Audit of fidelity of clinicians to the Mental Capacity Act in the process of capacity assessment and arriving at best interests decisions

Abstract

PurposeThe purpose of this paper is to evaluate health professionals' fidelity to the Mental Capacity Act (MCA) principles on determining mental capacity and arriving at best interests decisions in the care of individuals found to lack the relevant decision‐making capacity.Design/methodology/approachA retrospective review of the case records of 68 patients previously determined by clinicians as lacking mental capacity in at least one of three identified areas: treatment consenting capacity, capacity to decide on place of abode and capacity to manage financial affairs, was conducted. Notes were examined to determine how mental capacity was assessed and the process of arriving at best interests decisions in the care of the non‐capacitous individuals.FindingsIt was difficult to locate relevant entries as there were no designated folders for MCA related issues. There were (mostly) minimal entries made about the assessment process, only patchy documentation of the legal criteria used in capacity assessment, and which of the criteria the patient did not fulfil. Clinicians only partially followed the procedure prescribed by the MCA in determining best interests of non‐capacitous patients.Originality/valueThis paper highlights the need for health care professionals to better adhere to the principles of the MCA in assessing mental capacity and in determining the best interests of non‐capacitous individuals. Health care professionals and the public need to be better informed of the provisions of the MCA.

What do we know about the application of the Mental Capacity Act (2005) in healthcare practice regarding decision-making for frail and older people? A systematic literature review

“…, , Bond & Lowton , Sorinmade et al . ), care home staff (Manthorpe et al . ), community healthcare staff (Alonzi et al .…”

“…However, Sorinmade et al . conducting a hospital case records review reported ‘patchy documentation of the legal criteria used in capacity assessment’, and furthermore ‘clinicians only partially followed the procedure prescribed by the MCA in determining best interest’ (p. 174).…”

“…), community nursing (Samsi & Manthorpe ), ‘housing with care’ schemes (Manthorpe & Samsi ), specialist palliative care (Harris & Fineberg ) and acute services (Sorinmade et al . ).…”

“…Research at the time of enactment suggested that there was much confusion among health and social care professionals, with negative implications for implementation (Willner et al 2011). Subsequent studies have examined use of the Act in various contexts: care homes , community nursing , 'housing with care' schemes , specialist palliative care (Harris & Fineberg 2011) and acute services (Sorinmade et al 2011).…”

Poor adherence to the mental capacity act and premature death

“…Research within the past three years has suggested that improvements were needed with regard to the implementation of the MCA particularly within health (Phair and Manthorpe, 2012;Rowley et al, 2013;Sleeman and Saunders, 2013;McVey, 2013) and social care (Dunn et al, 2010;Boyle, 2011;Willner et al, 2012) settings. In particular, research has suggested shortcomings in assessing capacity by health and social care staff (Willner et al, 2011;Waight and Oldreive, 2011;Skinner et al, 2011;Roy et al, 2011;Lepping, 2011;Williams et al, 2012) and poor documentation of assessments of capacity and the decision-making process (Sorinmade et al, 2011). Although more recent research has highlighted some evidence of changing practice within health and social care (Manthorpe et al, 2014), the House of Lords Select Committee undertaking post-legislative scrutiny of the MCA concluded that:…”