In the third part of our blog series on Best Interest, we look at the various stages of consultation required, and how to review the information gathered.
Consultation with the relevant person (P)
This is arguably the most important part of the Best Interest Decision process and should be included throughout this process. The relevant person’s views, thoughts, wishes and beliefs should be determined by actively engaging with them, with appropriate support as needed for that individual. This may include use of an advocate, translator or interpreter; it may also include the use of assistive technologies such as talking mats, or visual aids and other objects of reference.
If the relevant person is unable to express their thoughts, wishes, views or beliefs around the decision being made, then careful consideration of their presentation (behavioural responses to associated options), social history and character should be made, ensuring greater consultation with relevant parties to gain a full understanding of their preferences.
Consultation with relevant parties
The relevant parties to be consulted will vary depending upon the decision being made. It may include, but is not limited to:
- Family and friends of the person in question
- The care team
- Professionals involved with the decision, for example Occupational Therapist(s) / Physiotherapist(s) who may be providing rehabilitation support
Weighing up the risks and the benefits
The risks and benefits of each viable option should be considered, placing the greater priority on what the individual would think, feel, believe or value in relation to each. Part of this process will be done as part of the consultation phases. For some cases, it may be of benefit to draw up a ‘balance sheet’ to aid assessment of the various risks and benefits. However, if this option is taken, then due care and consideration as to how the balance sheet is used is essential.
For everyday decisions within a care and support plan, it is not necessary to document the weighing up process in full as it will often be recorded within the care and risk assessments themselves, which can be referred to. However, if specific risks or concerns have been identified around the decision or a higher level of restrictions have been put in place, it is recommended that greater record keeping of risks and benefits is upheld.
For complex decisions and cases, professional involvement from health and/or social care professionals is recommended, as they may be able to further support in this matter.
Avoiding discrimination
It is a statutory, social and ethical requirement to avoid discrimination. Careful reflection should be taken to consider if a decision has been made solely on the basis of a defining characteristic (age, condition, religion, heritage etc). In which case, independent support should be obtained in order to review the decision and ensure any form of discrimination is avoided.
Review the process, conclude and document
It is good practice to take time to review assessments prior to conclusion, ensuring all steps have been taken and a clear outcome for the decision in the person’s best interests can be drawn. Conclusions should also be shared with the relevant person, including the rationale behind the final decision.
The assessment and its outcomes, including all handovers, should be documented and recorded appropriately. There are currently no official standards for the documentation of Best Interest Decisions, however, it is generally accepted that the more significant the decision, the more documentation and evidence to justify the decision should be recorded.
The primary source of reference for direction on recording in everyday practice can be found in Justice MacDonald’s case of North Bristol vs R (2023 EWCOP 5):
‘Given the number of capacity assessments that are required to be carried out on a daily basis in multiple arenas, it would obviously be too onerous to require a highly detailed analysis in the document in which the capacity decision is recorded. However, a careful and succinct account of the formulation of the matter to be decided and the formulation of the relevant information in respect of that matter, together with a careful and concise account of how the relevant information was conveyed and with what result, would seem to me to be the minimum that is required.’ (Paragraph 65)
Final thoughts
For more information on Best Interest Decisions please do consult our range of blogs on this topic.
We also provide a range of support services, including training and consultations. Please do not hesitate to get in contact if you would like to discuss options.