Abstract
Aims and method An audit cycle assessed compliance of healthcare professionals within Oxleas NHS Foundation Trust with the statutory requirements of the Mental Capacity Act 2005 in patient care. Each stage involved a retrospective review of relevant patient electronic records. The additional purpose of the audit was to make recommendations to improve compliance with the requirement of the Act by healthcare professionals and improve patient understanding of its provisions.Results The audit cycle demonstrated some improvement in clinical practice as well as the need for further efforts at raising the understanding and compliance of clinicians and the public with provisions of the Act.Clinical Implications Healthcare professionals need further understanding of the provisions of the Act and their responsibilities. There is also the need to enhance public awareness to provisions of the Act in relation to their decision-making autonomy. Stakeholders need to put strategies in place for these to be achieved.
Highlights
In 2009, 2 years after the Mental Capacity Act came into force, an audit was carried out at the Oxleas National Health Service (NHS) Foundation Trust to examine the compliance of clinicians with the prescriptions of the Act during capacity assessment as well as in the process of arriving at the best interests of individuals found to lack the relevant decision-making capacity
The outcome of the re-audit, highlights the need for further efforts at raising clinician compliance with prescriptions of the Act. This is in agreement with recent Care Quality Commission reports[5,6] as well as findings of the House of Lords select committee that scrutinised whether the Mental Capacity Act is working as Parliament intended,[7] i.e. that a lot of work remains to be done in raising the awareness as well as the understanding of healthcare professionals and the public to the utilisation of this piece of legislation
The capacity assessment tool designed after the initial audit has since been updated by one of the authors (O.S.) and made available to CSE Healthcare Systems through the London programme for IT Health and Social Care Information Centre (HSCIC) and features in RiO, the electronic patient care record system used by Oxleas NHS Foundation Trust as well as by some other mental health trusts around the country
Summary
The re-audit showed improvement in the details of documentation of the capacity assessment process by clinicians in terms of the diagnostic and functional tests involved in this process. There was a marginal increase in the efforts by clinicians to identify whether there was a court-appointed deputy to make decisions on behalf of non-capacitous individuals. In the cases where there was an effort at identifying the existence of a lasting power of attorney, the re-audit did not show improvement in the number of consultations with the named attorney. An encouraging finding of the re-audit was that clinical consultation with family members and friends with interests in the patient’s welfare continues to be a central part of the process of arriving at best interest decisions on behalf of non-capacitous individuals. Detailed entries were made of the best interest process in many more of the cases in the re-audit than at the initial audit. The re-audit found that there is still a distinct lack of effort in identifying whether an advance decision to refuse treatment was in place. There were more patients from White Irish and Pakistani ethnic groups than in the initial audit
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