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Mental Capacity Act poorly understood by care staff, CQC report reveals

The Care Quality Commission (CQC) has revealed a widespread lack of understanding among residential carers about the Mental Capacity Act and the Deprivation of Liberty Safeguards, finding excessive use of restraint in some care homes and hospitals.

The CQC said carers and professionals need to make more effort to understand someone's capacity to make decisions before resorting to restraint.

The report by the regulator of health care and adult social care services in England into its monitoring of the Deprivation of Liberty Safeguards found that too often senior staff had received training in Mental Capacity Act requirements but care staff had not.

The report also found that patients not detained under the MCA but sharing a ward with others who were subject to the mental capacity legislation were sometimes being restricted in a similar fashion.

The lack of involvement in decisions of people who use services and their relatives/friends was a further finding, described by CQC as a "significant omission". The regulator made it clear that consultation with "the ‘relevant person’ and with their relatives and/or close friends interested in their welfare" is a mandatory part of the assessment process.

David Behan, CQC Chief Executive, said: “If someone has dementia or has a severe learning disability they can still contribute to decisions about their care. If this is done properly then people will receive appropriate care; if it is not done then people can be deprived of their liberty. Understanding the Mental Capacity Act and the way it is applied is critical to good quality, safe care. Those providing services, must ensure that their staff understand the Act and what it means for the care and treatment of people.”

The CQC acknowledged that it needed to play its own part in improving understanding, outlining how work was needed to ensure inspectors "have a sufficient level of understanding of the MCA to support a consistent and effective approach to monitoring the use of the Safeguards".

BASW England Manager Ruth Cartwright said the findings did not come as a shock: "BASW has long held concerns about the way decisions can be made for rather than with those with dementia, learning disabilities and other mental impairments. This can happen particularly when there is some urgency, such as when someone is leaving hospital or a crisis has arisen at home.

"The legislation is clear: capacity should be presumed and a person should be enabled to make decisions and express views where they can, even if they do not have full capacity. It may take time for decisions to be reached but this is an important part of treating people fairly and with dignity."

View the report in full here