IMCA involvement in accommodation decisions and care reviews

Hospital discharge

A common IMCA instruction involves patients in hospital where a decision needs to be made about where they are discharged to. There are pressures for these decisions to be taken in a timely manner. Most importantly, it will usually be in a person's best interests to leave hospital after they have been declared ready for discharge. This will, for example, reduce the risk of a hospital-acquired infection. There are also financial pressures.

IMCA instruction should happen as soon as a potential accommodation decision arises (and not wait until the person has been judged ready for discharge). It is good practice for people who may be eligible for an IMCA – for either serious medical treatment or accommodation decisions – to be identified on admission.

The Community Care (Delayed Discharges etc.) Act 2003 set out how local authorities and health trusts should work together to minimise delayed discharge. There is a responsibility for the health body to advise the local authority if someone may need community care services on discharge in advance of the decision to discharge. The health trust could at this point advise the local authority if an IMCA may need to be instructed. Local authorities are required to produce discharge plans within fixed timescales and where they do not achieve this they can be fined by the health authority.

IMCAs may need to assert that this specific act does not remove both authorities' responsibilities to comply with the MCA in regard to making best interests decisions. They should ensure that there is adequate time to explore options, paying particular attention to the possibility of the person returning to where they lived before the admission as this may be the least restrictive option. This may in turn require introducing or increasing a package of support and home adaptations. An interim move may be suggested – for example, to allow adaptations to a home to be made, or for a fuller exploration of the person's best interests.

Practice example

Peter, an IMCA, was instructed to represent Mr Hill who had been admitted to hospital following a fall. While there he was diagnosed with dementia. A decision needed to be made about where he was to be discharged to. Peter met Mr Hill twice while in hospital. Mr Hill expressed clearly that he wanted to go home. He also talked about his belief in God and how he and his wife used to sing along to Songs of Praise when it was on television. While Mr Hill responded to some questions in a limited way, he became very animated when Peter asked him about animals and talked about his love of birds.

Peter contacted Mr Hill's neighbour who had known him for over 20 years. The neighbour described the importance of Mr Hill's garden and how he fed the birds even when he was not eating himself.

A best interests meeting was held with Mr Hill on the ward, chaired by his social worker. It was decided that it wasn't in Mr Hill's best interests to return home. Two care homes were being considered. It was agreed that Peter would visit both homes and afterwards meet with Mr Hill to show him the photographs he would take.

A further best interests meeting agreed that one home was preferable because it had a ground floor bedroom available which opened onto a secure garden. The manager of this home said they could support Mr Hill to feed birds in this garden and make sure he did not miss Songs of Praise. Mr Hill was supported to visit this home before a final decision was made.

Peter recommended that an IMCA was instructed again for the care review which was scheduled two months later. He also checked that the home had a good record of Mr Hill's views and wishes recorded in the care plan.

(Example provided by Asist advocacy services in Staffordshire)