Commissioning and monitoring of Independent Mental Capacity Advocate (IMCA) services

The range of services provided

In reviewing contracts, commissioners will want to consider what services should be provided in addition to the statutory requirement of providing IMCAs in response to instructions.

IMCA providers continue to act as a significant source of informal support to a range of health and social care staff about the workings of the MCA including IMCA . A lot of time is spent by most IMCA services dealing with enquiries regarding people who may be eligible for the service. In moving the service forward, commissioners should ideally be looking to reduce the volume of time spent by IMCA service providers in supporting the health and social care workforce in its understanding of the role of the IMCA service.

Many IMCA providers take an active role in supporting the local implementation of the MCA in other ways. Examples include participation in local implementation networks and working with NHS trusts to ensure their policies and procedures identify when IMCA instruction should be considered.

Where levels of demand for the IMCA service are lower than expected, commissioners will want to consider how the IMCA service can support local authority and NHS staff to be aware of their statutory responsibilities regarding instruction.

The legislation and associated regulations set out when there is a duty or power to instruct an IMCA . Paragraph 4.12 of the Explanatory Memorandum to the Mental Capacity Act 2005 (Independent Mental Capacity Advocates) (Expansion of Role) Regulations 2006), (Statutory Instrument 2006 no. 2883) states that the Expansion of Role Regulations do not prevent an NHS body or local authority from instructing an IMCA in other circumstances.

Where the service has spare capacity, having taken and continuing to take all opportunities to promote the statutory IMCA service, commissioners may want to make arrangements and establish clear criteria for IMCAs to be available to represent and support other individuals lacking mental capacity where other best interests decisions are being made. In so doing it must always be made clear that the cases arising as a result of the local authorities’ and NHS bodies’ statutory duties and/or use of their discretionary powers must have the highest priority.

The example service specification indentifies five distinct functions of the IMCA service.

  1. Providing IMCAs
    Providing IMCAs to undertake the roles set out in the MCA and regulations when instructed by a person authorised to do so. This includes the additional IMCA roles introduced by the DoLS.
  2. IMCA information service
    This covers the work involved in responding to enquiries about access to the IMCA service. Typically this includes providing information about the eligibility criteria and process of instruction to people who may be aware of an individual who may require an IMCA . It is recommended that all work prior to the receipt of an instruction by an authorised person is considered as part of the IMCA information service.
  3. Awareness-raising and training
    This includes providing IMCA awareness-raising and training sessions to health and social care staff about the IMCA role. The extent to which the IMCA service undertakes this work may be determined by:
    • The commissioning of and availability of other MCA awareness-raising and training opportunities.
    • The ability of the IMCA service to respond directly and flexibly to need. This would include targeting specific teams or units where gaps in knowledge have been identified by an IMCA , for example arranging to attend a team meeting.
    • The opportunity for the IMCA provider to vary the balance of work between responding to IMCA instructions and awareness-raising and training.
  4. Supporting the local integration of the MCA into policy and practice
    Good practice is for the IMCA service to be a key partner in supporting the local integration of the MCA into practice. This includes contributing to any local implementation networks and safeguarding adult boards. It may also involve identifying and supporting local policy and practice issues. Through their work, IMCAs are in a unique position to identify gaps in knowledge of the MCA.
  5. Providing additional advocacy services
    One way to commission against a backdrop of fluctuating and expected increasing IMCA instructions is to permit the IMCA service to provide services other than those where the local authority or NHS body is required to, or may provide by statute where, as above, there is capacity to do so.