Involving an Independent Mental Capacity Advocate

The aim of the IMCA service is to provide an independent safeguard for people who have been deemed to lack capacity to make certain important decisions.

The person must be 16 years old or above and have no-one other than paid staff to be consulted or support and represent them. Before instructing an IMCA, clarify that the person has not previously named someone who could help with a decision and that they have not made a Lasting Power of Attorney.

An IMCA must be instructed and consulted for people lacking capacity in the following two situations:

An NHS body or Local Authority is proposing to arrange accommodation (or change accommodation) in hospital or a care home and the person will remain in hospital longer than 28 days or in a care home for longer than eight weeks.
An NHS body is proposing serious medical treatment. This relates to providing, withholding or withdrawing medical treatment. It is impossible to set out all types of procedures that may constitute serious medical treatment, although examples include: chemotherapy and surgery for cancer, major surgery (such as open-heart surgery or neuro-surgery) and amputations. The British Medical Association, The Resuscitation Council (UK) and the Royal College of Nursing have issued a statement regarding IMCA and serious medical treatment.

“Where there is genuine doubt about whether or not CPR would have a realistic chance of success, or if a DNAR decision is being considered on the balance of benefits and burdens, in order to comply with the law an IMCA must be involved in every case”.

If in doubt, please contact the IMCA service to discuss.

An IMCA may be instructed and consulted by a responsible body to represent a person who lacks capacity in the following two situations;

A Care Review has been arranged and the responsible body has arranged accommodation for the person. There may be a review of the arrangements as part of a care plan and there are no family or friends who it would be appropriate to consult.
Adult Safeguarding cases where a person lacks capacity where it is alleged that the person is or has been abused or neglected by another person. It also applies if the person is abusing or has abused another person. In this case, an IMCA may be instructed whether there is family and friend involvement or not as long as the local authority or NHS propose to take or have already taken protective measures.

IMCAs may also be involved in Deprivation of Liberty situations.

Who instructs an IMCA?

The decision maker will normally instruct an IMCA. However, in some cases it could be a nurse referring to the IMCA service regarding serious medical treatment and a surgeon is the decision maker. An IMCA would need to clarify who the decision maker is in each case.

For example, the following could be decision makers in Salford depending upon the type of referral .

PCT General Practitioners
Local Authority Social workers
Acute MedicineNurses
Clinicians
Medical Consultants
Mental HealthNurses
Psychiatrists
Care Coordinators

How to consult/instruct an IMCA

If you have evidence to indicate that the person lacks capacity and the above criteria are met.

If you are unsure, contact the IMCA service to discuss the circumstances of the referral.
Be ready to share relevant information about:
What is the decision to be made?
How urgent is the decision?
Why you believe the person lacks capacity to make this particular decision. Evidence that a test for capacity has been recorded.
What reasonable steps you have already taken to enable the adults decision making ability, other professionals consulted (if any)
What reasonable steps you have already taken to identify family friend, the existence of Attorney or Advance Decision.
Complete the referral form at the bottom of this page and forward it to the IMCA service. Retain a copy on client/patient file.
The IMCA will contact the Decision Maker on receipt of the referral and liaise with them to arrange meeting with the person deemed to lack capacity. The IMCA will also consult everyone involved in the person’s care and treatment. The IMCA must write a report on their findings for the Decision Maker at the Local Authority or NHS body. The Decision Maker has a duty to consider the findings of the IMCA report in their decision making process.
Decision Maker and Referrer (if different) complete the IMCA service provider’s outcome questionnaire and returns to the IMCA service.

Inappropriate referrals to IMCA

Please note that IMCAS are not involved in emergency situations/ decisions.

IMCAs do not resolve conflict between families or services. The Code of Practice clearly states in Chapter 10 paragraph 10.79, “If a family disagrees with a decision-maker’s proposed action, this is not grounds for concluding that there is nobody whose views are relevant to the decision”.

For more information, referral forms or to consult/instruct an IMCA please contact our IMCA provider North West Advocacy Services