The “large cultural shift” needed to implement the Mental Capacity Act 2005 “has hardly begun” with councils and NHS bodies failing to fulfil key duties towards vulnerable people, the Department of Health has said.
The criticisms came in a circular from DH implementation lead Lucy Bonnerjea this month, eight months after the full implementation of the act.
Since last April, councils and NHS bodies have had to refer people to an independent mental capacity advocate (IMCA) if they lack capacity, have no family or friends to support them and are facing decisions over accommodation changes or serious medical treatment.
But Bonnerjea said only half the expected number of users had been referred to an IMCA scheme, and urged councils and NHS bodies to ensure staff were trained, had procedures in place and were held to account for failings.
A Community Care probe last year found the development of the IMCA scheme had been hampered by short-term contracts for providers and more than 10% of referrals were inappropriate (www.communitycare.co.uk/105894).
Bonnerjea also said assessments of capacity now had to be undertaken and recorded by all relevant health and social care staff, not just psychiatrists. But she said “early evidence suggests many staff and managers” were not doing so, while there was little evidence of suitable procedures being developed and specific training given.
She cited problems in implementing requirements to carry out decisions in people’s best interests and record how these decisions were reached. She said this “required a cultural shift which few organisations have yet achieved”.
Richard Webb, co-chair of the Association of Directors of Adult Social Services’ mental health network, said there had been progress, including in IMCA uptake in some areas. But this was not “necessarily consistent”.
Rick Henderson, chief executive of umbrella body Action for Advocacy, called for sanctions to be used against professionals who did not have due regard to the act “once the initial bedding-in process was over”.