Mental Capacity Act Policy

Policies & Procedures

Mental Capacity Act 2025 Policy & Procedure v1.1

Mental Capacity Act 2005 Policy and Procedure

Policy and Procedure

1. Purpose

This policy explains how VCare Consultancy Services Limited applies the Mental Capacity Act 2005 (MCA) and its Code of Practice to day-to-day care, support and safeguarding activity. It sets out how staff presume capacity, support decision-making, assess capacity lawfully, make best-interests decisions where required and record decisions clearly.

2. Scope

This policy applies to all adults using VCare services and to all staff, workers, subcontractors and managers acting on behalf of VCare. It is relevant to care delivery, consent, safeguarding, information sharing, medication support, finances, accommodation-related decisions and restrictive practices.

3. Legal framework and core principles

• A person must be assumed to have capacity unless it is established that they lack capacity.
• A person is not to be treated as unable to make a decision unless all practicable steps to help them do so have been taken without success.
• A person is not to be treated as unable to make a decision merely because they make an unwise decision.
• Any act done or decision made for a person who lacks capacity must be done or made in their best interests.
• Before the act is done or decision is made, regard must be had to whether the purpose can be achieved in a way that is less restrictive of the person's rights and freedom of action.

4. When capacity must be considered

Staff must consider whether a capacity assessment is required whenever there is reasonable doubt about a person's ability to make a specific decision. Common examples include consent to care, safeguarding referrals, medication decisions, information sharing, finances, mobility restrictions, technology used for safety, accommodation moves and healthcare decisions.

5. Supporting a person to decide

• Provide information in a format the person can understand, using plain language, visual prompts, interpreters, family support or advocacy as appropriate.
• Choose the best time and environment for the discussion and allow enough time.
• Consider whether hearing aids, glasses, communication aids or pain relief are needed before the discussion.
• Revisit the decision if capacity may fluctuate or if short-term illness, distress or fatigue is affecting understanding.

6. Assessing capacity: the two-stage and functional test

Capacity assessments must be decision-specific and time-specific. The assessor must apply both stages of the MCA test:

1. Is there an impairment of, or disturbance in, the functioning of the mind or brain?
2. If so, does that impairment or disturbance mean the person is unable to make the specific decision when it needs to be made?

A person is unable to make the decision if they cannot do one or more of the following: understand the relevant information, retain that information long enough to make the decision, use or weigh that information as part of the decision-making process, or communicate the decision by any means.

Recording requirements

• What the specific decision is and why the assessment was needed.
• What practicable support was offered to help the person decide.
• The evidence for impairment/disturbance and the outcome of the functional test.
• Who completed the assessment, when, where and who else was consulted.

7. Best-interests decision-making

Where a person lacks capacity for the specific decision, VCare will make or support a best-interests decision in accordance with section 4 MCA. The decision-maker must:

• Involve the person as far as possible and use any communication support required.
• Consider the person's past and present wishes, feelings, beliefs and values.
• Consult anyone named by the person, family members, friends, attorneys, deputies, advocates and relevant professionals where practicable and appropriate.
• Avoid discrimination and ensure the decision is not based solely on age, appearance, condition or behaviour.
• Choose the least restrictive lawful option that achieves the intended purpose.

Complex or high-impact decisions should be discussed in a formal best-interests meeting. A written best-interests decision record must be completed and retained on file.

8. Consent, refusal and record keeping

Where a person has capacity, their valid consent or refusal must be respected, even where others disagree, unless another legal framework applies. Consent discussions and outcomes must be recorded clearly in care records and reviewed whenever there is a relevant change in needs, risks or presentation.

9. Independent Mental Capacity Advocate (IMCA)

An IMCA referral must be considered where the person lacks capacity for a serious medical treatment decision or a long-term accommodation move and has no appropriate family or friends to consult, or where safeguarding processes require independent representation under local arrangements. Staff must escalate this to the Registered Manager without delay.

10. Lasting Power of Attorney, deputies and advance decisions

Where relevant, VCare will verify whether there is a valid and applicable Lasting Power of Attorney, Court-appointed deputyship or Advance Decision to Refuse Treatment. Records will show what authority exists, what evidence has been seen and how this affects the decision-making process.

11. Restrictions, restraint and interface with DoLS

Any restrictive intervention must be necessary, proportionate and the least restrictive option. Restraint may only be used within the MCA where the person lacks capacity for the relevant decision and the restraint is necessary to prevent harm and proportionate to the likelihood and seriousness of that harm. Any ongoing or significant restriction must trigger consideration of whether there is, or may be, a deprivation of liberty and the DoLS / Court of Protection process must then be followed.

12. Training, supervision and quality assurance

• MCA training is mandatory at induction and refreshed regularly thereafter.
• Managers will review capacity assessments and best-interests records as part of care-record audits and supervision.
• Where assessments are in place for people using the service, these will be reviewed whenever circumstances change and, for ongoing decisions in residential settings or equivalent arrangements, at least monthly or in line with the care review cycle, whichever is sooner.

13. Responsibilities

14. Review and related policies

This policy will be reviewed annually or sooner if legislation, case law, national guidance or commissioning requirements change. It should be read with the Safeguarding Adults Policy, DoLS Policy, Consent Policy, Information Governance Policy and Care Planning and Risk Assessment Procedure.