1. The Role of the IMCA Northwest Advocacy Services (A Division of SHAP Limited) Elly Davis Lead IMCA

2. Northwest Advocacy Services IMCA – 7 local authorities: Bolton, Salford, Trafford, Warrington, Halton, St Helens & Knowsley Knowsley Specialist Advocacy – S117 Advocate – Generic service based in Halton Private Hospitals (secure provision) Specialist research in Learning Disabilities eg Cornwall report

3. The Five Underlying Principles of the Act A person MUST be assumed to have capacity unless it is established that they lack capacity A person is not to be treated as unable to make a decision until all practicable steps to help them to do so have been taken without success A person must not be treated as unable to make a decision merely because they make an unwise decision An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done or made in their best interests Before the act is done or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action

4. What is the IMCA service? The Act set up a service that provides safeguards for people who: Lack capacity to make a specified decision at the time it needs to be made Are facing decisions about serious medical treatment or a long term change of residence Have nobody else who is willing or able to represent them or be consulted in the process of working out their best interests (other than paid staff) or that the family have been deemed ‘inappropriate to consult with’

5. When MUST an IMCA be involved? Serious Medical Treatment Providing, withholding or withdrawing serious medical treatment Examples include: Diagnostic examinations, tests and dental treatment (which may require a general anaesthetic) Treatment options e.g. chemotherapy and surgery for certain types of cancer, major surgery, electro-convulsive therapy (ECT), non-therapeutic sterilisation, caesarean section and abortion. IMCA is NOT involved in emergency treatment

6.  Changes to Residence An NHS body or Local Authority is proposing to arrange accommodation (or a change of accommodation) in a hospital or care home, and: the person will stay in hospital longer than 28 days OR the person will stay in a care home for more than 8 weeks

7. When might an IMCA be involved? An IMCA may be instructed to support someone who has no-one to support them other than paid staff and is deemed to lack capacity to make decisions involving; – Care reviews – Safeguarding Adult cases that involve vulnerable people – In this case, an IMCA can be instructed whether there is family involvement or not

8. Care Reviews A responsible body can instruct an IMCA to support and represent a person who lacks capacity when; they have arranged accommodation for that person they aim to review the arrangements eg: as part of a care plan there are no family or friends who it would be appropriate to consult

9. Safeguarding Adults Responsible bodies have the powers to instruct an IMCA to support and represent a person who lacks capacity where it is alleged that: the person is or has been abused or neglected by another person OR The person is abusing or has abused another person An IMCA can only be instructed if the responsible body is proposing to take or have already taken protective measures.

11. The Referral Process On receipt of a referral the IMCA will: Contact the decision maker to ensure the referral meets the IMCA critera Clarify that the test for capacity has been done, using alternative forms of communication where necessary Clarify that the person being referred has no family or close friends to speak for them Arrange to meet with the person who has been deemed to lack capacity

12. Recording Decisions All professional staff – involved in the care and treatment of a person who may lack capacity to make a particular decision should keep a record of long-term or significant plans made about capacity. The record should be made in the place where you regularly record details about a service user such as a care plan. The record should show: - what the decision was - why the decision was made and when - how the decision was made – who was involved and what information was used.

13. Meeting with the person…. Find out what support a person who lacks capacity has had to help them make the specific decision. Attempt to communicate in private, where possible, with the person who lacks capacity. Use alternative, non-verbal techniques where necessary. Ascertain what the client’s wishes and feelings are as much as possible. Attempt to identify what their beliefs and values would be and what would be likely to influence the person if they had capacity. Get the views of professionals and paid workers providing care and treatment for the person. Get the views of anybody else who can give information about the wishes and feelings, beliefs or values of the person who lacks capacity

14. Further actions….. Find out if there are any alternative options available Consider whether getting another medical opinion would help Get hold of any other relevant information Examine any relevant records – Section 35(6) MCA(2005) Prepare a report for the decision maker, which they must consider Challenge the decision maker if necessary

15. And we do all this…… IN 8 HOURS!!

16. Who do IMCAs report to? Department of Health Commissioners of the service Feedback forms

17. Where IMCAs come from….. Advocacy including non-instructed Health and social care Secure services Training: 4 days in training plus 2 study days CRB checked Authorisation by local authority Advocacy qualification

18. What’s Next? Deprivation of Liberty Safeguards

19. Contact IMCA on: Office: 0845 680 0513 Elly Davis: 07966 883694 imca@nwas.org.uk