Memorandum submitted by the Alzheimer's
Society
PUBLIC TRUST OFFICE QUINQUENNIAL REVIEW NOVEMBER
1999
There are over 700,000 people with dementia
in the UK and the combination of mental frailty and physical disability
that results from dementia places those with the condition in
a particularly vulnerable position. Dementia affects one person
in 20 over 65 and one person in five as they reach 80 years of
age in the UK. The number of people with dementia will grow as
the population ages. As a result, the issues surrounding capacity
and consent and the needs of people with dementia is of increasing
importance. Dementia is perhaps the major health and social care
challenge of this century. Reform of the law on mental capacity
and improvements in the organisations which administer it are
crucial.
The Alzheimer's Society is the leading care
and research charity for people with Alzheimer's disease and other
forms of dementia and their carers. It is a national membership
organisation and works through nearly 300 branches and support
groups. The Society has expertise in information and education
for carers and professionals. It provides help and support for
carers, runs quality day and home care, funds medical and scientific
research and gives financial help to families in need. It campaigns
for improved health and social services and greater public understanding
of all aspects of dementia.
Note: these comments and numbers are related
to the paragraphs in the quinquennial review.
EXECUTIVE SUMMARY
11. We strongly support the proposals to
improve, update and de-stigmatise terminology used by the PTO.
12. Consideration should be given to breaking
down the four main different functions of the PTO into more manageable
discrete areas of work.
19. We welcome the appointment of a Director
of Change for the PTO.
20. We support the four proposals under
this point to reduce work levels in the PTO, shifting responsibility
for performance and delivery of services to other organisations,
concentrating the activities of PTO staff on specific functions
and establishing a simple transparent fee regime.
21. A new PTO should refocus itself on the
needs of users and customers. The aim should be to enable and
assist individuals to manage the affairs of another person and
not focus on controlling the finances itself.
22. Whilst we support the recommendation
that the PTO moves away from providing specialist client services
directly by its own staff there are a number of considerations
and safeguards that would need to be applied to ensure client
satisfaction.
Other organisations like solicitors or other
agencies that might become involved in trust or receivership work
or fund management would require specialist training in assisting
those without mental capacity. The same would be essential for
PTO staff who might have some regulatory and monitoring functions
over them.
RAISING PUBLIC
AWARENESS
44-46. The sentiments expressed here are
very familiar to our Society. We support the proposal to improve
public awareness of EPAs and we would be pleased to participate
in such activity.
49. We note and support the proposal to
set up a Registering Authority for EPAs as a discrete business
unit within the Official Solicitors Office. However careful consideration
should be given to the monitoring procedure needed for this and
for there to be an accessible process of enquiry and complaint.
APPOINTMENT OF
RECEIVERS
50. This paragraph is an excellent assessment
of the issues that individuals face when considering becoming
a receiver. The opportunity for a prospective receiver to talk
through the implications and responsibilities openly would be
welcomed.
51. We support the recommendation that a
process be devised to allow all prospective receivers to be interviewed
prior to their appointment.
54. We support the proposal to regularly
review the maximum level of assets held by a patient prior to
full COP jurisdiction and that the maximum level be reviewed every
three years.
55. Whilst we support the recommendation
to discharge receivers responsible for assets less than £10,000,
it is essential that the individuals concerned are made fully
aware of their responsibilities. Some may not be in a position
to accept full control of the money. This process will in itself
generate considerable additional requests for independent advice
and guidance on financial management.
RECEIVERSHIP PROVISION
59. We support the recommendation that for
all patients who truly lack a private receiver the PTO should
exercise this responsibility via a contractual arrangement devised
in conjunction with the Law Society to provide the service via
local solicitors. However, it should be noted that this might
increase costs to patients.
The Society already has contact with two networks
of solicitors who specialise in the legal issues of mental incapacity
who would be well placed to contribute towards this work.
FEES AND
FUNDING
62. We endorse the recommendation that a
simple, viable and auditable system of fees is worked out for
the PTO's services using comparable experience in other agencies.
The current basis and levels of fees remains at the heart of many
of the complaints the Society receives about the work of the PTO
and CoP. A new fee system needs to be justifiable to the users
of the PTO.
We also support the recommendation that for
those people who fall below an agreed limit support should be
declared an essential public service and provided for as such.
SUBMISSION OF
ANNUAL ACCOUNTS
BY RECEIVERS
74. We note the recommendation that all
private receivers are required to submit a final account after
the death of the patient whose affairs they were administering
as this will strengthen the degree of protection the Court can
exercise through the submission of accounts. However this may
well be perceived by some individuals as an additional burden
after the death of their relative. Appropriate explanation and
public relations will be needed.
77. We note the recommendation that the
Court of Protection require all private receivers to take out
an insurance bond and that all professional receivers have full
indemnity.
It would be helpful to have some examples of
the levels of bonds required for private receivers. We would need
to be assured that the cost would be minimal regarding individual
risk. We also believe that competitive tendering should be applied
if such a bond is introduced.
COURT OF
PROTECTION'S
VISITING SERVICE
81. We agree with the analysis that the
current visiting service is fundamentally flawed and impractical.
83. We endorse the need for appropriate
and updated training for whoever is contracted to carry out this
work. There is the possibility that our Society might be in a
position to contribute to some of this training.
85. There is the possibility that the Society
might be able to participate in a visiting scheme subject to detailed
discussion and the nature of any service level agreement. Any
such agreement would have to ensure that the Society's independence
was not compromised in any way.
86. We support the recommendation that the
PTO move to a contract management role instead of directly providing
a visiting service adopting quality standards similar to the examples
given.
THE COURT
OF PROTECTION
AND THE
PTO
96. We endorse the recommendation that the
Court, LCD and the PTO should explore the scope for amending any
terminology covering the Court's responsibilities to remove any
stigma and avoid archaic and off-putting terms.
We also advise that a greater consideration
be given to how the PTO works and interacts with other agencies:
the DSS, Inland Revenue, and other government agencies. This may
be addressed through future publicity and marketing of a restructured
PTO.
We also wish to identify the needs of people
with learning difficulties who may be partners of someone who
has lost mental capacity. There are instances of them still wishing
to have some input into their current financial situation but
requiring some assistance to achieve this.
STAKEHOLDER RELATIONS:
PERFORMANCE AND
PROPOSALS: LIAISON
AND FEEDBACK
131. We endorse the recommendation that
the PTO set up a regular liaison forum involving the main stakeholder
groups. The Society would be pleased to participate in this.
133. Depending on the nature of the surveys
decided on the Society may be in a position to participate in
or contribute to these.
136. We support the recommendation that
there be a thorough review of the PTO's practices and procedures
for reviewing complaints.
COMMUNICATIONS
138. The Society would be pleased to share
its experience of producing information in languages other than
English. It would also be prepared to explain its proposals for
future support and services for people from ethnic minority groups
who may be affected by dementia and issues of mental incapacity.
April 2000
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