- Care providers must involve service users in all aspects of the care planning process.
- Providers must carry out a needs assessment to determine a service user’s needs and preferences.
- The five principles of the Mental Capacity Act 2005, in particular Principle 4: Best interests, state that anything done for or on behalf of a person who lacks mental capacity must be done in their best interests.
- The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 include information on involving people in their care, in particular: Regulation 9: Person-centred care, Regulation 10: Dignity and respect, and Regulation 11: Need for consent.
The right to self-determination is a fundamental part of who we are. We all value the right to choose: how we dress, what we eat and who we socialise with. If this right is restricted or taken away, we are often upset or angry as it stops us from being who we are. Yet the social care sector regularly takes away people’s rights to choice and self-determination. In some cases this is valid, as the person is no longer able to make such choices. But in many cases it is inappropriate as people are ‘written off’ because of diagnosis, behaviour or even their age.
The Mental Capacity Act 2005 sought to address this in the five principles, in particular Principle 4: Best interests, which states that anything done for or on behalf of a person who lacks mental capacity must be done in their best interests.
The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 also address this issue in Regulation 9: Person-centred care, Regulation 10: Dignity and respect and Regulation 11: Need for consent. All of these regulations are included in the fundamental standards. In addition, failure to comply with Regulation 11 constitutes an offence.
This article looks at ways of involving people in their care that will provide evidence that the care service is meeting the re-quirements of Regulations 9, 10 and 11.
Regulation 9: Person-centred care
Regulation 9: Person-centred care requires that care and treatment are appropriate and meet the person’s needs and preferences. The regulation requires that, except in the case of people who lack mental capacity or who are cared for under the Mental Health Act 1983, the care provider must:
- assess the service user’s needs and preferences for care and treatment
- design care or treatment to meet the service user’s preferences and meet their needs
- enable and support service users and/or their carers to understand the care or treatment choices available
- discuss the balance of risks and benefits involved in any particular course of treatment
- enable and support service users to make decisions or participate in making decisions relating to their care or treatment
- make reasonable adjustments to enable service users to receive their care or treatment
- have regard to the service user’s well-being regarding meeting their nutritional and hydration needs (where applicable).
Fully involve the person in their care
In practical terms this means that the care provider has to fully involve the person in their care. Care providers must involve the person in all aspects of the care planning process. This includes the initial assessment, planned care plan reviews, unscheduled reviews in response to a change in need and in the risk management process. If there are valid reasons why the person was not involved, for example if they did not wish to be involved, then these must be clearly documented along with the actions taken to make the process as inclusive as possible to promote the person’s involvement.
Determine their needs and preferences
The assessment must include determining the person’s needs and preferences. A need is a circumstance that requires a course of action. A preference is the way the person wishes their need to be met. One way to accomplish this is to redesign the assessment forms to facilitate the assessment of needs and preferences. An example would be a person who needs the support of one member of staff to shower. Their preference is to shower in the evening after their supper and then to dress in nightwear to watch TV in their room.
Regulation 10: Dignity and respect
Defining outcomes supports involvement
Regulation 10(2)b states that a registered person must support the autonomy, independence and involvement in the community of the service user. Care providers must work with people to design care plans that reflect the way in which they wish to be supported in this respect. Outcome-focused care plans are one way of doing this. An outcome is the end result of the care and support provided, e.g. Mr A goes to church every Sunday for the 11am to 12pm service. This outcome then requires an assessment of needs and preferences, and sufficient resources must be allocated to ensure that the outcome is met. The outcome can then be measured at care plan reviews and action taken to either maintain the outcome if it was met and the person was happy with this, change the outcome if the person wished to do so or change the processes if the outcome was not met.
Regulation 11: Need for consent
Regulation 11(1) states that care and treatment of service users must only be provided with the consent of the relevant person. This means that only the relevant person can consent to their care and treatment – the ‘relevant person’ is the service user who receives the care and treatment. If they lack the mental capacity to be involved in this process, a person acting legally on their behalf becomes the relevant person and it is they who should be involved in the care planning process. This will generally mean any person with lasting power of attorney or court-appointed deputy status who makes health and welfare decisions on behalf of the service user.
Many care providers are confused about the powers granted under enduring power of attorney, which is only for financial deci-sions, or lasting power of attorney, which is for property and financial affairs. They ask those with such powers to make care decisions on behalf of someone who lacks mental capacity and to sign the care plan to authorise these decisions. This is in breach of the Mental Capacity Act 2005 and Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
To involve people in their care is fundamental to delivering person-centred care, as well as a legal obligation on care providers. A few simple steps will ensure that people are not only involved in their care but are treated with dignity and respect and that their needs are met in the way they prefer.
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Mental Capacity Act 2005.
Use the following items in the Toolkit to put the ideas in the article into practice:
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