The National Mental Capacity Forum

Professor Baroness Finlay of Llandaff highlights the work of the National Mental Capacity Forum and the key priorities it aims to tackle…

The National Mental Capacity Forum has started its work. In September, as the appointed chair answerable to Ministers, I began to explore the reasons that the 2005 Mental Capacity Act (MCA) had failed to meet expectations and failed to deliver the change in attitudes and behaviours that it was expected to usher in. There is a great deal of work going on up and down the country to implement the MCA; evidence of this was brought together and shared at a National Mental Capacity Action Day in February.

So after many consultation events, meetings and taking soundings, a few areas have emerged as needing to be addressed urgently. Of these the National Mental Capacity Forum Leadership Group agreed to tackle of these as the main priority of work for the coming year.

Firstly, the principles of the MCA are confusing and somehow difficult to grasp. Secondly, carers have reported feeling excluded and often unrecognised. They carry the main responsibility for someone and yet are often ignored when it comes to decision making on behalf of the person who lack capacity for that decision – who I shall refer to as ‘P’ from now on. These carers have needs themselves; they need information about P and they know a great deal about P, which is invaluable for best interests’ decision-making. They may well observe failings in care either of P, or of others in a facility such as a care home or ward where P is, but fear saying anything in case it rebounds on P.

The Mental Capacity Action Day brought some possible solutions to simplifying the message over the MCA itself, with presentations of excellent teaching/training initiatives. One, from Shropshire CCG, used a simple diagram of a hand to remind people of the 5 principles of the Act. Three fingers remind everyone of the principles that apply to everyone every day – they are about ‘you and me’, so please:

  • Assume I have capacity unless proved otherwise;
  • Support me by doing all you can to enhance my ability (explain things in language and terms I am more likely to understand, make sure I have glasses, hearing aids);
  • Realise that we all make unwise decisions at times. And the remaining fingers (forefinger and thumb which together form the most powerful pincer movement of the hand) concern P when capacity is lost. So:
  • Best interests’ decisions need to gather information from everyone who knows P about the preferences and probable refusals to determine what P might have wanted;
  • Use the least restrictive option – i.e. don’t keep P under anyone’s thumb.

slide of hand

When it comes to carers, a cross cutting initiative is being launched as the National Carers Strategy gets underway, which will raise awareness of the needs of relatives and that large army of informal and largely unrecognised carers who are important to P.

All this needs to change attitudes and behaviours in society far beyond health and social care, even though these services are where the majority of interactions with P occur. For example, the finance sector is addressing the training of front line staff to support P and their carers. Banks and building societies are often best placed to detect grooming and fraud, as they can see that tell-tale change in the way an account is used when unusual sums of money, large or small, are suddenly being paid out.

Preparation for possibly losing mental capacity through creating Lasting Powers of Attorney (LPAs), both for finance and for health and welfare decisions, has been promoted through the Office of the Public Guardian (OPG). Excellent training videos on the OPG website about finance LPAs are being further developed to also cover health and welfare LPAs. Several groups have been working at producing Advance Care Planning support materials.

The activity around the MCA through the National Mental Capacity Forum is being hosted in part on the Social Care Institute for Excellence (SCIE) website. Its pages are being updated to create a reference forum for ideas and experiences to be shared. The coming year will prove exciting – turning round the tanker of risk averse approaches to achieve behaviours that support all and recognise the intrinsic value of each and every person- whether P or those important to P – will take time and persistent effort. But it is worth it – after all, most of us will be P one day and we don’t know how soon that day will come.

Baroness Ilora Finlay


National Mental Capacity Forum Chair


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