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Help those who find decision-making difficult, urges NICE

Even if you disagree with their choices, says draft guidance

Caroline White

Wednesday, 20 December 2017

Health and social care professionals should help those with the mental capacity to make decisions, but who find this difficult —even if you disagree with their choices, says new draft guidance from the National Institute for Health and Care Excellence (NICE).

People should not be assessed as lacking mental capacity because they make choices that professionals don’t recommend, the draft guidance says.

And health and social care services should also take all reasonable steps to help people who lack mental capacity to be involved in decisions made on their behalf.

This includes making sure any relevant information, such as a person’s views and beliefs, or a written statement made when they had capacity in the past is taken into account, says the guidance.

Advance care plans can set out a person’s wishes in relation to future care and decisions, the draft guidance says. This can be recorded through the use of visual aids or involving friends and family to help the person communicate their wishes.

Decisions that may need to be made on behalf of someone include consenting to medical treatment, what support they need, and financial matters.

NICE says staff who are assessing a person’s mental capacity should have sufficient knowledge of that person’s condition to understand how it can affect their ability to make decisions.

The Care Quality Commission estimates that around 2 million people in England and Wales may lack the capacity to make certain decisions for themselves at some point because of an illness, injury or disability.

Nageena Khalique QC, barrister at No5 Chambers and vice-chair of the committee, said: “If someone is assessed as lacking capacity to make a decision, we must do everything to keep them involved in the process and take into account their wishes and feelings. They should be at the heart of decisions made on their behalf.

“Our draft guidance will also help empower and support people who do have capacity to overcome difficulties they may face when making decisions. They should be provided with the right information to support that specific decision. Health and social care professionals should also make sure families, friends and carers are involved in these discussions.”

Independent advocacy should be provided if someone needs to be supported to make key decisions that are causing substantial difficulty, NICE says. Examples include moving into a care home or when safeguarding issues arise. Advocates can help people make these decisions if they do not have support from friends and family.

NICE also recommends service providers and responsible bodies involved in decision making ensure that staff are trained to enable them to apply the Mental Capacity Act 2005 and its Code of Practice.

Professor Gillian Leng, deputy chief executive at NICE, commented: “Our advice, once final, will support government legislation and make sure all steps are taken to keep people at the centre of the decision-making process.”

The draft guidance is now out for public consultation until 5 February 2018. Final guidance is scheduled for May next year. 

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