Best interest meetings
Some decisions are controversial or complex so it is appropriate to hold a best interests meeting.
Best interests meetings can be formal or part of a multi-disciplinary meeting, for instance within a ward round. The decision-maker will need to consider what sort of meeting is appropriate and what sort of involvement and support is necessary for making and recording each particular decision.
A formal meeting will need to be chaired by someone other than the decision-maker. In Devon, this may be a Team Manager, or Senior Social Worker or Occupational Therapist. The Best Interest Meeting agenda outlines the issues that will be discussed in the meeting.
If a best interests meeting does not successfully resolve the issues, seek advice to discuss options. Your Team Manager may be the first point of contact in this.
Formal meetings to make complex decisions
A best interests meeting should include information from relevant professionals, family members and the person who lacks capacity. If these people don’t attend the meeting their views must be represented. This is a requirement in the best interests checklist. (s4 MCA) (Part 8: Best interests decisions)
- The decision-maker will need to convene the meeting, including arranging who will chair the meeting. There should be a formal record of the meeting and the decision made.
- A best interests meeting may be included as part of a multi-disciplinary team meeting, but it must be clear when the meeting becomes a best interests meeting, how it is organised and who should attend.
- Where the person does not have someone who can advocate on their behalf, an advocacy service should be engaged to support them through Devon Advocacy Consortium. Where the issue being considered is a deprivation of liberty, the Independent Mental Capacity Advocates (IMCAs) should be contacted.
- If a decision is being disputed you must seek advice.
Before the meeting the chair should liaise with the decision-maker to:
- check there is an appropriate and valid capacity assessment
- clarify exactly what the decision is
- clarify what information is necessary to make the decision
- plan the detail of the meeting, including where it will be held, when it should happen, who should attend, who will represent the views of those who can’t attend and who will take minutes
- organise any support needed by the person the decision is being made for, this may be support to understand the purpose of the meeting or to express their views
- organise any support needed by friends and family of the person
- prepare an agenda.
The agenda should cover:
- a statement about the confidentiality of the meeting and any related documents
- the purpose of the meeting – what decision is being made?
- confirmation of the decision-specific capacity assessment
- a review of the Best Interests Checklist to make sure everyone is clear about their statutory responsibilities under MCA (MCA section 4) (Part 8: Best Interests Decisions)
- information from relevant parties. What does the person who lacks capacity want? What is known about their previous wishes, their values and beliefs? This includes the view of anyone named as to be consulted such as someone with Lasting Power of Attorney, Enduring Power of Attorney or a deputy. Also include views from an Independent Mental Capacity Advocate (IMCA) or other advocate, views from family, friends or supporters and the views of professionals (MCA section 4)
- discussion – the chair will need to make sure that everyone can participate
- a summary from the chair, including a risk assessment.
- the decision that the meeting believes is in the person’s best interests – the decision-maker is still responsible for making the decision and they are not obligated to follow the decision of the meeting, but will need a clear reason if they do not.
- the action plan – the meeting may ask for further assessments or reports and then reconvene. There may need to be interim decisions made about the person’s safety or care. Other actions or decisions may become clear during the meeting
- making decisions about how to proceed if the meeting cannot agree.
After the meeting the chair should:
- make sure an accurate record of the meeting is prepared
- make sure this record is distributed to everyone who attends or who gave apologies
- make sure any agreed actions are completed.
The authority of a decision-maker (MCA s4(9))
The MCA gives the power to make a decision to the decision-maker. (Part 7: Being a decision-maker)
Families often assume they can make decisions and may be upset and angry if their views are not followed. It is important to make sure people understand how and why decisions are made. It may be the role of the decision-maker to explain the law and their role to any family or friends. (Part 24: MCA and family and informal carers)
If professionals disagree about a decision, the decision-maker makes the final decision. There would need to be appropriate discussion of the issues and a clear record made of reasons why the decision is made.
If a best interests decision is disputed
It may be appropriate to consider referral for independent mediation. Seek advice from your Team Manager, the local MCA Lead or, if there is a risk of abuse or neglect, from the Safeguarding team.
The Court of Protection is a branch of the High Court, set up to protect people who lack capacity and it can make determinations concerning any decision. Referral to the Court of Protection should be a last resort. (Part 23: The Court of Protection)
If legal action may be necessary speak to your team manager, and with their agreement seek legal advice.
Make sure the priority remains the welfare and safety of the person whose best interests are being considered. Consider if their circumstances mean a referral should be made to the Safeguarding Adults process.