focused on the more obvious types of abuse ‐ sexual, physical, financial and emotional. The Mental Capacity Act addresses a much wider issue of abuse where a person's right to make their own decisions, and to have proper safeguards and protection if decisions need making on their behalf, is overridden or ignored. This article gives an overview of the Mental Capacity Act and its relevance to the files of adult protection.

This paper comments on emerging themes derived from recent official publications on older people's advocacy in the UK. There is an examination of relevant policy documents and the responses from service user groups. Discussion includes: clarity in defining advocacy; the nature of the advocacy relationship; sustained and reliable financing of advocacy services; the uneven nature of provision; lack of inter‐agency connectivity; the need to establish national standards for advocacy; problems of mental capacity; and advocacy for care home residents and for minority groups. The need for and direction of further research is proposed.

This paper seeks to present findings from a review of hospital policies and practices in one NHS Trust in England.

The focus of the review was hospital staff policy and practice in safeguarding the rights of vulnerable patients. A sample of staff was surveyed to investigate their knowledge of the Mental Capacity Act 2005 in 2010. Interviews, incorporating discussion of a vignette, were undertaken with a range of staff and findings were analysed thematically. These findings are contextualised by an analysis of Trust policies and the wider literature. The findings of this case study are used to develop recommendations for the hospital and healthcare sectors.

Analysis of survey data and interviews revealed limited confidence and knowledge about the Mental Capacity Act 2005 and uncertainties about its relevance to clinical practice. In relation to safeguarding, there was limited realisation of the potential of the Act to uphold the rights of patients lacking capacity and staff responsibilities. MCA training had not made a great impression; hospital policies were inconsistent and lacked coherence.

This case study was conducted in one Trust and may not be generalisable. Other hospitals may have different training, policy and procedure systems.

The findings of this case study may be applicable to other hospitals and to other providers of health and social care services. The relevance of the MCA could be highlighted and used on several induction and training programmes. The study identifies features of policy and practice that could be investigated in other organisations.

Few studies have investigated the operationalisation of the MCA in hospital settings. This study reveals that there are opportunities to refresh MCA and safeguarding training strategies for hospital staff but these should be accompanied by changes to culture and attention to the coherence of different procedures. Audits of MCA and safeguarding compliance can be undertaken within hospitals and a systems approach could be adopted to address any issues identified and to sustain good practice.

This paper aims to report on an exploratory study exploring the provision of dementia advocacy.

The study adopted a qualitative approach. Data is based on 17 semi‐structured interviews with a range of key stakeholders, and observations of the practice of advocates working in third sector organisations. The study was conducted in five localities across the UK.

The study draws attention to the benefits of advocacy as a means of supporting older people with dementia and illuminates internal and external challenges encountered by third sector organisations providing this type of support.

The study captures the additional dimension that austerity brings to third sector organisations working in this field and the ways in which financial constraints are shaping the field of dementia advocacy.

This paper contributes to ongoing debates in relation to a contradiction between the current coalition government's Big Society ideas and the reality as it unfolds in a specific part of the third sector.

There are currently no national adult safeguarding outcome measures that focus on people who have been through an adult safeguarding investigation in England. There is a need for local authorities (LAs) and their partners to be able to measure whether the services provided to adults at risk of abuse and neglect are effective. The paper aims to discuss these issues.

This paper describes the cognitive testing phase of a study to develop and implement a standardised adult at risk outcome measure in adult safeguarding for use by LAs in England. An outcome measure (a set of seven survey questions administered in a face to face interview) was cognitively tested in three LAs with adults at risk (or their carers/advocates) for whom an investigation of abuse had been concluded (n=40), with the aim of assessing whether it was commonly understood. A set of guidance notes was designed and LA staff (n=12) who assisted with the survey were interviewed about its usability and the feasibility of administering the survey.

The survey questions required modifications to improve their reliability, validity and comparability. LA staff also suggested improvements were needed in the guidance document and survey. LA managers, adults at risk (and their relatives/carers/advocates) were willing to be involved in the survey and it was considered feasible to proceed with piloting the measure.

The development of this unique survey is of interest to those working in adult safeguarding, user involvement, survey management and outcome measurement in LAs.

The purpose of this paper is to report the findings of the Confidential Inquiry into premature deaths of people with intellectual disabilities (CIPOLD) in relation to the Mental Capacity Act (England and Wales) (MCA) 2005.

CIPOLD reviewed the deaths of all known people with intellectual disabilities (ID) aged four years and over who had lived in the study area and died between 2010 and 2012.

The deaths of 234 people with ID aged 16 years and over were reviewed. There were two key issues regarding how the MCA was related to premature deaths of people with ID. The first was of the lack of adherence to aspects of the Act, particularly regarding assessments of capacity and best interests decision-making processes. The second was a lack of understanding of specific aspects of the Act itself, particularly the definition of “serious medical treatment” and in relation to Do Not Attempt Cardiopulmonary Resuscitation guidelines.

CIPOLD did not set out to specifically evaluate adherence to the MCA. It may be that there were other aspects relating to the MCA that were of note, but were not directly related to the deaths of individuals.

Addressing the findings of the Confidential Inquiry in relation to the understanding of, and adherence to, the MCA requires action at national, local and individual levels. Safeguarding is everyone's responsibility, and in challenging decision-making processes that are not aligned with the MCA, the authors are just as effectively protecting people with ID as are when the authors report wilful neglect or abuse.

CIPOLD undertook a retrospective, detailed investigation into the sequence of events leading to the deaths of people with ID. To the authors’ knowledge, this is the first time that such research has associated a lack of adherence to the MCA to premature deaths within a safeguarding framework.