Presentation on theme: "Mike Warwick, Medical Officer Borders Providers Forum 6/12/13"— Presentation transcript:
1Mike Warwick, Medical Officer Borders Providers Forum 6/12/13 Adults with Incapacity (Scotland) Act Part 5 – “Medical Treatment and Research”Mike Warwick, Medical OfficerBorders Providers Forum 6/12/13
2Commission’s RoleIndependent organisation established under the 1960 Mental Health ActResponsibilities to protect and promote the rights and welfare of people with a mental disorderExtended duties under new legislation – AWI Act 2000, MH Act 2003, ASP Act 2007Accountable to Scottish Parliament
3The wider role of the MWC Duty to give advice (S9 of the MHA) –NB Telephone advice lineVisiting individuals receiving care and treatment in various settings and/or subject to certain orders under the MHA and AWIConducting investigations into concerns re personal welfare or property of adult (S11 of MHA, S9 of AWI)Duties to cooperate with, and bring matters to the attention of various agencies (S7 and 8 of the MHA and S9 of the AWI)
4Adults with Incapacity Act Part 1- “General”Includes:the PrinciplesDefinitionsSections on Sheriff and public bodies including the MWC“Adult” means anyone over 16
5Adults with Incapacity Act - Principles Everyone carrying out functions under the Act mustapply the general principles of:BENEFITMINIMUM INTERVENTIONTAKE ACCOUNT OF ADULT’S WISHES AND FEELINGSCONSULT OTHERSENCOURAGE EXERCISE OF RESIDUAL CAPACITY
6Adults with Incapacity Act CONSULTING OTHERSPrinciples include taking account of:The views of the nearest relative and primary carer of the adultThe views of any guardian, continuing or welfare attorney who has powers relating to the proposed intervention.In so far as is reasonable and practicable to do so.
7In AWI “incapable” means incapable of: (a) acting; or(b) making decisions; or(c) communicating decisions; or(d) understanding decisions; or(e) retaining the memory of decisions,by reason of mental disorder or of inability to communicate because of physical disability.only if communication deficiency cannot be made good by human or mechanical aid
8Mental Disorder in AWISame meaning as in Mental Health (Scotland) Act 2003(a) mental illness;(b) personality disorder; or(c) learning disability,however caused or manifested;
9CapacityCapacity is not an “all or nothing” conceptCapacity is decision-specificA person can be capable of making a decision about one treatment but incapable of making a decision about another more complicated treatmente.g. someone with learning disability may be able to understand and consent to paracetamol for pain but be incapable of consenting to treatment for diabetes.
13Adults with Incapacity Act Part 2 – Continuing Powers of Attorney and Welfare Powers of AttorneyPart 3 – Accounts and FundsPart 4 – Management of Residents’ FinancesPart 5 – Medical Treatment and ResearchPart 6 – Intervention Orders and Guardianship
14Adults with Incapacity Act CODE OF PRACTICE (Third Edition)FOR PRACTITIONERS AUTHORISED TO CARRY OUT MEDICAL TREATMENT OR RESEARCH UNDER PART 5 OF THE ACTor Google “SG/2010/57” – the document reference code
16Part 5 does not apply to Emergency Treatment Common law allows medical treatment to be given in an emergency to patients who cannot consent.This remains the case and there is no need to go through the steps in Part 5 of the Act in order to give treatment for the preservation of the life of the adult or the prevention of serious deterioration in the adult’s medical condition.Code of practice covers in more detail and also MWC’s Right to Treat good practice guidance.
18AWI Part 5Medical treatment is “any procedure or treatment designed to safeguard or promote physical or mental health”.Section 47 allows authorisation of medical treatment for an adult who “is incapable in relation to a decision about the medical treatment in question”A Section 47 Certificate of Incapacity is needed to authorise treatment
19AWI Part 5Section 47 certificate needed, but cannot alone authorise treatments subject to further safeguards under S48/RegulationsNeed MWC-appointed Doctor arranged to approve:Drug treatment for the purpose of reducing sex drive, other than surgical implantation of hormones.ECT for mental disorder.Abortion.Any medical treatment which is considered likely by the medical practitioner primarily responsible to lead to sterilisation as an unavoidable result.
20AWI Part 5 Under S48/Regulations Need Court of Session approval for: Sterilisation where there is no serious malfunction or disease of the reproductive organsSurgical implantation of hormones for the purpose of reducing sex drive.
21AWI Part 5 Section 47 and Mental Disorder Section 47 cannot authorise treatment for mental disorder for an adult to whom Part 16 of the Mental Health Act applies (i.e. treatment of mental disorder authorised under Mental Health Act).MWC advises advise using the Mental Health Act if it is necessary to give treatment for mental disorder and the person resists or objects to that treatment.
22AWI Part 5Who can assess the adult’s capacity and complete a Section 47 certificate?The medical practitioner primarily responsible for the medical treatment of the adultSince amendment of 2005, a dental practitioner; ophthalmic optician; registered nurse if………………….……….they have done the training, and are primarily responsible for medical treatment of the kind in questionUsually completion of S47 certificate falls to doctor (can be paid for dental certificates).
23AWI Part 5This was removed from original code of practice after the 2005 amendments:A person acting on behalf of the medical practitioner primarily responsible under his or her instructions or with his or her approval or agreement could include any member of the healthcare team involved in the adult’s medical treatment, including other doctors, nurses, nursing auxiliaries, physiotherapists, psychologists, occupational therapists, phlebotomists etc. It could also include dentists, opticians, chiropodists or other professionals allied to medicine who might be asked at different times to attend to an adult’s particular healthcare needs.
24Adults with Incapacity Act Section 47 Certificate and Treatment PlansSee HandoutAnnex at back of code of practice gives directions for completionSection 47 printable .pdf at: edical-Report-FormsTreatment plan – I am not aware of any blank proforma other than the one in the code of practice.NB this lacks prompt for name of person signing in print, designation, address and date. Best if can be added.
25Adults with Incapacity Act Scottish Government Section 47 Certificate proforma does not have to be used.An local electronic certificate can be created as long as the wording is exactly the same as the wording on the Government’s form.
26Section 47 certificateShould be completed in line with the Principles including consulting carer and nearest relative.Entries on the Certificate or treatment plan can include “Fundamental Healthcare Procedures”Otherwise should be named conditions.New medical treatment for new conditions in future will not be covered.General catch-all entries do not meet the requirements of the legislation and will not cover specific treatment.
27A treatment plan I saw recently Fundamental healthcare procedures + routine treatment of chronic diseases + intercurrent illnesses as detailed in the hospital, nursing and GP records.LD + cerebral palsyIrregular periodsBladder instabilityVery good - Covers all treatments, but still has generalised statement.
28Section 47 certificateCovert medication should not be put on S47 certificate:the treatment should be, but how to give it is a care planning issues.
29Section 47 certificateProvides “general authority to treat” with exceptions.(1) If there is a welfare proxy with power to make decision re medical treatmentand the person who completed the certificate is aware of thisand it would be reasonable and practicable for them to obtain their consent but they have not done so………….The S47 certificate provides no authority to treat(See code of practice page 18. If person completing certificate suspects there may be a welfare proxy, it would be good practice to check with close relatives.)
30“General authority to treat” exceptions. (2) If an application for an intervention order or a guardianship order with power in relation to medical treatment has been made to the sheriff and not been determined. MWC have concerns re this. If situation occurring phone us.(3) If there has been an interdict granted that prohibits the provision of the treatment.(4) Where there is unresolved welfare proxy dispute in process or application has been made to Court of Session. See Medical Treatment Flowchart.But…..in all of these situations can give treatment to preserve life or prevent serious deterioration.
31Section 47 “shall not authorise”……. “the placing of an adult in a hospital for the treatment of mental disorder against his will” (Mental Health Act would be needed for this)Or………“the use of force or detention, unless it is immediately necessary, and only for so long as is necessary in the circumstances”
33Section 47 certificates and Care Homes Care Inspectorate check use of Part 5 for residents on some inspections.MWC have undertaken unannounced visits in care homes and hospitals to review use of Part 5Care home staff are advised that they should know medication they are supporting people to take is prescribed within the law.They are encouraged to ask GPs for copies of S47 certificates to keep in care home.
35Covert medication Related issue. MWC have issued good practice guidance.Nobody who can make a capable decision to refuse treatment for physical disorder would be given covert medication.All would need to have the medication covered by Section 47 certificate.The exception would be where they are receiving treatment for mental disorder under Mental Health Act and that is given covertly.
36Draft update of this guidance is now on website for consultation