1. The Independent Mental Capacity Advocate (IMCA) Service Lucy Bonnerjea Department of Health

2. The Independent Mental Capacity Advocacy (IMCA) Service The Mental Capacity Act 2005 set up the IMCA service. It started in April 2007. The Regulations require local authorities, to commission a local IMCA service from advocacy organisations. * The Regulations require IMCAs to have both advocacy training and IMCA training.

3. A Duty To Instruct The Act introduces a duty to instruct an IMCA in certain situations. The failure to instruct and IMCA becomes a breach of law. The duty applies to everyone who is involved in making decisions with and for those who qualify.

4. THE IMCA SERVICE IMCAs must support and represent people who: –- lack capacity; –- have no friends or family to support them;

5. When? In 4 situations - where they need: 1.serious medical treatment; or 2.a change in long term accommodation; 3.or a care review OR 4. adult protection (even with family/ friends)

6. THE IMCA’s role To ensure that the person’s views, preferences, values and beliefs are heard and protected; To ensure that the person’s rights are protected in accordance with their wishes and current legislation.

7. Role of IMCA To represent the person; To find out about the persons feelings and wishes as much as possible To find out about different courses of actions To present the information to the decision maker/ or decision making meeting To challenge the decision maker if necessary

8. What can the IMCA do? Meet the person, in private if necessary; Talk to the person, use communication aids if necessary; Talk to people involved in person’s care or treatment; Examine and take copies of medical and social care records; Request a second medical opinion.

9. How do the IMCAs do this? By working in a person centred way; By using communications aids; By involving specialist support/language workers; By using Person Centred Planning Tools – such as Essential Lifestyle Planning

10. What else can IMCAs do? Ensure that Advanced Statements and living wills are respected; Apply to the Court of Protection if there are disagreements; Remind everyone that capacity can be enhanced and for some people capacity can be regained.

11. What can we expect from the IMCA? To represent the person in the most appropriate way; To write an IMCA report for each referral.

12. IMCAs must: Work within the advocacy organisations’ quality standards; Work within the Vulnerable Adults Policy; Work within a Confidentiality policy; Work within the MCA Code of Practice; Work within the agreed commissioning arrangements for raising problems with commissioners.

13. IMCA services There are about 70 IMCA services (because some work in several LA areas). They all have completed the national IMCA training. They work with all client groups who lack capacity. They provide a statutory service. They are accountable to their commissioners as well as their clients.

14. Examples: Care home closures; Ward closures; Resettlement in the community; Serious medical treatments: breaking a badly healed hip; heart surgery; withholding life sustaining treatment. Hospital discharges. Adult Protection Working with the Official Solicitor.

15. Achievements for Individuals Better decision-making for the most vulnerable people A specialist service which has time for individuals with limited capacity to communicate A more holistic approach to decision making in the NHS A more rights based approach to looking at options

16. Beyond individuals: Achievements include: A new profession with the right to question A new profession with the right to challenge A new profession able to identify and highlight poor individual practice A new profession able to identify and highlight poor institutional practice A specialist safeguard