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How many stages are there in a Mental Capacity Assessment?

According to the Mental Capacity Act (2005), a Mental Capacity Assessment is made up of two stages, functional and diagnostic. It has therefore been referred to as the ‘two-stage’ test. However, a quick browse online, alongside discussion with different professionals, reveals quite a bit of misunderstanding around how many stages there are and when these stages apply. This is perhaps due to the inconsistent way that assessments are referred to by certain institutions and professional bodies. There also seems to be some confusion between the four steps of the functional stage of an assessment, and the two stages of the overall assessment.

Clearly, terminology is important, and we should make efforts to ensure we are always using the correct terms.

Read More »How many stages are there in a Mental Capacity Assessment?
Mental Capacity Ltd - Mental Capacity Assessment

Retrospective Mental Capacity Assessments

A standard mental capacity assessment (also known as the two-stage test) is usually carried out for a specific decision at a specific time. It is completed prior to the decision being made if there is either a ‘reasonable belief’ that an individual may lack capacity, or to reduce the risk of someone challenging the person’s capacity to make the decision at some point in the future.

Meanwhile, a retrospective mental capacity assessment refers to a traditional assessment of capacity for a specific decision, but for a decision made historically. Examples might include a Lasting Power of Attorney submission signed and submitted the previous month, or a financial gift made to a family member or friend several years in the past.

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Case study: What do we mean by ‘decision specific’?

We all make many thousands of micro-decisions on a daily basis, from the way we make a cup of tea to what we watch on TV. However, when it comes to decision making, the Mental Capacity Act (2005) is ‘decision specific’. This means that it relates to a specific decision made at a specific time. It does not refer to decision-making more broadly. This raises the question: how specific do we need to be when we assess capacity?

Read More »Case study: What do we mean by ‘decision specific’?
Man with learning disability getting married

DoLS in focus: The role of the Best Interest Assessor (BIA)

The primary role of a Best Interest Assessor (BIA) is to complete the Mental Capacity Assessment and Best Interest Assessment steps within the DoLS process. These are recorded as part of Form 3.

They can also be commissioned by the Supervisory Body to complete ‘Age’ and ‘No Refusals’ steps if required.

Read More »DoLS in focus: The role of the Best Interest Assessor (BIA)
Two women interviewing / assessing a person wearing a checked yellow shirt.

The six key assessments for DoLS

The Code of Practice for DoLS (2008) directs that wherever possible, DoLS authorisations should be applied for in advance of a hospital or care home admission, in order to ensure that appropriate safeguards are in place from day one. As such, a DoLS application should really be made at the point where the individual is assessed prior to admittance, in order that the application be processed in time.

Read More »The six key assessments for DoLS
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DoLS in focus: The role of the Managing Authority (MA)

Under DoLS, the Managing Authority (MA) is the nursing/care home or hospital providing (or going to provide) care and treatment for the relevant person. The responsibilities of the MA are outlined within the Code of Practice for DoLS (2008) and expanded on through Court of Protection (CoP) case law.

These documents require that the Managing Authority carry out its responsibilities with due care and diligence, with appropriate consultation. All decisions and actions taken should be fully documented as part of professional best practice.

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UK Parliament

New official statistics for DoLS cases, 2022-23

NHS Digital has published national statistics for DoLS cases for the period April 2022 to March 2023. The report reveals that:

  • There were an estimated 300,765 requests for authorisations during 2022-23, up 11% on the previous year
  • There were 289,150 authorisations completed in 2022-23, while 126,100 remain uncompleted as of the end of the year
  • Of all DoLS applications, 56% of applications were not granted, mostly due to either change of circumstances, misapplication (requiring a community DoLS or Inherent Jurisdiction) or not meeting the assessment criteria
  • The statutory 21-day timeframe for authorisations was only met in 19% of cases
Read More »New official statistics for DoLS cases, 2022-23