Themes A: Outcomes and experiences B: Leadership, strategy and commissioning C: Service delivery, effective practice and performance and resource management D: Working together Elements Outcomes People's experiences of MCA and Dols Leadership Strategy Commissioning 6) Service delivery and effective practice 7) Performance and resource management 8) Partnerships This theme looks at what difference in outcomes there are for people who lack capacity and people subject to a DoLS. It also looks at the experiences of people who lack capacity with the services provided. This theme looks at the overall vision for MCA including DoLS, the strategy that is used to achieve that vision and how this is led and commissioned. This theme looks at service delivery, the effectiveness of practice and how the performance and resources of the services, including their people, are managed. This theme looks at the role and performance of partnerships, including the Health and Wellbeing and Safeguarding Adults Boards and how all partners work together to ensure high quality services and outcomes. These areas to question relate to both council and partners (particularly the NHS and social care providers).
compliance (eg MCA audits and MCA trained workforce planning) CQC and local Healthwatch reports address MCA issues. Stated cross-party support for the improvement of MCA including DoLS Senior councillors, non-executives and key senior managers and officers communicate how DoLS principles and duties contributes to the wellbeing of individuals and communities There is joint and coordinated leadership with and by other key partners, including the CCG and NHS Trust designated MCA leads Managers and leaders communicate clearly the requirements of the DoLS (how to support people with mental impairments to make decisions, when to carry out capacity assessments, best interests decisions, how to balance autonomy with risk and when interventions are (and are not) proportionate). Minutes of the health and wellbeing board, SAB, Community Safety Partnership etc have evidenced an interest in MCA practice. Examples of support and training for leaders; of regular managers’ briefing on case law; or staff consulting lawyers providing clear advice
Authorisers are at an appropriately senior level within the organisation and .provide strategic leadership oversight and scrutiny. There is clear leadership of the process for applications to the Court of Protection for ‘Community DoL’s’ (this means applications for those deprived of liberty in all settings which are not care homes or hospitals included a persons own home) Strategy: The ideal service The high level strategy of the council and the NHS recognises that people with mental impairments are a large and growing proportion of their business2 The council and NHS have a clear vision, priorities, strategies and plans for ensuring that all their services and commissioning are MCA including DoLS compliant and this is shared with key partners including the providers and G.Ps Areas to question Achievements/strengths Current developments/ work in progress Areas of challenge/further consideration Possible sources of evidence
These policy and procedures are understood and followed by all professionals and by staff at all levels File audits (demonstrating evidence of supported decision making; assessments of capacity, best interests decisions; family/IMCA involvement; MCA compliant care plans) Interviews with service users and their families/ carers Any staff surveys Staff views of support from MCA including DoLS and safeguarding specialists Office of the Public Guardian (OPG) and Court of Protection papers Evidence of MCA including DoLS compliance with safeguarding adult cases Evidence that MCA specialists and or lawyers disseminate leaning from Court of Protection case law. Providers, the voluntary sector, all council and partner staff are clear about the limitations of their ability to intervene in people’s lives, and be able to seek legal advice where needed. people who fund their own services are enabled to understand and work within the MCA Providers have clear access to information and advice and are responded to effectively Providers receive regular updates in relation to the DoLS and are clear about the implications of any changes to case law. Professionals understand and respond to people whose capacity fluctuates.
Performance and resource management: The ideal service Services are held accountable for performance and quality, with a focus on outcomes, needs and rights of people who lack capacity. There are sufficient, knowledgeable and skilled staff employed in all organisations or commissioned from external organisations to efficiently and effectively deliver the requirements of MCA There is sufficient resources available to train and equip staff to provide an effective service. There are sufficient IMCA and Advocacy services, to support, involve and empower service users and carers. Areas to question Achievements/strengths Current developments/ work in progress Areas of challenge/further consideration Possible sources of evidence There is a practice and performance management framework that runs across council and partner agency functions and which looks at regional and national variations in practice in relation to MCA implementation. A suite of indicators including quantitative and qualitative measures of performance that is reported regularly to senior and team managers Summaries of training activity Skills and confidence as demonstrated in interviews and through file audits Overview and scrutiny agendas and reports with evidence of follow up Safeguarding adult review protocol Quality assurance framework OSC report Quality assurance systems incorporate MCA and risk management, together with improved outcomes for people Local workforce and training plans provide sufficient people with the right skills for MCA.