Fluctuating capacity and how to address future uncertainties of care planning in a section 21A appeal

By Emma Sutton (instructed on behalf of MB) and Rebecca Evan-Williams (CJCH Solicitors). Re-post of article from No5 Barristers Chambers.

31 January 2018

Background

The court had before it an application brought on behalf of MB pursuant to section 21A of the Mental Capacity Act 2005 (‘the Act’) by his RPR, Mrs Claire Reid, to challenge a standard authorisation made in accordance with schedule A1 of that Act; the primary challenges being whether the mental capacity and best interests qualifying requirements were met. So far, so good.

MB had resided in a care home since 2008 and had a diagnosis of moderate learning disability, autism spectrum disorder and complex epilepsy and as a consequence of his diagnoses, required close supervision of daily living and prompting from his carers.

Due to the complexities of MB’s presentation, a number of expert reports were necessary to assist the court to resolve the proceedings and a position was reached whereby the capacity evidence prepared by Dr Michael Layton (Consultant Psychiatrist) and Dr Lisa Rippon (Consultant Developmental Psychiatrist), and their jointly prepared statement, was accepted by the parties. The expert evidence unanimously concluded that MB had the capacity to make decisions regarding his residence and care needs, but lacked the capacity to conduct the proceedings.

By reason of the above, the court accepted that it had no jurisdiction to make best interest decisions regarding MB’s residence and care; notwithstanding his requests to leave his care home and move to alternative accommodation. The court determined (per section 21A(2)(a) and section 21A(3)(a) of the Act) that MB did not meet all of the necessary qualifying requirements in order for a standard authorisation to be in place (the mental capacity qualifying requirement not being met), and on such basis, the standard authorisaation was terminated with immediate effect.

Comment

Mrs Reid, as MB’s litigation friend, fully recognised that MB would (as a consequence of the expert evidence) effectively be removed from the procedural safeguards contained in schedule A1 of the Act. Her status as RPR would also end upon the termination of the standard authorisation.

Although his ‘appeal’ had been successful, careful consideration had to be given prior to the final hearing as to whether the case fell into the ambit where ‘contingent’ capacity decisions were appropriate. The Court of Protection Practice helpfully provides a template order [see pages 2362-2364 of the 2017 edition] for such circumstances and this was brought to the courts attention. However, on the facts of this particular case, it was accepted that there was no identifiable external trigger which would ‘cause’ a loss of capacity – for example, another person who unduly influences P, P resorting to alcohol use, capacity being dependent on a continuance of training/ advice etc.

Instead, MB’s fluctuation of capacity was intrinsically linked to his own inherent complex functioning and could not be put into a prescribed ‘box’ of when he would and wouldn’t have the ability to make capacitous decisions. In this regard, the experts said this:

Both Dr Rippon and Dr Leighton agreed that MB’s capacity could fluctuate during times of seizure activity but also when his level of anxiety rises and he becomes distressed because of environmental triggers. It was Dr Leighton’s view that these periods could last for several days and he gave the example of the time that MB had become angry with his RPR and had refused to see her for a week. However, what is less clear is whether his capacity was affected over the whole of this period. Therefore, although both doctors agreed that MB’s capacity had fluctuated, what is less certain is how long these periods could last(my emphasis)

As MB’s care plan had (for the past 10 years) met his complex needs, and due to the lack of specificity regarding whether and if so, for how long, seizure activity could potentially impact on his decision making, it was not considered appropriate for further exploration to be given to this issue – particularly as the ongoing nature of the proceedings was having an impact on MB.

A further point that required consideration was whether the appointment of an independent advocate (within the meaning of section 67 of the Care Act 2014) to represent and support MB for the purpose of any future needs assessment and the preparation of a care and support plan (etc) was necessary.

This was raised on behalf of MB which HHJ Parry addresses in her Judgment (with reference to the Care and Support (Independent Advocacy Support) (Number 2) Regulations 2014) and emphasised that the order would record ‘the Local Authority’s willingness and indeed, in my view, obligation to consider this ongoing additional support for MB in the decisions that he will now be making on his own behalf’.

Although set out in a recital (which is positive for reference as to the ‘reasonableness’ of future actions) this ultimately relates to a primary issue that the powers of the court do not extend to decisions compelling parties to provide services for P (N (Appellant) v ACCG and others (Respondents) [2017] UKSC 22, Baroness Hale, paragraph 29).

 

 

Emma Sutton was instructed by Rebecca Evan-Williams and Amy Rees-Roberts (Partner) of CJCH Solicitors (Cardiff) on behalf of MB

Claire Reid is a professional RPR and Project Lead for Training in Mind

Reflection on Mental Health Awareness Week with a look to the future.

By Keith James, Solicitor/Partner

Last week, 8 to 14 May 2017, marked UK Mental Health Awareness week for 2017. The purpose of this annual event is to ‘prompt a national conversation about what we can do as communities, schools, families and individuals ‘to move from surviving to thriving’ (The Mental health foundation).

There is little doubt that in recent months awareness of the wide variety of mental health conditions and of the impact of mental health problems has grown and now appears to be rising up the political agenda.

High profile individuals who have experienced the impact of issues such as depression, including prominent figures in the football world, have helped to shine a light on how mental health problems can impact on the lives of everyday people – Mental Health issues do not discriminate.

Also in the news have been many stories from prominent individuals of how bereavement can impact on families and how help can be provided to families to talk through these issues.

Of particular current interest is how the result of the general election will impact on Mental Health Law and the provision of Mental Health Services. Already suggestions have been made of manifesto commitments to increase provision of community mental health staff and services but also a suggestion that the Mental Health Act should be replaced. This perhaps is the most intriguing suggestion.

The Mental Health Charity, Mind, has called for a review of the Mental health Act but there is a suggestion this could go further to avoid ‘unnecessary detentions’. It will certainly be interesting, during the General Election campaign, to see if this forms part of a manifesto commitment. Of particular interest will be what alternative proposals are suggested.

There is little doubt that Mental Health issues have risen up the political agenda, and for CJCH will continue to be an important part of our focus and drive to support our community.

For any questions or queries, please do not hesitate to contact our Mental Health and Mental Capacity Law team at mentalhealth@cjch.co.uk or call on +44 333 231 6405 (24 hour emergency line: +44 7967 305949)

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Planning for tomorrow – Introduction to Lasting Power of Attorney

By John Moore, Solicitor

We live in a time of better healthcare and advances in science where we are able to enjoy life for longer than previous generations.  We never know what is around the corner, however, with many people experiencing challenges with their mental health in their later years or are incapacitated through accident, injury or illness.

Here at CJCH, we regularly meet people of all ages who come to us for advice and who are concerned about safeguarding their personal affairs in the future.  Where appropriate, we try and assist by arranging a Lasting Power of Attorney for our clients in respect of their property and financial affairs.

A Lasting Power of Attorney is a legal document which allows individuals to appoint someone of their choosing to act on their behalf (as their attorney) if they are no longer able to manage things themselves for whatever reason. An attorney would be able to access a person’s property and finances to help pay bills, manage investments and pay care home fees. An attorney is legally under a duty, however, to act in the person’s best interest at all times.

Sadly, however, many people that we meet have loved ones who have not set up a Lasting Power of Attorney and no longer have the mental capacity, whether by illness or accident, to be able to do so.  We often find that family members hit a brick wall when dealing with banks and buildings societies who will of course only deal with the account holder themselves.  As there is no one legally able to act for the person it means that there are often situations where bills and care fees cannot be paid. This causes a great deal of stress for everyone involved because a person’s finances cannot be accessed or their property cannot be managed or sold.

In order to resolve this our team of experienced lawyers represent families in making applications to the Court of Protection so that family members can be appointed as Deputies to manage a person’s property and financial affairs.  Once the Court has approved an application the family members who have applied will be able to access a person’s finances and manage the sale of a property under a Court Order.  The Majority of applications to the Court are straightforward and dealt with on paper and do not require any attendance at Court.

If you would like to speak with us for a free consultation on better preparing for your future to ensure those things that are so important to you can be managed property should you no longer be able to do so yourself, you can contact Mr John Moore (solicitor) in our Private Clients department:

Telephone number0333 231 6405, or email privateclients@cjch.co.uk.

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