1. *Powers, duties and the protection of P Alex Ruck Keene, Benjamin Tankel, June 2013 - See more at: http://www.step.org/powers-duties-and-protection- p#sthash.NnOL2tpm.dpuf INTRODUCTION DNA WORKSHOP – 14 May 2015 We received positive feedback from delegates in January 2015 and hope you will enjoy the talks and discussions today – Thank you all involved.

2. Aims of DNA Group -An increasingly integrated, multi disciplinary team approach between the professionals involved in the care of a person with dementia syndrome – clinicians, social care team, advocates, other professionals assisting financial or health Attorneys/Deputies and paid carers. -A national support charitable network, four times per year, in London. -Encourage questions and answers and networking face to face -The next workshop will take place in September 2015.

3.  PRESENTATION BY REETA RAM Advocate’s Experiences of DEMENTIA PARTNERS

4. *Powers, duties and the protection of P Alex Ruck Keene, Benjamin Tankel, June 2013 - See more at: http://www.step.org/powers-duties-and-protection- p#sthash.NnOL2tpm.dpuf About Dementia Partners’ Advocacy Services Dementia Partners was founded by Reeta in 2012. An advocacy service with a defined role specified in the Care Act 2014. Providing services to deputies/attorneys (not publically funded services) -Deputyship Assist Services -Personal Budget Assist Services -Care Home Plan Assist Services Receiving referrals from organisations which do not provide the same services (care homes, charities, commissioned advocacy services and clinicians)

5. *Powers, duties and the protection of P Alex Ruck Keene, Benjamin Tankel, June 2013 - See more at: http://www.step.org/powers-duties-and-protection- p#sthash.NnOL2tpm.dpuf Advocate’s Experiences - Case Study  Mr N is the long term partner of Mrs M since 1980 (24 years)  They mostly cohabited in each other’s property  73 years of age. She was in hospital for a UTI and sepsis  There is an unspecified diagnosis of dementia with type unknown  At the discharge meeting a best interest decision is made by LA to move to a residential home  Mr N said Mrs M has always wanted to be cared for at home (a domiciliary care package)  He offers to move in with her asap and to supervise a self-funded care package  He requests a more specific diagnosis of dementia  The decision of the LA, subject to review at 6 weeks is:  -Mr N is not the NOK  -Mr N is told to hand over the keys to her flat and hand over bank cards  -The LA inform him they will automatically apply for financial deputyship asap  - He can apply for financial deputyship at the same time as the LA if he wishes to challenge the decision for Mrs M to return home (nb 4 months)

6. *Powers, duties and the protection of P Alex Ruck Keene, Benjamin Tankel, June 2013 - See more at: http://www.step.org/powers-duties-and-protection- p#sthash.NnOL2tpm.dpuf What is the Challenge? The House of Lords Select Committee on the Mental Capacity Act THE SCALE “……The challenge is to ensure that people are empowered and supported to make those decisions and that any decisions which must be taken by others on their behalf take into account their wishes, preferences and best interests…” PREPARATION One of the most important aspect of the MCA is the right to prepare with a LPA and giving control to a trusted family member, friend or appointed person. (3.5)

7.  ONCE THE PERSON HAS LOST CAPACITY TO MANAGE THEIR OWN CARE RELATED FINANCIAL AND HEALTH/WELFARE AFFAIRS The family are placed under immense strain to get a deputyship from the Court of Protection to manage financial matters. It is rare for a health/welfare deputyship to be granted because MCA provides the most appropriate best interest processes (right to escalate to COP on the question of best interest decisions). Delay of up to 4 months PREPARATIO N  A person may feel unable to ‘prepare’ for the future when they are already suffering from a medical problem

8. *Powers, duties and the protection of P Alex Ruck Keene, Benjamin Tankel, June 2013 - See more at: http://www.step.org/powers-duties-and-protection- p#sthash.NnOL2tpm.dpuf WHO IS THE NOK?  Mental Health Act list of NOK: Mental Health Act  Husband or Wife  Son or Daughter  Father or Mother  Brother or Sister  Grandparent  Grandchild  Uncle or Aunt  Nephew or niece  NOK does not include cohabitees, divorcees or long term partners  NOK does not include friends or anyone interested in welfare of the person  A person can get a next of kin card or specifically tell their GP to record the above as chosen NOK BUT there is no guarantee this will be accepted in law

9. *Powers, duties and the protection of P Alex Ruck Keene, Benjamin Tankel, June 2013 - See more at: http://www.step.org/powers-duties-and-protection- p#sthash.NnOL2tpm.dpuf NOT NEXT OF KIN…. ‘A person interested in welfare’ BUT who is NOT a next of kin has:  no legal right to manage financial affairs.  they do have Care Act and MCA 2005 Act right to be consulted in health and welfare decisions being made by LA/clinicians.

10. *Powers, duties and the protection of P Alex Ruck Keene, Benjamin Tankel, June 2013 - See more at: http://www.step.org/powers-duties-and-protection- p#sthash.NnOL2tpm.dpuf WHO DOES THE COURT PREFER AS A DEPUTY? *‘Generally speaking, the order of preference is: P’s spouse or partner…a close friend…..etc finally A local authority’s social services department; and finally A panel deputy, as deputy of last resort.’ *Powers, duties and the protection of P Alex Ruck Keene, Benjamin Tankel, June 2013 - See more at: http://www.step.org/powers-duties- and-protection-p#sthash.NnOL2tpm.dpuf  In 2011, Senior Judge Lush noted, this order of preference is largely borne out by the statistics.

11. *Powers, duties and the protection of P Alex Ruck Keene, Benjamin Tankel, June 2013 - See more at: http://www.step.org/powers-duties-and-protection- p#sthash.NnOL2tpm.dpuf Involvement and the Care Act 2014 The Local Authority must Assume that people are the help people be involvedbest judge of their own in decisions made about them,wellbeing and their care and support Ensure the person can participate as fully as possible in decisions about their care Take into account a carer’s input and provide carer’s needs assessment

12. *Powers, duties and the protection of P Alex Ruck Keene, Benjamin Tankel, June 2013 - See more at: http://www.step.org/powers-duties-and-protection- p#sthash.NnOL2tpm.dpuf Care Act Advocates  A person who has substantial difficulty in being involved in public funded care and support processes and does not have an appropriate individual to facilitate support them in this will be referred by the LA to an independent advocate ‘free of charge’  To: facilitate a persons involvement in the assessment, planning or review process  Needs assessment  Carers assessment  Preparation of a care and support or support plan  A review of a care and support or support plan  A safeguarding enquiry  A safeguarding adult review

13. *Powers, duties and the protection of P Alex Ruck Keene, Benjamin Tankel, June 2013 - See more at: http://www.step.org/powers-duties-and-protection- p#sthash.NnOL2tpm.dpuf Information and Advice – The Care Act 2014  The person has no right to receive via the LA an advocate free of charge:-  Where a person with substantial difficulty in being involved in publically funded care and support HAS any person able and willing to assist them with being involved, the person WILL NOT be provided by the LA with an advocate free of charge LA Initiatives: The LA must provide information about care and support in the local area on care, funding options and how to access services. Signpost to local services for people to get LPAs or financial Deputyships.

14. *Powers, duties and the protection of P Alex Ruck Keene, Benjamin Tankel, June 2013 - See more at: http://www.step.org/powers-duties-and-protection- p#sthash.NnOL2tpm.dpuf Outcomes for Mrs M with the help of an advocate 1. Mr M is applying for financial deputyship. Whilst an unclear diagnosis on capacity is being considered by the clinician (COP 3 form), he asks the LA to put on hold their automatic application to be the financial deputy. 2. LA decides on an early review within three weeks (not six weeks) for a fresh best interest decision for Mrs M to be cared for in her flat. A visit of the home on the question of suitability is requested. 3. Until then Mr N requires permission each time from the LA to take her outdoors. There is a standard DoLs authorization in place.  The court’s order of preference suggests Mr M, as the partner will be preferred as the financial deputy. Mr M is gathering evidence to provide the LA and COP with details of his role as carer in their long term relationship.  The LA is asked to promote Wellbeing and suitability of returning to her flat under the Care Act ie. not to take a one size fits all approach.  Mr M appreciates that he needs to inject his views to the LA in Mrs M’s needs assessment and review meeting, bearing in mind the LA’s right to make the best interest decision on where she will reside long term. Progress with LA Mr N’s Views injected in the needs assessment process by the Advocate

15. *Powers, duties and the protection of P Alex Ruck Keene, Benjamin Tankel, June 2013 - See more at: http://www.step.org/powers-duties-and-protection- p#sthash.NnOL2tpm.dpuf The future responsibilities  MCA 2005 plus The Care Act 2014 Assessments for eligibility for care needs Assessments for eligibility for public care and support packages Principles of: Promotion of Wellbeing Prevention of deterioration Promotion of advocates Provision of Information  Integrated Initiatives  See MCA Government’s Response in 2015 on Action Taken  Raising Awareness  Review of Banking and policing  Ensuring GMC promotes leadership in psychiatry in all medical schools and promote good MCA practice amongst GPs  Government issues guidance to LAs to promote a greater understanding of LPAs and deputyships  Plus many more

16. *Powers, duties and the protection of P Alex Ruck Keene, Benjamin Tankel, June 2013 - See more at: http://www.step.org/powers-duties-and-protection- p#sthash.NnOL2tpm.dpuf What is the Challenge for Advocates in 2015? MCA and the Care Act 2014 provides urgently needed solutions, which will be monitored for results on improvement. Whilst it is confusing to bring in a new statute for the LA after 60 years, we will aim to keep up to date with new law aimed at vastly improving the experience of advocates, people and their carers.