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Adults with Incapacity Act Update
Jan Killeen
National Practice Co-ordinator
Civil and International Justice Directorate
Guidance: Provision of community care services for adults with incapacity (Circular CCD5/07)
Applying Principles is mandatory to all considerations for action for adult with impaired capacity to make decision in hand
Local authority should obtain an order where: it appears the adult is incapable, no application is being
made and the order is necessary for the protection of welfare and finances of the adult
provision of care would amount to deprivation of liberty
Where use of powers under 68 Act sufficient
No proxy in place with relevant powers Risk assessment indicates no issues to warrant an
order Adult won’t be deprived of their liberty under
Article 5 ECHR No other benefit to adult in applying for an order
Guidance cont:
Additional indicators that 68 Act may be appropriate:
person does not disagree with proposed action and appears unlikely to do so
all interested parties agree with care intervention proposed
Monitoring
Delayed discharge cases due to AWI census:
April 2007 243
January 2007 226
April 2006 201
Key forthcoming changes to AWI
Changes aim to streamline procedures and improve access.
Most require regulations and changes to court rules so likely to commence in Spring 2008 (subject to change).
Part 3: Access to FundsChanges will make it easier for cares and other private
individuals to apply- More flexible arrangements for countersigning applications- More flexible arrangements for managing bank accounts of
adult and transferring funds between accounts- Provision for the Public Guardian to authorise banks to
release informaiton about an adult’ s account- to judge if AtF or guardianship will be more appropriate
- Provision to open a bank account where no pre-existing account
Access to Funds
Major change:Organisations, including local authorities
will be able to use the scheme for adults with no one else to do so – this will make big saving as only previous option was financial guardianship – often inappropriate to adult’s level of income and assets
Guardianship and intervention orders
Discretion for sheriffs to accept medical reports which are older than 30 days old in certain circumstances e.g. where capacity is unlikely to change
Sheriffs to be able to make interim orders for a period of more than 3 months up to a maximum of 6 months where this is appropriate to circumstances
Guardianship changes (cont.) New provision allowing for an order to be applied
for in the 3 months period prior to a person’s 16th birthday
A simplified renewal process Simplified process for local authority recall of
welfare guardianships where CSWO is the guardian
Guardianship changes (cont.) Sheriffs to dispense with caution where
appropriate Regulatory provision to enable Ministers to
prescribe new classes of medical practitioner who can sign the 2nd medical certificate for applications where incapacity is as a result of a mental disorder
Guardianship (cont.)
Express provision that sheriffs must take account of views expressed on behalf of adult by independent advocate
Provision for displacement of adult’s nearest relative on application by anyone with an interest
Enhanced powers for PG to obtain information when carrying out an investigation
Signposts
(1)Brief overview of Citistat process
(2)Delayed Discharges Citistat National Pilot – our experience
(3)Delayed Discharges Citistat Mark 2 – our experience
(4)Pros and Cons of our approach
(5)Future development
Brief Overview of Citistat Process
Information and Analysis
Forum for scrutiny and agreeing action – panel and podium
Action and timely follow up
Delayed Discharges Citistat National Pilot – Our Experience
Citistat 1 – National Pilot Panel: 3 local authority and health
Chief Executives
Podium: 3 Directors of Social Work and 2 Operational Directors in Health
Logistics
Outcomes
No single model of Citistat
Delayed Discharges Citistat Mark 2 – Our Experience
Citistat 2 – Local Process
Panel: COE, Director of Hospital Services
Podium: Senior Managers in CHPs and Hospital Services
Logistics
Outcomes
Pros and Cons of our approach
Comparison of Citistats 1 and 2
Information and Analysis
Scrutiny and Agreement
Action and timely follow up
Citistat 1 – Vision
Citistat 2 - Delivery
Future Development
? “hall full – back door blocked”
Patients ready for Discharge‘WHY ARE WE WAITING’
12TH JUNENORTON HOUSE HOTEL
LENGTHY DELAYS‘WHY ARE WE WAITING’ALEX DAVIDSONJOINT IMPROVEMENT TEAM
Whole System Working
• At Macro Level• Capacity Planning• Performance Review• Interagency agreements
and protocols• Housing needs analysis
and protocols• User and Carer Support• Outcome Focussed
• At Micro Level• Clinical Protocols• Single and Shared
Assessment• Risk assessment• User and Carer
Involvement• Care Management• Options for Support and
Care
Some Key Messages• Understand local community and balance of services• Actively engage patient and carer• Recognise carer importance• Effective Communication between agencies• Performance Manage Multidisciplinary practice• On Admission identify ‘Additional’ Needs• Care Coordination/ Management• Specialist Discharge Planning Support• Rehabilitation needs assessed• Funding Agreements – Continuing Care/Care
Home/Intensive Support
And Some Principles
• Front End Prevention – unnecessary admissions• Partnerships – agencies, carers, patients• Discharge as a process – not an event• Coordinated by named person throughout ‘journey’• Multidisciplinary/agency framework thro’ journey• Effective use of transitional and intermediate care• Assessment and delivery as continuum of health and
social care services• Rights, advice, information to enable informed decision
making
And some other stuff• Choice (and the lack of it)• Adults with Incapacity Act • Mental Health (Care and Protection) Act• Adult Support and Protection Act• Advocacy• Care Programme Approach• Advocacy• Provider support• Public and Private Safety• Homelessness
Money doesn't talk it swears!
• Strategic Financial Framework• Individual Financial Framework• Joint Commissioning??• Contingency Planning• Options – alternatives to hospital or care
home• Out of Area Placement
Time – the other dimension
Time – the other dimension - learning disability, mental health and other groupsRehabilitation. Inclusion, Outcomes!Independent LivingRisk management
And what matters• Leadership at all levels• Shared Vision between partners• Communication across systems - and within
individual organisations• Shared approach to service monitoring and review• Culture of reflective innovative practice, and
review• Sharing and managing financial risk• Multidisciplinary working
And without it!• Pre – judged referrals• Differing ideologies between health and social care• Lack of engagement with patients and carers• Duplication of assessments• Pace of assessments• Poor Quality and inconsistent documentation• Need for progress chasing• Poor information to providers• Engagement with independent sector• Lack of good information to community staff
So!
• Leadership and Planning• Discharge policy/ies• Communication and Co-ordination• Assessment and Care Co-ordination• Good Documentation• Data Collection• Discharge Arrangements and Protocols• Training and Education• Outcomes for Users and Carers
