An individual (aged 16 and over) lacks capacity if they're unable to make a particular decision. An assessment of capacity must be based on a person’s ability to make a specific decision at the time it needs to be made, not their ability to make decisions in general. Someone can lack capacity to make one decision but be able to make others. Everyone must apply the five guiding principles of the Mental Capacity Act:

• An assumption of capacity
• Supporting people to make their own decisions
• People have the right to make eccentric or unwise decisions
• Where someone lacks capacity staff must act in the person's best interests
• Where someone lacks capacity any action we take on their behalf must generally be the least restrictive option

Step 1 is diagnostic: there must be some proof that the person has an impairment of the mind or brain, or some sort of disturbance that affects the way their mind or brain works. This could include the following:

• Conditions associated with some types of mental illness
• Dementia
• Significant learning disabilities
• Effects of brain damage
• Physical or medical conditions causing confusion, drowsiness, loss of consciousness
• Delirium
• Concussion, head injury
• Symptoms of alcohol or drug use

Step 2 is functional, and can only be carried out if step 1 is confirmed. Does the impairment mean the person is unable to make a specific decision when they need to? This is tested in four areas; a person is unable to make the decision if they fail any one of the four. Can they:

• Understand the information relating to the decision
• Retain the information long enough to make the decision
• Use and weigh the information
• Communicate the decision

If the person lacks capacity to make their own decision, a serious medical treatment or a permanent change of accommodation is proposed, and the person has no appropriate family or friends to support them with the decision, a referral to an IMCA must be made by the decision maker. Further information can be found on the POhWER website.

The new MCA competency framework for staff identifies training courses which are necessary and relevant to your role. Bespoke training can always be arranged, and practice based workshops are offered throughout the year. Find out more from our Joint Training team.

We have a suite of tools to assist our staff with issues of mental capacity:

• MCA checklist - supports any day-to-day decision making to check that it's being made in accordance with the MCA
• Best interests checklist - supports decision making on behalf of a person who lacks capacity
• Shropshire Mental Capacity Tool - used to record assessments of capacity to make bigger or more major decisions such as admission to residential care
• Best interests meeting agenda - an outline for any meeting held to decide what's in a person's best interests
• MCA and Care Planning Guides 1, 2 and 3 - guides to check that the MCA has been considered at all points in the care planning process
• Other resources are available on the Social Care Institute for Excellence website
• A variety of guidance materials are available for staff on the Local Government Association website

We've published standard and easy read versions of the Mental Capacity Act booklet.

Joint DoLS Team:

• Email: dols@shropshire.gov.uk
• Phone: 01743 255850