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Offering a hand of support

Mental Capacity Ltd: Where it all began

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The idea for Mental Capacity Ltd started one day when my brother Mike was visiting me in at my home in the South East, and we got chatting about my work as a mental capacity assessor and advocate.

During our chats, we started to talk about some of the frustrations I was experiencing with my work, and the poor practice I was encountering on an almost daily basis. Examples included wrongly applied DNAR orders, care plans that unduly restrained users in their wheelchairs, and the unlawful application of Deprivation of Liberty Safeguards (DoLS), particularly within the private sector as well as lack of application in main stream hospital wards.

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Communication is key: elderly couple sitting in the garden enjoying the sunshine

Communication to support capacity

Communication is an absolutely vital part of the Mental Capacity Act (2005). If we are to support capacity effectively then we should do everything in our power to ensure good, effective communication that is adapted to the needs of the service user. This may mean taking extra measures to aid the process of communication, to consider environmental and/or external factors, and also to make allowances for any fluctuations in an individual’s ability to understand.

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Isolation and seclusion: old man looking out a window

Covid ‘isolation’ or seclusion: Are we in breach of Human Rights?

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It has been a trying few years for everyone with the impact of Covid and related restrictions. During this time, I have been privileged to see some incredible person-centred care. For example, one of the homes I have worked with went above and beyond to ensure that an isolating gentleman with learning disabilities, who had tested positive, had a staff member at his door throughout the day to engage with him and give him someone to talk to. They also supported him by doing activities at a distance and he had thrice-daily supported access to the gardens to get fresh air and a change of scene.

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Gillick competence. Teenager receiving injection from doctor.

Gillick Competence and the Fraser Guidelines

The Mental Capacity Act (2005) currently applies to adults aged 18 years and above. However, as with many things, there are specific areas of exception. One of which is known as ‘Gillick Competency’ (or Gillick Competence), and the related Fraser Guidelines. These two important judgements set out rules around when a young person is deemed competent to make their own decisions without specific parental consent.

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Central Middlesex Hospital, part of London NW University Hospital Trust

Patient dies as NHS Trust fails to comply with the MCA

On the 29th December 2021, Jenny Kitzinger and Celia Kitzinger shared a challenging and troubling case on the website Open Justice Court of Protection.  This case demonstrates the lack of knowledge and application of the Mental Capacity Act (2005) by London North West University Healthcare NHS Trust, who continue to be rated as ‘Requires Improvement’ by the Care Quality Commission

In this case, the patient, Mrs W had her nasogastric tube removed by medical staff on 10th November 2021. Mrs W had previously assigned the role of Lasting Power of Attorney (LPA) for Health and Welfare to her children. However, her children were not consulted in this process, and the clinicians declined to reinstate the feeding tube when challenged. The Trust then proceeded to withdraw hydration from Mrs W as well.

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Holding hands

What is a Relevant Person’s Representative (RPR)?

A Relevant Person’s Representative (RPR) is a necessary and essential role under the Deprivation of Liberty Safeguards (DoLs). It is the role of the RPR to maintain regular contact with the relevant person who has been deprived of liberty, and represent them in all relevant matters. This can include: appealing against a DoLs authorisation, requesting a review, ensuring least restrictive practices are in place or raising a complaint.

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