Children and Social Work Bill [HL]

Written evidence submitted by the Royal College of Speech and Language Therapists (CSWB 03)

Public Bill Committee: Children and Social Work Bill [HL]

Best interests assessors: extending eligibility to carry out an assessment

1 Executive summary

· Best interests assessment is a process to consider authorisation of deprivation of liberty for individuals who do not have mental capacity to make decisions about their own care.

· By law, such assessments can be undertaken only by:

o an approved mental health professional

o a social worker

o a nurse

o an occupational therapist

o a psychologist

· Given their unique and specialist skills in assessing and supporting the communication needs of vulnerable people, and their role in supporting capacity assessments of individuals with communication difficulties, eligibility to undertake best interests assessments should be extended to speech and language therapists (who are registered practitioners with the Health and Care Professions Council).

· This would help promote the interests of people with communication needs and reduce risks to them, including being deprived of their liberty because their communication needs were not properly assessed and supported.

· Amending Clause 43 of the Bill (approval of courses for best interests assessors) to amend the Mental Capacity (Deprivation of Liberty: Standard Authorisations, Assessments and Ordinary Residence) Regulations 2008 (Statutory Instrument 2008: 1828) could extend the ability to undertake best interests assessor training to other registered health and social care professionals.

2 The Royal College of Speech and Language Therapists

2.1 The Royal College of Speech and Language Therapists (RCSLT) is the professional body for speech and language therapists, speech and language therapy students and support workers working in the UK. The RCSLT currently has almost 17,000 members. We promote excellence in practice and influence health, education, employment, social care, and justice policies.

2.2 This submission is based on the experience and expertise of our members who help support the determination of capacity for those who have communication needs.

3 Supporting people who have communication needs

3.1 Speech and language therapists are registered health practitioners who support people with communication and swallowing needs.

3.2 They are uniquely trained and qualified to:

· undertake in-depth, detailed assessments of an individual’s current, and likely future, communication capacity, including their ability to understand, express themselves, and retain and recall information.

· advise on, and provide the best means by which, someone with communication needs can be appropriately supported to make and communicate informed decisions about their treatment and care.

· support people who cannot make an informed decisions to express their preferences and wishes in relation to the decision.

· support carers to understand how to communicate with loved ones around patient preference or wishes when they have been found to lack decision making capacity.

3.3 Examples of client groups speech and language therapists work with include stroke survivors, those with head and neck cancer, learning disabilities, traumatic brain injury, and people living with dementia and other progressive neurological conditions (such as Parkinson’s disease, Motor Neurone Disease, and multiple sclerosis), and those with mental health issues. All of these can have a significant impact on an individual’s understanding and expression.

3.4 Both directly, and through advising others, speech and language therapists are experts in removing barriers to communication, including through adapting communication styles to meet people’s individual needs and supporting individuals to communicate in whichever way suits them. This can involve the use of Augmentative and Alternative Communication: using gestures, signing, symbols and pictures, word boards, communication boards, books and in some cases technology to support or replace spoken communication.

4 Supporting the determination of capacity for those with communication needs

4.1 The Mental Capacity Act Code of Practice (2007)1 and the General Medical Council (2013)2 recommend seeking the professional opinion of a speech and language therapist to support capacity assessment of individuals with communication difficulties.

4.2 Appendix 1 provides examples of where speech and language therapists have used their unique and specialist skills to support capacity assessments.

5 Extending safeguards to those with communication needs

5.1 Extending the eligibility to undertake best interests assessments to speech and language therapists would promote the interests of people with communication needs.

5.2 It would help support differential diagnosis and an accurate assessment of their communication needs and how they can be supported and ensure that people with communication needs were able to participate in decisions about their treatment and care.

5.3 It would reduce the risk of an individual’s communication needs being mistaken for incapacity with the potential for them to be deprived of their liberty unintentionally due to their individual needs not being recognised and supported.

5.4 Amending Clause 43 of the Bill (approval of courses for best interests assessors) to amend the Mental Capacity (Deprivation of Liberty: Standard Authorisations, Assessments and Ordinary Residence) Regulations 2008 (Statutory Instrument 2008: 1828) could extend the ability to undertake best interests assessor training to other registered health and social care professionals.

December 2016

References

1 Department of Constitutional Affairs (2007) Mental Capacity Act Code of Practice. London, Department of Constitutional Affairs.

2 General Medical Council (2013) Good medical practice. Available from: http://www.gmc-uk.org/guidance/good_medical_practice.asp

ANNEX 1

Speech and language therapists supporting determination of capacity

Case study 1

Mr J (retired) had been diagnosed with dementia following a series of unexplained changes in his behaviour and communication. After some months he was admitted to a care home on a temporary basis to give his wife some respite. Mr J remained in the home for five months. He continually asked to go home. At a subsequent case review it was determined that Mr J lacked capacity to make a decision about his permanent care situation. His wife reported that he no longer understood her when she was speaking to him and that she felt unable to receive him home again. Following an assessment by a speech and language therapist, and the introduction of appropriate supports, including visual strategies and appropriate language, Mr J was able to communicate sufficiently well to demonstrate that he could understand when asked if he wished to return home and thus was able to evidence that he was able to make a decision about his future care. He subsequently decided that he wished to stay in residential care voluntarily.

Case study 2

Ms P was admitted to hospital following a stroke. She had a range of communication difficulties, including problems using language and problems saying sounds, syllables, and words. She also had a history of anxiety. She wanted to return home on discharge. Her family had concerns about this and wanted her to go to a residential home. The medical team met separately with the family without the patient present and agreed this seemed the most sensible option. Speech and language therapists had assessed Ms P’s communication and found her strengths included reading at short phrase level and being able to speak clearly for short periods when in a relaxed environment. They had also built up rapport with Ms P who was very wary of "strangers", including her social worker. The speech and language therapist and social worker carried out a capacity assessment, with written word and pictorial support. This demonstrated that Ms P was able to understand, retain, weigh and communicate the risks associated with returning home.

Case study 3

Mr S was admitted to hospital after choking on a sweet wrapper. He had previously had a stroke and depression. He had a range of communication needs, including problems using language correctly and difficulty speaking. He was non-compliant with speech and language therapist swallowing recommendations on the ward. Using adapted communication, a speech and language therapist assessed Mr S’s capacity to eat and drink as desired accepting that this might cause food and drink to go down the wrong way. The speech and language therapist also highlighted the need for mental health input as this may have been impacting on his decision-making and organised a multi-disciplinary meeting with the patient and his next of kin to discuss the outcome and next steps.

Case study 4

Ms P was admitted to hospital with aphasia (difficulties understanding and using language effectively) and right-sided weakness. She was being investigated for a primary or secondary brain tumour. She had significant problems using and understanding language and cognitive deficits. She required significant communication support to participate in conversations about her diagnosis and treatment planning. She was incorrectly diagnosed with a mental health disorder and proceedings were started to consider sectioning her. A speech and language therapist advised that Ms P had communication and cognitive deficits secondary to another cause and not a mental health disorder. A capacity assessment was undertaken, with pictorial support, which deemed that Ms P did not have capacity to self-discharge. A best interest meeting was organised and safeguarding were contacted regarding deprivation of liberty.

 

Prepared 13th December 2016