Focus on Frailty breakout session: Capacity and Positive Risk Taking
Portsmouth Rehabilitation and
Sarah Grainger Modern Matron
Karen Squibb Assistant Team Manager
The Portsmouth Rehabilitation and Reablement
Team is an integrated health and social care team
the purpose of which is to provide responsive
support for people whose needs have intensified,
often as the result of an acute illness.
Solent NHS Trust is the lead for this service on
behalf of both Solent and Portsmouth City Council
Aim of PRRT
Adults with complex health and social care needs
often require a collaborative approach from both
Primary and Secondary, NHS and Social care.
The aim of this collaborative approach being to
assist in both the avoidance of unnecessary acute
hospital admission and also to ensure hospital
discharge planning is both safe and effective.
Rapid assessment of patients that can be managed
safely in the community with the right support.
Facilitation of hospital discharges following the Home
Recognition and understanding of MDT roles and skills
to deliver the appropriate therapy/ care to meet the
Falls risk assessment and management to reduce risk
of further falls Including SCAS referrals
Case management and care co-ordination with weekly
Referring to the appropriate services to meet the
Sign Posting to other services
Referral into PRRT at 4pm on a Tuesday
In groups look at the information you have
and formulate a plan of action
The five principles of The Mental Capacity Act 2005 are:
1 Every adult has the right to make his or her own decisions and must be assumed to have
capacity to do so unless it is proved otherwise. This means that you cannot assume that
someone cannot make a decision for themselves just because they have a particular medical
condition or disability.
2 People must be supported as much as possible to make a decision before anyone concludes
that they cannot make their own decision. This means that you should make every effort to
encourage and support the person to make the decision for themselves. If a lack of capacity is
established, it is still important that you involve the person as far as possible in making
3 People have the right to make what others might regard an unwise or eccentric decision.
Everyone has their own values, beliefs and preferences which may not be the same as those of
other people. You cannot treat them as lacking capacity for that reason.
4 Anything done for or on behalf of a person who lacks mental capacity must be done in their
5 Anything done for, or on behalf of, people without capacity should be the least restrictive of
their basic rights and freedoms. This means that when you do anything to or for a person who
lacks capacity you must choose the option that is in their best interests and you must consider
whether you could do this in a way that interferes less with their rights and freedom of action.
So you think an individual lacks capacity? The law sets out that
You should always start from the assumption that the person has capacity to make
the decision in question. This is known as the 'presumption' of capacity', until there
is proof that they do not have capacity you must assume that an individual has
If you believe someone is making an unwise decision, it is important to think about
what an unwise decision actually means, and how this differs from not having the
capacity to make a decision.
A decision is made by using a constant and logical thought process, and by
evaluating the risks and consequences of that decision. (Remember this only needs
to be for the amount of time required to make the decision and communicate it).
If an individual has followed the above process of thinking the decision through and
still decides to proceed, then this may be considered as an unwise decision. If the
individual is unable to follow the above process, then it may be that they lack
capacity to make that decision, and certain steps need to be taken in order to
Following intensive support and issue of
appropriate equipment Mr Anon Ymous
needs have reduced from assistance of 2
to assistance of 1.
He remains living with his wife in their
family home. There will always be some
risks however he has capacity and risks
have been reduced significantly.
Mr Anon Ymous and his wife are very
happy to be together.
And where is Mr Anon Ymous now?