To build a care plan
If you are starting from scratch, this tool will help you build an MCA-compliant care plan. Questions are suggested for you to think about, starting with the essential question of whether there is any doubt about the person’s capacity to make their own care decisions.
Go to either ‘Shared care planning with someone with capacity’ (click here) or, if the person may lack capacity, work through the questions that start with the heading ‘Capacity assessments’ (click here).
We know restraint and restrictions are not always recognised in practice. If there is any doubt that you are already restraining someone lacking capacity to consent to it, or if you think that restraint may be needed to be added to a care plan, work through the questions in ‘Restriction and Restraint’ (click here).
Deprivation of liberty is also not always well understood. Consider the questions under the heading ‘Deprivation of liberty’ (click here) if it is likely that the care plan will meet the ‘acid test’ (does the person lack capacity to consent to be in this setting to be given necessary care or treatment? And is the person under continuous supervision and control? And is the person not free to leave?).
To audit existing care plans
If you already use the MCA in designing and working within care plans, this document provides a useful audit tool for ensuring that your decision-making and planning are compliant with the Human Rights Act 1998, the MCA and associated case law.
Ensure ongoing, lively person-centredness. Everyone changes over time, and it is crucial that no care plans show signs of being ‘fossilised’. Check your existing systems against those within the tool and consider how to amend both practice and recording where gaps appear or where the same perceptions and strategies seem to be thoughtlessly pasted over from earlier care plans.
To develop a reviewing schedule for care plans
Clear timescales should be set for reviewing a care plan. There is nothing set down in law, but six months is often suggested as the longest a care plan should be left without review. In many situations, the length of time should be shortened.
When someone is being restricted or restrained, in particular when they are given covert medication to relieve anxiety or influence their behaviour, six months should be the absolute maximum: good practice would be to review more frequently.
Whenever someone’s autonomy is restricted, the overarching aim of this tool is to
- enable active consideration of whether this level of restriction of freedom is still necessary and proportionate, and to
- encourage an ongoing search for less restrictive options to keep the person safe.