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Focus on Frailty breakout session: Capacity and Positive Risk Taking


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Slides from the breakout session at #WessexFrailty19

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Focus on Frailty breakout session: Capacity and Positive Risk Taking

  1. 1. Portsmouth Rehabilitation and Reablement Team PRRT Sarah Grainger Modern Matron Karen Squibb Assistant Team Manager Social Care
  2. 2. PRRT 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
  3. 3. 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.
  4. 4. Rapid assessment of patients that can be managed safely in the community with the right support. Facilitation of hospital discharges following the Home First principles Recognition and understanding of MDT roles and skills to deliver the appropriate therapy/ care to meet the patient’s needs. Falls risk assessment and management to reduce risk of further falls Including SCAS referrals Case management and care co-ordination with weekly MDT meetings Referring to the appropriate services to meet the patient’s needs Sign Posting to other services
  5. 5. Referral into PRRT at 4pm on a Tuesday Evening In groups look at the information you have and formulate a plan of action
  6. 6. 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 decisions. 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 best interests. 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.
  7. 7. 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 capacity. Unwise decisions 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 confirm this.
  8. 8. 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?