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Seizing the opportunity to understand capacity

Author: Deirdre Shanagher
06 June 2017

Important lessons can be learned from the the UK as the Assisted Decision Making (Capacity) Act is commenced on a phased basis in Ireland, according to Irish Hospice Foundation development officer, Deirdre Shanagher.

Ms Shanagher attended the recent  "Next steps for palliative and end of life care: choice, standards and reducing inequalities" conference in London. The UK's Mental Capacity Act 2005 was one of the topics addressed at the event. She believes the UK's experience of capacity legislation provides a learning opportunity for Ireland.

She has given a first hand account of the conference for the Irish edition of eHospice.com

"Innovation and idea sharing were central themes of a half day conference held in central London last month that was organised by Westminster Health Forum. The delivery of palliative care in the community was the central theme of the first part of the morning. 

Peter Hartland CEO, spoke about work at St Luke's Hospice, Sheffield and delivery of palliative care in the community.  He spoke about up-skilling community specialist palliative care nursing teams to see, do and visit more in the community. To support this, a community rapid response team was put in place at St Luke's that is available 7 days a week at all times of the day to help families through crisis situations and in some cases avoid emergency calls and subsequent inappropriate hospital admissions.

Dr Catherine Millington Sanders outlined joint RCGP and Marie Curie work that was undertaken to understand why the experience of delivering end of life care is difficult for GPs. Time, lack of resources in the form of community nursing, identifying those with end of life care needs and problems with advance care planning were outlined as being challenging for GPs. This work has led to the development of the UK General Practice Core Standards for Advanced Serious Illness and End of Life Care that will be piloted during the Summer.

Within Ireland, the delivery of palliative care in the community is quite topical. The Irish Hospice Foundation Primary Palliative Care Steering Committee has been in place since 2010 and has been working to shape policy with regard to palliative care services that are available in the community. One of its projects has specifically looked at enhancing communication between GPs and out of hours services to enhance the availability of palliative care in the community.

A key theme of the second part of the conference centred around the Mental Capacity Act 2005 (UK). A new capacity decision support tool from the General Medical Council was presented by Mary Agnew. This tool was developed from the end of life guidance that is available from the General Medical Council but was expanded to cover all situations where capacity is an issue for patients. This was followed by an interesting presentation from Amanda Cheesley from the Royal College of Nursing who spoke about training and education for undergraduate and post graduate nurses. During her presentation Amanda spoke about consent and the reasons for obtaining consent advocating that it shouldn’t just be a tick box exercise for organisations.

The conversation that occurred after these presentations centred around training and education that is available in relation to the Mental Capacity Act 2005 (UK). It was proposed that healthcare professionals, have little true understanding of the Mental Capacity Act 2005 in relation to advanced care planning and powers of attorney, how they impact upon practice and what it means for the person being cared for. It was pointed out that healthcare professionals still think of capacity in terms of the person either having capacity or lacking it and that there is little emphasis placed on maximising or acknowledging that a persons capacity can fluctuate.

With the Assisted Decision Making (Capacity) Act 2015 being commenced on a phased basis within Ireland there are important lessons that can be learned from the situation in the UK who are twelve years into their capacity legislation. There is an opportunity for the Irish healthcare system to proactively ensure that all healthcare professionals become comfortable with caring for people within the grey areas of capacity. 

The Assisted Decision Making (Capacity) Act 2015 has created a real opportunity for healthcare professionals to become true patient advocates by becoming familiar with the concept that people may need assistance to make decisions and that a person’s ability to take part in the decision making process can vary depending on the environment, illness, medication or even seated position. 

Healthcare professionals are key people that will be working within the remit of this new legislation. Although it requires new ways of doing things and indicates a need to move from some archaic practice, if our closest neighbours have taught us anything it is to seize this opportunity to truly understand capacity and all its grey areas so that we are not having the same conversation in twelve years time."


Note: Deirdre Shanagher is a registered general nurse who has worked as a nurse and nurse manager for 7 years, primarily in a nursing home setting. Deirdre obtained an MSc in Gerontological nursing in 2011 and is a member of the All Ireland Gerontological Nurses Association and The Irish Association of Palliative Care.

She is a member of the National Advance Healthcare Directives (AHD) Sub-group, which has been set up to prepare recommendations for the Code of Practice for the Advance Healthcare Directive provisions (AHD) of the Assisted Decision Making (Capacity) Act 2015. 

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