An Independent Mental Capacity Advocacy (IMCA) story: Sonya and Jade

Jade - an IMCA (Independent Mental Capacity Advocate), was instructed to support decision-making around a change of accommodation for Sonya - an older lady with dementia.

Sonya was in hospital at the time of referral. She met the criteria for an IMCA, as she had been assessed as lacking the capacity to decide on her future accommodation and had no family or friends to support with this decision.

An IMCA has the right to view any records relevant to the decision. In the hospital notes, Jade discovered that Sonya had been admitted to hospital for emergency surgery and an operation had taken place under general anaesthetic. Under the Mental Capacity Act this is considered a Serious Medical Treatment decision and if the criteria are met, an IMCA should be instructed. This had not happened. A capacity assessment had not been undertaken, and the issue of consent had not been effectively considered.

This contravention of the both the Mental Capacity Act and the required statutory processes was reported to the Hospital Trust and a Major Incident investigation was launched. As a result of the investigation, recommendations were made and significant changes to the Trust procedures were implemented. These included increasing the frequency of MCA staff training across the Trust, providing bespoke MCA training for surgical, theatre and anaesthetic staff and an audit of the consent process.

These changes should help provide a safeguard for future patients.

Sonya recovered well from her surgery and a Best Interest decision was made, supported by Jade that her future care should be provided in a Nursing Care Home local to her previous home.

Sonya is subject to a Deprivation of Liberty Safeguard (DoLS) authorisation in the care home, as she is subject to continuous supervision and not free to leave. Jade was also instructed to represent Sonya as part of the assessment of the decision to authorise this Deprivation of her Liberty. Sonya continues to receive support from Jade who now acts in the role of Relevant Person's Representative.