Commissioning and monitoring of Independent Mental Capacity Advocate (IMCA) services
Which local authority is responsible for commissioning?
The MCA Code of Practice says the IMCA service to be instructed is the one which ‘works wherever the person is at the time that the person needs support and representation’ (10.12).
There is a strong consensus for which local authority is responsible for commissioning the IMCA service for the different IMCA roles. This is set out below and included in the example service specification.
- Accommodation decisions and 39A IMCA role: where the person is staying before a possible move, for example in hospital awaiting discharge.
- SMT decisions: where the person is staying rather than where the medical practioners who need to make the decision are based (e.g. if the person has an outpatient appointment with a consultant who has made the instruction in a different local authority it would be the IMCA service where they live).
- Safeguarding adult cases: where the person is staying. In the majority of cases this will be the local authority which is responsible for coordinating the safeguarding adults process. In exceptional circumstances the person may be staying in a different local authority to where the abuse is alleged to have occurred.
- Care reviews, 39C IMCA roles: where the person is staying.
- 39D IMCA role: where the person is staying. This includes if the IMCA is instructed to support a relevant person’s representative who lives in a different area. This is because the IMCA is still required to meet the person where practical and appropriate. The IMCA ’s support to the person’s representative may be provided over the phone or in person when they have the required contact with the person they are representing.
Where the person is staying may change to a different local authority after the instruction of an IMCA and before decisions are made. For example:
- A person who has an IMCA instructed for an SMT decision may be admitted into hospital before final decisions have been made about their treatment.
- A person who has an IMCA instructed for safeguarding adult decision may be moved temporarily during the investigation process.
- A person who has an IMCA instructed for an accommodation decision may need to move into temporary accommodation.
In many such cases it would be desirable for the same IMCA service to continue to work with the person. In others, particularly where the person has moved a significant distance away, where they are unlikely to return to the original local authority, or where the IMCA has limited contact with the person before the move, it may be appropriate for another IMCA service to be instructed.
There is a positive picture of different IMCA services working flexibly in such situations and so there is little need to specify what should happen in such cases in the service specification.
The commissioning responsibilities set out above have avoided the need to cross charge local authorities or health trusts. It is unlikely that there would be any financial saving to local authorities were they to attempt to charge for ‘out-of-area’ instructions.
The administrative costs of any ‘recharging’ may instead increase the real costs for the IMCA service.