IMCA involvement in accommodation decisions and care reviews

Which care reviews can IMCAs be instructed for?

Local authorities and NHS trusts have the power of instructing an IMCA when they are undertaking reviews for individuals staying in accommodation arranged by a local authority or NHS trust, including care homes and hospitals.

Reviews include:

• care reviews for people in accommodation arranged by the local authority
• reviews undertaken by PCTs for those people who are receiving continuing healthcare
• care plan reviews undertaken by NHS trusts for inpatients.

The requirements are:

• the person lacks capacity to make a decision about their accommodation
• there are no family and friends who are appropriate to consult
• the person has been staying, or is likely to stay, in the accommodation for a continuous period of more than 12 weeks.

This power does not apply if the person is required to live in the accommodation while detained under the MHA 1983 or if they are subject to an authorisation under the Deprivation of Liberty Safeguards.

Where a person meets the requirements for IMCA instruction in care reviews, local authorities and NHS trusts must consider in every case whether to use this power based on their assessment of the potential benefit to the person. If the power to instruct an IMCA is not used, it is good practice to record the reasons why in the care review record.

The MCA Code of Practice (10.61) expects local authorities and NHS bodies to have a policy setting out when this discretionary power to instruct IMCAs is used. The appendices provide template policies which can be adopted by local authorities and NHS bodies.

When should reviews take place?

Because needs are likely to change over time, local authorities are expected to undertake regular reviews. DH guidance says that good practice is to undertake a review within three months of a person moving to new accommodation or where there have been other major changes to the support plan. Otherwise, reviews should take place at least annually. The guidance, contained in Prioritising need in the context of Putting People First (DH 2010a) says that 'adults lacking capacity are likely to need more frequent monitoring arrangements than other service users' (Section 146).

For people receiving continuing healthcare, the NHS continuing healthcare practice guide (DH 2010b) recommends that reviews should similarly take place by the relevant PCT within three months of the decision to provide continuing care, and then at least annually.

For hospital patients it would be appropriate for the frequency of reviews to reflect these two guidance documents. This would include a review within three months of admission to hospital.