There is no excuse not to achieve professional practice and recording standards.
Posted by Paul Wilkins on November 18, 2016
In 2006 I was working as a Head Occupational Therapist and Clinical Specialist in Social Inclusion based in a Community Mental Health Trust. Looking for a change I applied for a secondment to support the introduction of the Mental Capacity Act (MCA 2005) across the county and to deliver training to embed learning into practice. Very early on I recall an experienced colleague, who specialised in the Mental Health Act (MHA), commiserating with me and saying that he and others had been working on the same goal around the MHA since 1983 (over 30 years) and he wasn’t convinced that they had managed to achieved this yet! Over the last couple of weeks, since the launch of our Desuto MCA tools, I have had discussions with trainers and practitioners working in the same field. Many have been really positive but some have questioned whether our tools are too generalised and whether a tool could actually reduce the likelihood that a person will adopt the MCA into the heart of their health or social care practice I have thought about this a lot since and could understand their point of view but we are not 30 years on and I think that unless we are realistic about our current progress with the act and accept the current reality we will not be able to change and develop further. Reports from the House of Lords and CQC confirm that we all, still, have a long way to travel before the principles and practices of the MCA become part of everyday health and social care practice. In their last (2015/16) report “The state of health care and adult social care in England” the CQC highlighted the following: “In providers across all sectors, we found variable practice in how capacity assessments and best interests decision making are carried out and documented. In providers across all sectors, we found variable practice in the implementation of capacity assessments and best interests decision-making. While we have previously highlighted some appropriate practice, we have also found some areas of concern. In particular, many providers made assumptions that individuals lacked capacity without having carried out or documented assessments, or they assessed individuals as lacking capacity without ensuring this was time and decision-specific. For some providers, the ‘blanket’ approach to capacity assessments suggested to our inspectors that their focus may be more on managing organisational risk than delivering person-centred care. Some providers also made blanket assumptions that individuals with particular conditions lacked capacity, such as people living with dementia. There was also variation in the documentation of evidence of family and other professionals being involved in best interests decision-making. Evidence of MCA compliant decision-making, including the involvement of family or friends, was recorded in a majority of care homes rated as outstanding overall, but only in a very small minority of those rated as inadequate overall.” For the last 4 years the Desuto Team have worked to improve compliance with the MCA and improvements in recording standards. My experience as a Deprivation of Liberty Safeguards Lead has led me to conclude that there is such a thing as good enough when it comes to MCA practice and reporting and expecting perfection at this stage of MCA development does no-one any favours. The Desuto team feel it is critical to see a minimum national standard set as a baseline from which to develop and believe that our tools provide this. With the tool editing feature this standard can very easily be exceeded by the user but as a minimum our reports demonstrate a clear level of compliance and record keeping. We would argue that there really is no excuse now not to expect this fundamental standard of compliance with the MCA across health and social care sectors. Our tools are not the end of the MCA development, they are a significant step along the way and as practice improves we fully intend to be setting the pace.