Safeguarding Adults
Mental Capacity Act
Deprivation of Liberty Safeguards
Power of Attorney
A brief overview
Safeguarding team
Safeguarding Vulnerable Adults from Abuse
Safeguarding Adults is:
 all work which enables vulnerable adults to retain independence,
well being and choice and to be able to live a life free from
abuse and neglect
 preventing abuse and neglect as well as promoting good practice
for responding to concerns on a multi-agency basis
2
Who are Vulnerable Adults?
 Those aged 18 or over
 Who “is or maybe eligible for community care services”
those whose independence and well being would be at
risk is they did not receive appropriate support and who
may be at risk of abuse or neglect”
 Includes adults with physical, sensory and mental
impairments and learning disabilities
Source – Berkshire Safeguarding Adults Policy & Procedures 2008 in line with
No Secrets. Department of Health, 2000
berksadultsg.proceduresonline.com/index.htm
3
Indicators of Abuse
The following may indicate abuse:
 Seeking shelter or protection.
 Unexplained reactions towards particular individuals.
 Unexplained reactions to particular settings.
 Frequent visits to GP, hospital casualty or hospital admissions.
 Frequent or irrational refusal to accept investigations or treatments.
 Unexplained change in material circumstances.
 Inconsistency of explanation.
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Risk Indicators
Destruction of physical environment
Turning night into day - sleep disturbance
Chronic incontinence
Extreme physical and/or emotional dependence
Verbal abuse and/or aggression towards carer
Changes in personality
Wandering/absconding
Self harm
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Reporting and Recording
Concerns about abuse must be reported and recorded on the same day,
or as soon as possible.
 What you saw if you witnessed the abuse
 What was said, use exact words where possible
 Information on the setting
 Describe any significant points about adult’s appearance and emotional
presentation
 Use a body map as necessary
 Separate factual information from your opinion
 Who the concerns were reported to (Police?)
 Any decisions as a result of these contacts
6
How to Report
 Where the alleged abuse happened is important information.
 This will guide you as to which Local Authority Safeguarding Team to
report to.
 The Local Authority where the abuse is alleged to have happened is
responsible for leading the investigation.
 Make yourself aware of who your local safeguarding adults team is
and how to contact them.
 Reading – 0118 9374747 (Main contact number for Adult Social Care)
or safeguarding.adults@reading.gov.uk
Mental Capacity Act 2005
 Framework to protect those
who lack capacity.
 To enable people to take part,
as much as possible in
decisions that affect them.
 Includes five statutory
principles.
 For people 16 years and over.
 http://www.legislation.gov.uk/u
kpga/2005/9/contents
 www.scie.org.uk/publications/
ataglance/ataglance05.asp
5 Principles
1. You must always assume the person has capacity, unless proved
otherwise
2. You must take all practicable steps to enable people to make their
own decisions
3. You must not assume incapacity simply because someone makes an
unwise decision
4. Always act or decide, for a person without capacity, in their best
interest
5. Carefully consider your actions to ensure the least restrictive option is
taken
Mental capacity
Remember:
 Mental capacity is decision and time specific
 So you cannot just say/document “……lacks mental capacity”
 You will need to document “….. lacks mental capacity in relation to…”
e.g. care and/or treatment, managing finances, leaving the hospital,
discharge planning.
 Accurate documentation is required throughout to support your
assessment and any decisions made thereafter.
Mental Capacity is not
 a (Mini) mental assessment/score
 GCS
 Related to age, appearance or
medical condition
Assessment of Capacity - two stage test.
Stage One:
Does the person have, or do you have good reason to believe they have,
an impairment of the mind or brain (temporary or permanent)?
If ‘yes’ go to Stage Two
Stage Two - capacity assessment
Is the person able to:
 Understand the decision they need to make and why they need to
make it (decision specific).
 Retain, use and weigh information relevant to the decision.
 Understand the consequences of making or not making this
decision.
 Communicate their decision (by any means).
Failure on one point will determine a lack of capacity.
Best Interest Decisions
 Do not make assumptions.
 Do encourage the person to participate.
 Do consider the person’s past and present beliefs, values wishes and
feelings.
 Do take into account the views of others.
 Do consider the least restrictive option.
 www.legislation.gov.uk/ukpga/2005/9/section/4
Best interest Actions
The decision maker must:
 Ensure the proposed treatment is in the best interest of the individual
and is the least restrictive option.
 Check if there is an advanced decision, lasting power of attorney,
deputy or if there is a friend, carer or other person nominated by the
person to consult.
 Refer to an IMCA if decisions are related to serious medical treatment
or change of accommodation and the individual is not “befriended”.
(Social Services have details of your local IMCA service)
Fluctuating/Situational Capacity
 Be clear that if a person’s capacity fluctuates the assessment must
take place when they have the best chance to make the decision
themselves.
 This can cause difficulties as they may ‘change their mind’ and come
to a different decision later on.
 Use your MDT to risk assess decisions made and to be confident you
are supporting them to make their own decision if possible.
 Situational – The person can seem to be able to make a capacitated
decision but then becomes ‘frozen’ when faced with the situation. For
example; domestic violence or hoarding.
Emergency care, best interest and consent
 Emergency care can be undertaken – there should be no liability for
acting in the reasonable belief that someone lacks capacity and where
what you do is reasonably believed to be in their best interest.
 Consent: Can anyone give consent for another person?
Lasting power of attorney
 A lasting power of attorney (LPA) is a legal document that lets the
person appoint one or more people as attorneys to help the individual
make decisions or to make decisions on their behalf.
 You must be 18 or over and have mental capacity when you make
your LPA.
 There are 2 types of LPA; ‘health & welfare’ and ‘property & financial
affairs’
 They must be registered with the Office of the Public Guardian
 www.gov.uk/government/organisations/office-of-the-public-guardian
Health and Welfare LPA
Gives an attorney the power to make decisions about things like:
 your daily routine (e.g. washing, dressing, eating)
 medical care
 moving into a care home
 life-sustaining treatment
It can only be used when the person is unable to make their own
decisions. If the person is believed to retain capacity then their
wishes must be respected.
Property and Financial Affairs LPA
Gives the attorney the power to make decisions about money and
property, for example:
- managing a bank or building society account
- paying bills
- collecting benefits or a pension
- selling their home
It can be used as soon as it’s registered, with the permission of the
individual.
IMCA
When should you appoint an IMCA:
- When the person is not befriended
- Can/should be appointed if there
are safeguarding concerns or a
DoLS application has been made
- www.pohwer.net/about-us/form
Restraint
Restraint – are any of these restraint?
 1:1 care/supervision
 Low bed
 Bed rails / Lap strap on wheelchair
 Holding a patient
 Sedation / covert medication
 Constantly telling a patient to sit
down
 Use of pressure sensors/falls
alarms
 Use of mittens
What is restraint?
Restraint is defined as ‘the intentional restriction of a
person’s voluntary movement or behaviour.’
(Counsel and Care UK, 2002)
An alternative plain English definition is ‘stopping a person
doing something they appear to want to do.’
 A use of force where a person who lacks capacity resists.
 Any restriction of liberty or movement
 Restraint is only permitted if the person using it reasonably believes it
is necessary to prevent harm to the person who lacks capacity and if
the restraint used is proportionate response to the likelihood of serious
harm
 Is restraint, therefore, in the patients best interest?
If restraint is used
 Any restraint used must be the least restrictive possible in terms of
intensity and duration.
 It should be a MDT decision and considered to be in the patient’s best
interest
 Where restraint is used or is likely to continue for a long period of time
and where the patient is assessed as lacking mental capacity under
the terms of the Mental Capacity Act (2005) consider a Deprivation of
Liberty Safeguards Authorisation (DoLS).
Deprivation of Liberty Safeguards (DoLS) 2007
 An amendment to MCA 2005
 Legal framework to protect those
over 18 who lack capacity to
consent to the arrangements for
their treatment or care, receiving
care in hospital or a care home
setting
 webarchive.nationalarchives.gov.uk/
+/www.dh.gov.uk/en/SocialCare/Del
iveringadultsocialcare/MentalCapaci
ty/MentalCapacityActDeprivationofLi
bertySafeguards/index.htm
Supreme Court ruling - March 2014
 The Supreme Court has ruled that if a patient, without capacity, is
being deprived of their liberty a new ‘acid test’ should be applied.
 This ‘test’ defines what constitutes a deprivation at a lower level than
had previously existed.
 It provides new guidance to identify, assess and lawfully restrict a
person considered to be being deprived of their liberty, when subject to
a ‘protective care’ regime.
The ‘Acid Test’ Explanation
www.supremecourt.co.uk
 Is the patient subject to continuous supervision?
A significant degree of supervision or monitoring is present
 Is the patient subject to continuous control?
There is a clear element of control over what the patient is doing, as
opposed to helping or encouraging a patient to do something
 Is the patient free to leave?
The patient is not free to go anywhere without permission and close
supervision
Interface between MHA and MCA
 It may be appropriate to treat the patient in their best interest as per
the terms of the Mental Capacity Act in the short term
 A patient with mental health needs may lack capacity or have mental
capacity
 Advice can be obtained via the Mental Health Coordinator - Older
People’s Mental Health Team and/or the Psychological Medicines
Service
 As part of the DoLS process there is a requirement for a mental health
assessment by a section 12 doctor who has taken on additional
training
Miss F
You have been asked to do a home visit by social services who are
concerned about a 22 year old lady:
 There is a ‘learning disabilities’ flag on her notes
 Current medication; antidepressants and pain relief
 Her child was removed due to issues of neglect
 When you arrive at the house she tells you she has been on the sofa
for 18 months as her ‘legs hurt’
 She lives with four other adults; history of anti-social behaviour and
reports of domestic violence within the household
Ms F - Questions
 What else do you need to know?
 What should/can you do?
 Who else can/should you talk to?
Mr W
You are asked to visit Mr W in a nursing home:
 He appears very thin and you believe he has lost a significant amount
of weight since your last visit.
 He has been referred to the District Nurse with pressure damage
 Do you have any concerns?
 What do you want/need to know?
 What would you do?