Safeguarding leads told to probe fall in use of mental capacity advocates

The government has asked adult safeguarding co-ordinators to examine why independent mental capacity advocate (IMCA) referrals have fallen for adults at risk of abuse or neglect.

Access to independent mental capacity advocates for adults at risk of abuse is low and falling, the government has warned as it called on adult safeguarding co-ordinators to review their referral systems to IMCAs.

The warning came in the Department of Health’s latest annual report on the IMCA service, which revealed that the number of referrals for IMCAs in safeguarding cases fell from 1,564 in 2010-11 to 1,533 in 2011-12.

This was despite an 11% rise, to 108,000, in the number of cases of alleged abuse or neglect investigated by councils over the same period. The DH said the low and falling number of IMCA referrals for safeguarding cases were a cause for “concern”. Though many disabled or older adults at risk of abuse or neglect would not lack capacity to make decisions in relation to safeguarding procedures, a significant number would.

The DH called on all safeguarding co-ordinators to review the basis on which they made referrals and said co-ordinators in areas where IMCA referrals had fallen or stayed the same from 2010-11 to 2011-12 should review why this has happened. These authorities have been highlighted in an appendix to the report.

No IMCA duty in safeguarding cases

Councils have a power, though not a duty, to bring in an IMCA where adults at risk of abuse lack capacity to make decisions in relation to safeguarding. However, unlike in other cases of using IMCAs, they can refer people involved in adult protection cases even if they have family or friends who are willing and able to be consulted on the decision.

John Beer, chair of trustees at Action on Elder Abuse and a former director of adult social services, said he was surprised by the fall in IMCA adult protection referrals, given the overall rise in safeguarding cases and the increasing numbers of people with dementia who may lack capacity to take decisions in such cases.

“You have to look at how much of this is to do with the financial pressures on people not to be spending money on things that they might have spent on in the past,” he added.

Safeguarding IMCA referrals had risen year-on-year from 2007-8, when the advocacy service was introduced with the implementation of the Mental Capacity Act 2005, to 2010-11.

Big local variations in IMCA referrals

Overall, the number of IMCA referrals for all types of case rose by 9% to 11,899 from 2010-11 to 2011-12. However, the DH said that there were significant variations in referrals between areas that could not be accounted for by demographic differences.

“It is likely that in some areas the duties under the MCA are still not well embedded,” he said.

Over 40% of the total related to cases where a decision needed to be made about a change of accommodation, with the number of these cases rising from 4,619 to 4,916. In such cases, councils have a duty to refer a person to an IMCA if they suspect they lack the capacity to make the decision and they do not have friends or family who can be consulted.

About half of accommodation cases (48%) concerned decisions about where a person should move after a stay in hospital, while 34% concerned people facing a move from a care home; few involved people in their own homes or supported living. Analysis of a sample of accommodation decisions involving IMCAs revealed that very few people who were in their own homes remained there, most people in hospital moved into a care home and most people in care homes stayed where they were or moved to a new care home.

Care reviews

The number of IMCAs used to support people through care reviews rose by 32% to 1,032 in 2011-12. Councils have a power, but not a duty, to ask an IMCA to support a person through a care review where the service user lacks capacity to make relevant decisions and has no friends and family to consult. 

Despite the sharp rise in care review cases, the DH said the overall figure was still low and called on councils to ensure that people who would benefit from an IMCA during a care review, received one.

Dols cases

Since the introduction of the Deprivation of Liberty Safeguards in 2009, people subject to the safeguards or being assessed under them have been able to access an IMCA in certain circumstances. The number of Dols cases in which an IMCA was used rose by 18% to 1,979 from 2010-11 to 2011-12.

The biggest rise was in cases where IMCAs were appointed to support a person subject to a Dols authorisation who had had a family member or friend appointed as their relative person’s representative (RPR) – a statutory role which involves speaking up for the person deprived of their liberty.

The number of such cases rose from 620 to 910 from 2010-11 to 2011-12. 

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