Brings together emergency guidance for health and social care staff in England and Wales who are caring for, or treating, a person who lacks the relevant mental capacity during the coronavirus outbreak. The guidance ensures that decision makers are clear about the steps they need to take during this period. It focuses on new scenarios and potential ‘deprivations of liberty’ created by the outbreak. During the outbreak, the principles of the Mental Capacity Act 2005 (MCA) and the safeguards provided by the deprivation of liberty safeguards (DoLS) still apply. The MCA provides protection for people who lack or may lack the relevant mental capacity to make decisions about different aspects of their life. The DoLS are an important part of this act and provide further safeguards for those who need to be deprived of their liberty in order to receive care or treatment in a care home or hospital, but do not have the capacity to consent to those arrangements. [Published 9 April 2020. Last updated 27 April 2021]

Up to 75% of UK care home residents may lack the mental capacity to make certain decisions (Wade, Clinical Rehabilitation, 2019, 33, 1561-1570). Care home staff need evidence-based tools to help them assess residents’ mental capacity and provide decision-making support (NICE, Decision-making and mental capacity NICE guideline NG108, 2018). The Mental Capacity Assessment Support Toolkit (MCAST) was designed to support multidisciplinary healthcare staff to prepare, complete and document legally compliant mental capacity assessments. MCAST has not yet been trialled in care homes. This study used a descriptive qualitative design to: (a) understand the current challenges faced by care home staff when supporting residents to make decisions and participate in mental capacity assessments; (b) explore staff members’ support needs in this context and (c) to identify if and how the toolkit could be adapted for use in care homes. A purposive sample of 29 staff working as managers (n = 18), nurses (n = 7) and care assistants (n = 4) across five care homes in North West England participated in five semi-structured focus groups between May and July 2019. Data from the focus group transcripts were analysed thematically (Braun & Clarke, Qualitative Research in Psychology, 2006, 3, 77-101). Five main themes were identified: (a) involvement of residents in decision-making; (b) approaches to mental capacity assessment; (c) working with residents with communication difficulties; (d) feelings about practice and (e) responses to MCAST. Participants appeared competent and confident about supporting decision-making and assessing capacity, but recognised the complexity of this area of practice, and identified a need for further support. They reported a range of challenges, including accessing support from speech and language therapists for residents with communication needs. They responded positively to the toolkit and were keen to use it in practice. This study suggests that care home staff would benefit from, and welcome, support to develop their practice. Furthermore, MCAST appears usable in this context and formal feasibility testing is justified.

A short film depicting scenes in a domestic setting between an older man and his domiciliary care worker. The film introduces the principles of the Mental Capacity Act in relation to a financial decision.

A resource to help health and social care staff apply learning from MCA courses to their practice. The document lists the five guiding principles; outlines some of the things care workers do every day showing they are applying the MCA; and contains a reflective log template to help staff identify when they have applied one of the 5 principles in their work.