Realising the safeguarding potential of the <i>Mental Capacity Act 2005:</i> early reports from adult safeguarding staff

Manthorpe, Jill; Rapaport, Joan; Harris, Jessica; Samsi, Kritika

doi:10.1108/14668203200900010

Cited by 14 publications

(28 citation statements)

References 9 publications

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“…Without the assistance of well-informed, supportive relatives to initiate hospital and local authority complaints mechanisms, who could pursue challenges to the Court of Protection where necessary, many older patients with dementia will simply be unable to instigate these challenges and appeal mechanisms themselves (Manthorpe, Rapaport, Harris and Samsi, 2009). When the onus is placed on care-recipients and the discretion of their relatives to initiate complaints procedures and challenges in this manner, those procedures and informal safeguarding mechanisms appear to be little more than patchy, arbitrary measures that fail to deliver the protection and access to justice that vulnerable incapable older adults and their families and carers need and deserve.…”

Section: Resultsmentioning

confidence: 99%

A Relative Safeguard? The Informal Roles that Families and Carers Play when Patients with Dementia are Discharged from Hospital into Care in England and Wales

Emmett¹,

Poole²,

Bond³

et al. 2014

International Journal of Law, Policy and the Family

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ABSTRACT:In general hospitals, decisions are routinely made by health and social care professionals to discharge older people with dementia, who lack capacity, into long-term institutional care. There are few independent procedural safeguards that monitor how those professional 'best interests' decisions are made. Instead there is an assumption, implied by the Mental Capacity Act 2005 (MCA), which governs decision-making on behalf of incapacitated adults in England and Wales, that relatives will act as informal caretakers of patients' interests and will challenge professional decisions where necessary. This article examines whether this is the case in practice and the factors that may prevent relatives from carrying out this safeguarding role effectively. Our findings stem from a qualitative (ethnographic) study which captured observational data on acute and rehabilitation hospital wards in two hospitals within two NHS healthcare trusts in the North East of England. Our results show that relatives struggled to safeguard the rights of incapacitated patients with dementia when professional residence capacity and best-interests decisions were made about living arrangements and relatives were often ill-equipped or unsuitable to carry out this safeguarding role. Without better information-sharing and more robust independent procedural safeguards in the MCA, the rights of older patients with dementia are not being adequately protected during the hospital discharge process.

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Section: Resultsmentioning

confidence: 99%

A Relative Safeguard? The Informal Roles that Families and Carers Play when Patients with Dementia are Discharged from Hospital into Care in England and Wales

Emmett¹,

Poole²,

Bond³

et al. 2014

International Journal of Law, Policy and the Family

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“…While the MCA may be framed as helping with advance care planning (Manthorpe et al, 2009), this paper has illuminated its important potential in safeguarding. The abilities of people with dementia and their carers to retain control of their assets and thus choices for as long as possible should be set against the risks of exploitation in its multiple forms.…”

Section: Discussionmentioning

confidence: 99%

“…The questions asked were follow-ups of two earlier surveys of ASCs: (1) about their expectations of the MCA 2005 when it was newly implemented (2007-8) (Manthorpe et al, 2009); and (2) emerging experiences around the use of the MCA (2009-10) (Manthorpe et al, in press). Participants were recruited from London, southern, eastern, and north-west England.…”

Section: Participants and Recruitmentmentioning

confidence: 99%

Responding to the financial abuse of people with dementia: a qualitative study of safeguarding experiences in England

Manthorpe

Samsi

Rapaport

2012

Int. Psychogeriatr.

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Healthcare professionals may need to be more alert to the signs and risks of financial abuse in patients with dementia both at early and later stages. Engaging with safeguarding practitioners may facilitate prevention of abuse and effective response to those with substantial assets, but the monitoring of people with dementia needs to be sustained. In addition, professionals need to be alert to new risks from electronic crime. Researchers should consider including financial abuse in studies of elder abuse and neglect.

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“…264 Most were well informed about it and acted as sources of expertise locally. Prior to the MCA, many SACs considered there had been a legal vacuum around decision-making.…”

Section: Interpretation Of the Study Findings In Light Of Previous Rementioning

confidence: 99%

“…For example, while community nurses saw safeguarding as less of a priority in their jobs during time 1 interviews 258 SACs talked about the significant impact of the MCA on their practice experiences. 264 …”

Section: Approximate Timescalementioning

confidence: 99%

Changing practice in dementia care in the community: developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM)

Iliffe

Wilcock

Drennan

et al. 2015

Programme Grants for Applied Research

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BackgroundThe needs of people with dementia and their carers are inadequately addressed at all key points in the illness trajectory, from diagnosis through to end-of-life care. The EVIDEM (Evidence-based Interventions in Dementia) research and development programme (2007–12) was designed to help change this situation within real-life settings.ObjectivesThe EVIDEM projects were (1) evaluation of an educational package designed to enhance general practitioners’ (GPs’) diagnostic and management skills; (2) evaluation of exercise as therapy for behavioural and psychological symptoms of dementia (BPSD); (3) development of a toolkit for managing incontinence in people with dementia living at home; (4) development of a toolkit for palliative care for people with dementia; and (5) development of practice guidance on the use of the Mental Capacity Act (MCA) 2005.DesignMixed quantitative and qualitative methods from case studies to large database analyses, including longitudinal surveys, randomised controlled trials and research register development, with patient and public involvement built into all projects.SettingGeneral practices, community services, third-sector organisations and care homes in the area of the North Thames Dementia and Neurodegenerative Diseases Research Network local research network.ParticipantsPeople with dementia, their family and professional carers, GPs and community mental health team members, staff in local authority social services and third-sector bodies, and care home staff.Main outcome measuresDementia management reviews and case identification in general practice; changes in behavioural and psychological symptoms measured with the Neuropsychiatric Inventory (NPI); extent and impact of incontinence in community-dwelling people with dementia; mapping of pathways to death of people with dementia in care homes, and testing of a model of collaborative working between primary care and care homes; and understandings of the MCA 2005 among practitioners working with people with dementia.ResultsAn educational intervention in general practice did not alter management or case identification. Exercise as a therapy for BPSD did not reduce NPI scores significantly, but had a significant positive effect on carer burden. Incontinence is twice as common in community-dwelling people with dementia than their peers, and is a hidden taboo within a stigma. Distinct trajectories of dying were identified (anticipated, unexpected and uncertain), and collaboration between NHS primary care and care homes was improved, with cost savings. The MCA 2005 legislation provided a useful working framework for practitioners working with people with dementia.ConclusionsA tailored educational intervention for general practice does not change practice, even when incentives, policy pressure and consumer demand create a favourable environment for change; exercise has potential as a therapy for BPSD and deserves further investigation; incontinence is a common but unrecognised problem for people with dementia in the community; changes in relationships between care homes and general practice can be achieved, with benefits for people with dementia at the end of life and for the UK NHS; application of the MCA 2005 will continue to improve but educational reinforcements will help this. Increased research capacity in dementia in the community was achieved. This study suggests that further work is required to enhance clinical practice around dementia in general practice; investigate the apparent beneficial effect of physical activity on BPSD and carer well-being; develop case-finding methods for incontinence in people with dementia; optimise working relationships between NHS staff and care homes; and reinforce practitioner understanding of the MCA 2005.Trial registrationEVIDEM: ED-NCT00866099; EVIDEM: E-ISRCTN01423159.FundingThis project was funded by the Programme Grants for Applied Research programme of the National Institute for Health Research.

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Realising the safeguarding potential of the Mental Capacity Act 2005: early reports from adult safeguarding staff

Cited by 14 publications

References 9 publications

A Relative Safeguard? The Informal Roles that Families and Carers Play when Patients with Dementia are Discharged from Hospital into Care in England and Wales

A Relative Safeguard? The Informal Roles that Families and Carers Play when Patients with Dementia are Discharged from Hospital into Care in England and Wales

Responding to the financial abuse of people with dementia: a qualitative study of safeguarding experiences in England

Changing practice in dementia care in the community: developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM)

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