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Penn D, Lanceley A, Petrie A, Nicholls J. Mental capacity assessment: a descriptive, cross-sectional study of what doctors think, know and do. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2019-105819. [PMID: 32647042 DOI: 10.1136/medethics-2019-105819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/12/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The Mental Capacity Act (MCA) (2005) was enacted in 2007 in England and Wales, but the assessment of mental capacity still remains an area of professional concern. Doctors' compliance with legal and professional standards is inconsistent, but the reasons for poor compliance are not well understood. This preliminary study investigates doctors' experiences of and attitudes toward mental capacity assessment (MCAx). METHODS This is a descriptive, cross-sectional study where a two-domain, study-specific structured questionnaire was developed, piloted and digitally disseminated to doctors at differing career stages employed in a large, multi-site National Health Service Trust in London over 4 months in 2018. Descriptive statistics and frequency tables adjusted for missing data were generated and secondary analysis was conducted. RESULTS Participants (n=92) were predominantly UK trained (82%), female (58%) and between the ages of 30 and 44 years (45%). Less than half (45%) of the participants reported receiving formal MCAx training. Only one-third (32%) of the participants self-rated themselves as very competent (29%) or extremely competent (4%). Self-reported MCA confidence was significantly affected by career stage with Consultants with over 10 years of experience reporting lowest confidence (p=0.001). CONCLUSIONS This study describes significant variation in practice by doctors and low self-confidence in the practice of MCAx. These results raise concerns that MCAx continues to be inconsistently performed by doctors despite appropriate awareness of the law and professional guidance on best practice.
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Affiliation(s)
| | - Anne Lanceley
- Department of Women's Cancer, UCL Elizabeth Garrett Anderson Institute for Women's Health, UCL, London, UK
| | | | - Jacqueline Nicholls
- Department of Reproductive Health, UCL Elizabeth Garrett Anderson Institute for Women's Health, UCL, London, UK
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Abstract
The Mental Capacity Act (MCA) is a piece of statutory legislation which is designed to empower and protect those who are assessed as being unable to make decisions for themselves. At the time of implementation, the legislation was described as visionary and it had the potential to change the lives of many. However, a post-legislative scrutiny report published in 2014 concluded that there is a lack of knowledge among professionals of the MCA, and so it is not embedded into daily clinical practice. This review of literature has identified four key themes: assessment, training, knowledge and empowerment. These appear to concur with the findings of the House of Lords report. The successful integration of the MCA into professionals' everyday practice is high on the political agenda, thus reinforcing the message that following the guidance set out in the MCA legislation is mandatory and not a choice. A shift in culture and improvement in knowledge and understanding of the MCA is required in order for it to be used in the correct manner for which it was designed.
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Affiliation(s)
- Helen Marshall
- Safeguarding Adults Specialist Nurse, Liverpool Community Health, NHS Community Healthcare Trust
| | - Sally Sprung
- Senior Lecturer, Liverpool John Moores University, UK, School of Nursing and Allied Health
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Norrie C, Manthorpe J, Cartwright C, Rayat P. The feasibility of introducing an adult safeguarding measure for inclusion in the Adult Social Care Outcomes Framework (ASCOF): findings from a pilot study. BMC Health Serv Res 2016; 16:209. [PMID: 27363497 PMCID: PMC4929787 DOI: 10.1186/s12913-016-1464-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/23/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There are currently no national measures in England reporting the experiences of people who have been involved with adult safeguarding services following concerns that they may be at risk of abuse or neglect. The Health and Social Care Information Centre (HSCIC) aimed to develop a new adult safeguarding outcome measure (survey) for local authorities (LAs) that could be added to the Adult Social Care Outcomes Framework (ASCOF). The ASCOF is a national collection of social care outcomes performance indicators collected from the perspective of people receiving partial or total funding from a LA for care services. METHODS An outcome measure (a face-to-face interview based survey consisting of 7 questions) was piloted in 40 LAs with 382 adults at risk (or their representative) who had been the subject of a safeguarding investigation. The aim was to investigate the feasibility of the survey in three domains: i) if a statistically representative sample of adults at risk (or their family, friend, carer or advocate) could be recruited; ii) analysis of survey responses and its acceptability to participants iii) feedback from LAs about the survey's administration. RESULTS AND DISCUSSION Overall the survey results met statistical confidence; however the individual results for adults at risk did not, due to the high proportion of representatives who responded because adults at risk were unable. Responses to the survey were generally positive; 72 % of participants felt that the help received during the safeguarding investigation had made them or the adult at risk (if reporting as a proxy) feel 'quite a bit' or 'a lot safer'. These results are the most robust data collected in England on the perspectives of adults at risk and their representatives on safeguarding services. Participants reported they appreciated being asked for feedback. LAs suggested survey administration improvements. CONCLUSIONS This survey is one way LAs can meet their new legal requirement under the Care Act 2014 to 'seek feedback' from adults at risk about adult safeguarding services. The survey findings provide the first robust evidence that safeguarding services in the main meet their goals of promoting feelings of safety among adults at risk.
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Affiliation(s)
- Caroline Norrie
- />Social Care Workforce Research Unit (SCWRU), King’s College London, Strand, London, UK
| | - Jill Manthorpe
- />Social Care Workforce Research Unit (SCWRU), King’s College London, Strand, London, UK
| | - Cher Cartwright
- />Health and Social Care Information Centre (HSCIC), 4th Floor North, Trevelyan Square, Leeds, UK
| | - Pritpal Rayat
- />Health and Social Care Information Centre (HSCIC), 4th Floor North, Trevelyan Square, Leeds, UK
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Iliffe S, Wilcock J, Drennan V, Goodman C, Griffin M, Knapp M, Lowery D, Manthorpe J, Rait G, Warner J. Changing practice in dementia care in the community: developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM). PROGRAMME GRANTS FOR APPLIED RESEARCH 2015. [DOI: 10.3310/pgfar03030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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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Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Jane Wilcock
- Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Vari Drennan
- Centre for Health and Social Care Research, The Faculty of Health, Social Care and Education at Kingston University London & St George’s University of London (previously at University College London), London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Mark Griffin
- Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Martin Knapp
- Personal Social Services Research Unit (PSSRU), Department of Social Policy, London School of Economics and Political Science, London, UK
| | - David Lowery
- Older Peoples Mental Health Services, Central and North West London NHS Foundation Trust (previously known as Central & NW London Mental Health NHS Trust), London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, Policy Institute at King’s, King’s College London, London, UK
| | - Greta Rait
- Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - James Warner
- Older Peoples Mental Health Services, Central and North West London NHS Foundation Trust (previously known as Central & NW London Mental Health NHS Trust), London, UK, Department of Psychiatry, Faculty of Medicine, Imperial College London, London, UK
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