Commissioning and monitoring of Independent Mental Capacity Advocate (IMCA) services
The draft service specification (appendix 1) sets out a range of suggested information that IMCA services should provide for monitoring purposes. This includes:
- number of eligible and ineligible referrals
- types of referral, i.e. accommodation, serious medical treatment (SMT), etc
- figures relating to age, ethnicity and gender
- hours spent on case work
- staff turnover
- training and supervision of staff.
This information is expected to be provided quarterly. Some concern has been expressed that some IMCA providers are required to collect additional data which is time-consuming to collate but provides little information about the functioning or quality of the service.
DH IMCA database
Since April 2007 the DH has expected all IMCA services to log individual cases on a national database. In addition to the case data above, it asks specifically about:
- nature of mental impairment
- why referrals were deemed ineligible
- second medical opinions
- whether a formal challenge was undertaken
- where the person was at the time of referral
- nature of SMT decisions
- whether IMCA reports were submitted and the reason if not.
The current questions asked on the DH IMCA database are included in Appendix 2.
The database allows analysis of the IMCA service nationally. Most IMCA providers in addition maintain their own databases to support the recording of the IMCAs work in relation to individual instructions.
An annual analysis of the national data is available from the IMCA page on the DH website. IMCA providers can produce reports from the DH website regarding the services they provide. Local authorities are able to access information about the IMCA services they commission.
Commissioners will want to include a requirement for the IMCA provider to maintain the DH’s IMCA database in the services specification.
There needs to be extreme caution about trying to make comparisons of quality between different IMCA providers from the DH IMCA database. This is because individual IMCAs and providers may answer some questions quite differently. For example, in response to the question whether the IMCA challenged the outcome, some IMCAs will only mark ‘yes’ if a formal challenge was initiated (e.g. a formal complaint or legal action) while others will mark ‘yes’ if the IMCA informally raised issues which may have led to a different outcome for the person. Similarly, in response to whether the IMCA was satisfied that their involvement provided a safeguard for the client, some IMCAs are only marking ‘yes’ if they believed they positively affected the outcome for the person, while others are marking ‘yes’ if, regardless of the impact of the IMCA , the outcome for the person was satisfactory.