This toolkit helps to understand if correct processes are correctly being undertaken in relation to the MCA (2005); to ensure the MCA is being completed and fully documented including the consent form, MCA/determination of best interests form; to provide a base line audit to ensure practice is embedded across services; and to provide robust procedural evidence for internal and external assurance. The tool may be adapted to align to local provider policies and procedural documents.

Findings of an audit on the use of the MCA and Safeguarding Adults procedures across the nine prison and young offender institution healthcare teams in London. The audit reveals that: safeguarding is afforded a high priority by offender healthcare services; the organisational infrastructures for safeguarding (policies, procedures, training, etc) were rated higher than the infrastructures for the Mental Capacity Act (MCA); there are good working relationships between prison authorities and healthcare services around safeguarding, but the role of healthcare staff in safeguarding is limited by the prison context; mental capacity tends to be treated within offender healthcare services as an aspect of safeguarding; knowledge of and practice around the MCA is patchy – senior clinicians tend to have a good grasp of their obligations under the Act and how to apply them, while frontline nursing and other staff generally do not; there is a very weak infrastructure to support practice in relation to the MCA (policies and procedures, training, information, guidance, supervision, records); it is recommended that priority be given to strengthening the infrastructure to ensure that frontline practice in offender healthcare services is compliant with the MCA and the Care Act.