MCA case study - 64 year old gentleman

Produced by: NHS London Purchased Healthcare Team
Supplied by: NELFT NHS Foundation Trust
Hosted on: National Mental Capacity Act (MCA) Directory

AH, a 64 year old gentleman was receiving on-going care from the district nurses (DNs) for chronic leg ulceration. There had been increasing concerns regarding the environment in which he lives. The flat is a warden controlled dwelling with shared bathroom facilities although there is a small room with a toilet/shower within the flat. The walls have been previously smeared with excrement, the floors were filthy and there was no bed linen available. AH has minimal personal possessions and clothing. He has had previous episodes of diarrhoea and has then discarded any incontinence pads freely around the rooms. He has also thrown away soiled clothing as opposed to laundering them.

The DNs have attempted to manage AH with the assistance of the GP regarding anti-depressant medication to some effect. There had been a multi-disciplinary team (MDT) meeting arranged for Christmas Eve. The DN’s accessed the Trust’s safeguarding adult’s Duty Desk asking for advice and whether they should raise a safeguarding adult’s alert. AH’s capacity as regards the impact on his health and well-being from the living environment was in question and support was offered by the Trust’s safeguarding adults team to assess this, which was accepted by the DNs.

On arrival at AH’s flat he was found to be sitting in an arm chair in the living/bedroom. There were flies present and the walls and carpet was soiled with dirt and other substances, which appeared to be body fluids and mould. The bathroom was soiled with excrement over the toilet and light fittings. AH’s demeanour was of a low mood and his remaining clothes were shabby. The DN dressed his leg wound whilst he was engaged in conversation to assess his capacity regarding the effects from the living space to the wound healing and potential complications. AH was able to demonstrate via the conversation that he understood these and was able to articulate the worse possible outcomes for the leg and his overall health. He had a realistic appreciation of the likelihood of harm and the potential seriousness of same. AH demonstrated an understanding of our concerns and was able to give informed consent to the raising of a safeguarding adults alert to the local authority. The alert was made in relation to his significant self-neglect as per one of the categories of harm under the Care Act 2014.

This intervention resulted in a good outcome that ensured the gentleman received an increased support package that assisted him to attain a marked improvement in his day to day life and prevented significant harm. The underpinning six principles of safeguarding adults work are Empowerment, Protection, Prevention, Proportionality, Partnership and Accountability. This intervention demonstrates empowerment of the service user to choose an intervention he was comfortable with, prevention of significant harm which was proportionate to the level of risk achieved in partnership with him and other agencies.

About this case study collection

Purpose: The purpose of this document is to share MCA cases that have taken place within London for NHS staff to refer to when dealing with difficult MCA cases.

Audience: Commissioner and Provider staff involved with MCA decision making.

Background: The London NHS Commissioner MCA Board identified a number of tools/documents to support them to gain MCA assurance. One of the requests was to share MCA case studies. This document outlines a number of MCA cases which has been shared by CCG and provider MCA leads across London.

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