The Journal of Adult Protection

Lynne Phair; Jill Manthorpe

2012 The Journal of Adult Protection

doi: 10.1108/14668201211286020

Purpose – This paper seeks to present findings from a review of hospital policies and practices in one NHS Trust in England. Design/methodology/approach – The focus of the review was hospital staff policy and practice in safeguarding the rights of vulnerable patients. A sample of staff was surveyed to investigate their knowledge of the Mental Capacity Act 2005 in 2010. Interviews, incorporating discussion of a vignette, were undertaken with a range of staff and findings were analysed thematically. These findings are contextualised by an analysis of Trust policies and the wider literature. The findings of this case study are used to develop recommendations for the hospital and healthcare sectors. Findings – Analysis of survey data and interviews revealed limited confidence and knowledge about the Mental Capacity Act 2005 and uncertainties about its relevance to clinical practice. In relation to safeguarding, there was limited realisation of the potential of the Act to uphold the rights of patients lacking capacity and staff responsibilities. MCA training had not made a great impression; hospital policies were inconsistent and lacked coherence. Research limitations/implications – This case study was conducted in one Trust and may not be generalisable. Other hospitals may have different training, policy and procedure systems. Practical implications – The findings of this case study may be applicable to other hospitals and to other providers of health and social care services. The relevance of the MCA could be highlighted and used on several induction and training programmes. The study identifies features of policy and practice that could be investigated in other organisations. Originality/value – Few studies have investigated the operationalisation of the MCA in hospital settings. This study reveals that there are opportunities to refresh MCA and safeguarding training strategies for hospital staff but these should be accompanied by changes to culture and attention to the coherence of different procedures. Audits of MCA and safeguarding compliance can be undertaken within hospitals and a systems approach could be adopted to address any issues identified and to sustain good practice.

Matthew Gough; Lianne Kerlin

2012 The Journal of Adult Protection

doi: 10.1108/14668201211286048

Purpose – The Mental Capacity Act (MCA) was implemented in 2007 as a piece of legislation to empower and protect adults who require support making decisions. Many older adults in residential care homes will be in this position due to developmental disabilities associated with functional impairments of the mind and brain. This paper aims to evaluate the impact of MCA training within older persons' care homes within an East‐Midlands local authority. Design/methodology/approach – Semi structured interviews were conducted with key informants who had strategic responsibility for implementation of MCA training as well as a focus group conducted with managers/deputy managers of care homes within the local authority. Findings – With a primary focus on training, data revealed issues surrounding the delivery and content of training, and the organisational factors relating to both training and the subsequent implementation of the knowledge learned. Research limitations/implications – The key informants for this paper are limited to management perspectives. Interviews and a focus group were conducted with stakeholders who either had direct responsibility for service delivery or managerial oversight for training and development. Practical implications – The paper suggests methods of delivery with the Mental Capacity Act which offer a tailored, engaging and cost effective alternative to conventional “away day” training sessions. Originality/value – The paper challenges and critiques conventional approaches to training the social care workforce.

David Hewitt

2012 The Journal of Adult Protection

doi: 10.1108/14668201211286057

Purpose – This paper's aim is to consider three ways in which, recently, the English courts have sought to define deprivation of liberty (and, maybe, limit the effect of safeguards against it). Design/methodology/approach – Two significant decisions of the Court of Appeal were considered, together with one each of the House of Lords and the European Court of Human Rights. Consideration was also given to the context of those decisions, as disclosed in official policy documents and at least one piece of academic research. Findings – The decisions in question have limited the circumstances that will amount to deprivation of liberty and thereby reduced the scope of the Deprivation of Liberty Safeguards (DoLS). The English courts' understanding of false imprisonment is diverging from their understanding of deprivation of liberty. The English courts differ from the European Court of Human Rights in their understanding of the relevance of “purpose” to the question of deprivation of liberty. If the former are correct, the DoLS – and maybe even the Mental Health Act – are redundant. Originality/value – This is the first time these cases, and this subject, have been analysed in this way; and that these findings have been published together.

Alison Faulkner

2012 The Journal of Adult Protection

doi: 10.1108/14668201211286066

Purpose – Commissioned as part of a Joseph Rowntree Foundation scoping programme, this consultation aims to explore the views of disabled people and service users about risk. Design/methodology/approach – The consultation reached nine individuals and one focus group, reaching a total of 17 disabled people and service users. Their views were supplemented by the literature. Findings – The landscape of risk and rights is highly complex. Disabled people and service users have quite different concerns about risk to those of the professionals and the regulatory bodies acting on their behalf. Many people talked of the fear of losing their independence, of asserting their rights and the fear of powerlessness in the face of bureaucracy and (sometimes) uncaring staff. Research limitations/implications – The profile of rights needs to be raised in an accessible and acceptable way: it is necessary to make the language of rights more commonplace. There is a particular need to reach into mental health and residential care services to find ways of enabling people to have their rights realised. The report has implications for risk assessment and risk management as well as for the regulatory bodies responsible in adult social care. Raising awareness among professionals and policy makers about the risks that service users themselves fear and experience should demonstrate just how important it is that the people whose risk is under consideration are involved in the process. Originality/value – This paper highlights the views of users of adult social care about risk; their views have rarely been documented.

Alison Brammer

2012 The Journal of Adult Protection

doi: 10.1108/14668201211286822

Purpose – This paper aims to summarize the work of the Court of Protection. Design/methodology/approach – The paper outlines the history and range of applications within the jurisdiction of the Court, drawing from the Mental Capacity Act and the Code of Practice. Reference is made to annual reports of the work of the court which profile its workload. Finally there is a review of a line of case law dealing with the question of media attendance and reporting of cases before the court. Findings – The Court in its current form was established under The Mental Capacity Act, 2005 and is a significant decision‐making body in the UK within adult safeguarding practice concerning adults whose decision‐making capacity is impaired. The implications of several specific cases are discussed. Originality/value – This paper provides a unique insight into the work of the Court of Protection and the implications of recent decisions by the Court for adult safeguarding.