Report introduction: MCA and care planning

This report shows commissioners and providers of care how to embed the principles of the Mental Capacity Act (MCA) into care and support planning across the board.

Foreword by Baroness Liz Barker

Baroness Liz Barker, House of Lords Select Committee

The Mental Capacity Act 2005 (MCA) is widely recognised by those who work in health, social care and beyond as a positive and potentially transformative piece of legislation. Yet there is some way to go before it is widely understood and implemented.

Many of those who lack or have fluctuating capacity miss out on their fundamental rights to make, or influence, important decisions about their own care. That isn’t right. The House of Lords Select Committee on the Act set out a clear challenge to government to re-commit to implementing the Act in practice. This report, commissioned by the Department of Health, represents part of this re-commitment.

Good, person-centred, care and support planning is a vital part of protecting our freedom, choices and rights when we are at our most vulnerable.

Plans should be flexible tools that maximise people’s freedom to make decisions about their own care, lives and deaths. They should also clearly document how, when a person lacks capacity, decisions are made in their best interests and how their rights would be protected even when they are deprived of their liberty.

This report shows commissioners and providers of care how to embed the principles of the Mental Capacity Act into care and support planning right across the board.  

I welcome the publication of SCIE’s report and its contribution to the important work of making the Mental Capacity Act a reality.

Baroness Liz Barker
House of Lords Select Commitee on the Mental Capacity Act 2005

Purpose of this report

The MCA protects people’s basic human right to live the lives that they choose as far as they are able. Integrating the principles of the MCA into care planning and practice can transform the experience of adults with care and support needs. 

This report is not intended as a guide to care planning, commissioning or the MCA. There are already excellent resources available on each of these topics. What it does offer is a starting point for both commissioners and providers to understand and demonstrate how care and support plans can comply with the principles of the MCA.

A human being is a human being. Behaviours may be erratic, chaotic or self-sabotaging, but people still retain their human rights [1]

Despite examples of good practice, there is still considerable uncertainty about what the MCA means for care planning.

Care and support plans can and should:

  • consider questions of autonomy and liberty
  • reflect the efforts staff have made to maximise people’s capacity to be involved and to make decisions
  • reflect the right of people, who have capacity, to make unwise decisions.

Commissioners must check that providers are aware of this, and are implementing it – for all people, including those with challenging behaviour or complex needs.

This report aims to encourage and challenge providers to perform care planning differently and better; to think about promoting rights and liberty, promoting people’s capacity to make decisions about their life and their care, and supporting people to be involved in every decision about their care. It also encourages commissioners of residential and domiciliary care services to question and scrutinise care planning to ensure that it meets the requirements of the MCA and delivers human rights.

The report will also be of interest to people who use care services, their families or other caregivers. By setting out the principles of good quality care planning under the MCA, this report tells people what they can expect and what can be achieved.

A note on terminology

The terms ‘capacity’ or ‘lack of capacity’ are used throughout this report to refer to capacity that is specific to each decision at the time that it needs to be made.

How this report was produced

This report was commissioned by the Department of Health (DH) as part of its programme to implement the MCA 2005. The Social Care Institute for Excellence (SCIE) carried out a scope of available research on care planning and the MCA, which forms the basis of this report. Members of an advisory group of users and stakeholders from across the social care sector have also contributed to the content by drawing on their experiences.

The report was reviewed in September 2017.

What to look for in care and support planning

The report contains examples of evidence to illustrate what MCA-compliant care planning might look like. These examples are intended to be used as prompts. Not all of these prompts will be relevant to every situation, so you will need to pick and mix. Some of the evidence will be found in the care and support plan itself; other evidence may be in the care planning assessment documentation or may be gleaned from conversations with staff, users and/or their relatives/carers. 

Mental Capacity Act (MCA) and care planning (SCIE Report 70)
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  1. Gardiner, L. (2014) Contribution by member of the Mental Capacity Act and Care Planning Advisory Group.