The Best Interests Assessor Practice Handbook

Hubbard, Rachel, Stone, Kevin

• Publisher: Policy Press
• Year: 2018
• eBook ISBN: 9781447335566
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

Best Interests Assessors (BIA) are specialist practitioners with a unique professional identity. This is the first book to consider this complex role in depth, offering practical guidance and exploring its particular challenges in the context of the Mental Capacity Act and Deprivation of Liberty Safeguards legal framework. How can you work with people who lack capacity to make sure their voice is heard? How can you maintain quality of assessments and decision-making while managing an increasing workload? How do you keep up to date with case law and work out how to apply it to day-to-day practice? The book answers these questions and many more, allowing you to meet the ever-changing requirements of the role, whilst maintaining professional knowledge, values and ethics in practice, now and in the future. Activities including case studies, legal summaries, decision making activities, CPD support and case law will be welcomed by BIA students, practitioners and others interested in the role.

1

Introduction

“The world is full of obvious things which nobody by any chance ever observes.” (Sherlock Holmes in chapter 3 of The Hound of the Baskervilles by Arthur Conan Doyle, 1902)

Best Interests Assessors (BIAs) are experienced, knowledgeable health and social care professionals who investigate and explore people’s lives and care and provide a snapshot of how their care is, or could be, the least restrictive possible. The independent, yet critical, observer role they play can be invaluable in bringing insight into ways to increase a person’s ability to make choices about their life. Their ability to notice restrictive aspects of care that have been forgotten, or to identify paths for decision making that have not yet been explored, is a vital element of their value. Like consulting detectives, BIAs are not there to carry out the functions of other professionals. They are required to observe, scrutinise and offer fresh perspectives on a known situation. They gather evidence by analysing documents, consulting with people who know about the case, sifting through the evidence they find for meaning, and offering alternative solutions. Any actions as a result are handed back to those who have the continuing responsibility to make decisions about the person’s care.

The BIA role is a challenging one as it asks professionals to question the practice of their colleagues and suggest, at times, unpopular courses of action. This is vital or we risk the person continuing to be subject to ‘poor care … [that] has infiltrated the culture of the organisation’ (Graham and Cowley, 2015, p 24). BIAs can be the eyes that examine darkened corners ‘in small places, close to home – so close and so small that they cannot be seen on any map of the world … the world of the individual person’ (Roosevelt, 1958), where Eleanor Roosevelt saw human rights as having their most profound meaning, and act to protect them. BIAs also need to consider the power they have to remove these rights, perhaps by considering the five questions for people of power that Tony Benn (date unknown) asked:

What power have you got? Where did you get it from? In whose interests do you use it? To whom are you accountable? How do we get rid of you? Anyone who cannot answer the last of those questions does not live in a democratic system.

In order to remain focused on the person and not the interests of those who decide on care arrangements, BIAs should ensure they are fully aware of their power, accountability and the rights of others to challenge and question the decisions they make.

It is vitally important, then, that BIAs both understand the power they wield and value the role they play in giving voice to those restricted of their freedom to ensure that such restrictions only occur through necessity and that their impact is minimised. The BIA role is relatively new so our sense of identity is, as yet, still fragile. We hope that this book will help to continue to form the BIA identity and consider how it may develop in the future.

Terminology

In this book we use key terms in full at the first mention in each chapter followed by the abbreviation in brackets – for example, Best Interests Assessor (BIA) – and thereafter we use the abbreviation – BIA. A list of abbreviations used in the book and commonly in BIA practice appears at the start of the book. We use the term ‘the person’ to mean the person who is being assessed under the Deprivation of Liberty Safeguards, sometimes called ‘the relevant person’.

The Best Interests Assessor practice handbook

This BIA handbook is designed for qualified BIAs and BIA students as a practical and reflective guide to applying the role to practice. It does not replace the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) 2007 statute or their Codes of Practice (Department for Constitutional Affairs, 2007 and Ministry of Justice 2008). It should not be read instead of the increasing number of books on the law in this interesting area, such as Richard Jones’ (2016) Mental Capacity Act Manual or Brown, Barber and Martin (2015) The Mental Capacity Act 2005: A guide for practice. It is designed to complement these law textbooks by offering a resource to explore the ethical and practical challenges of applying this law to practice as a BIA and offer tools and ideas based on our years of teaching, advising and working as BIAs.

This book does not cover the legal processes for deprivation of liberty outside of the DoLS, for example in relation to those living restricted lives in supported living arrangements, extra care housing, Shared Lives schemes or their own homes, which require an application to the Court of Protection, as BIAs do not have a specific role to play in this process. We are aware, however, that the skills and knowledge of BIAs are invaluable to those who are involved in such applications so this book should offer some guidance to those applying to the Court of Protection. We also do not cover the inherent jurisdiction of the High Court.

This book has been mapped to The College of Social Work’s (2013) Best Interests Assessor capabilities, the statutory requirements for the BIA role laid out in the Mental Capacity (Deprivation of Liberty: Standard Authorisations, Assessments and Ordinary Residence) Regulations 2008, and the continuing professional development (CPD) curriculum for social workers on the application of the MCA (Beddow et al, 2015).

The book has been designed to consider some of the main practical elements of acting as a BIA, including the context for practice, the challenges of ethical decision making and the necessity for ongoing learning in the role. We have included case studies, summaries of key information and wider reading as well as reflective questions to help you consider important issues and support your development as a practitioner. This introductory chapter sets out the structure of the book and introduces some of the key ideas and themes, as well as setting out the main legal framework and developments since implementation. The book is divided into three main sections with chapters exploring key elements of the role, as follows.

Part 1: Context for practice

Chapter 2: BIA role in practice

This chapter considers the BIA’s duties, responsibilities and powers, how the role is regarded and the impact of significant case law since its implementation. It explores how assessors can maintain their independence and accountability in the range of contexts in which BIAs work, whether directly for local authorities or as independent practitioners, and how to maintain their boundaries from the pressures of expectations in these contexts.

Chapter 3: The multi-professional BIA role

This chapter explores the values and challenges of the BIA as a multi-professional identity as well as giving focus to the particular and complementary contributions made by social work, nursing and occupational therapy to the role. The chapter explores reasons why psychologists appear less engaged in the role than other professions, the differences experienced by BIAs practising in Wales, and the contribution of other professional expertise, particularly the potential contribution of speech and language therapists to BIA practice.

Chapter 4: Working with others

This chapter explores the practical skills and knowledge required for working with the person, their family, friends and carers as well as other roles relevant to the DoLS. These include advocacy and representative roles, powers of attorney given by the person, advance decisions or powers given by the Court of Protection as well as work alongside safeguarding processes. It considers consultation requirements with the mental health assessor as well as managing authorities, supervisory bodies and professionals involved in ongoing decision making with the person.

Part 2: Assessment: challenges and dilemmas

Chapter 5: Making Deprivation of Liberty Safeguards decisions

This chapter is structured around the six DoLS assessments and the other decisions that BIAs make during their assessment. It includes case law, scenarios and examples to help readers explore these decisions as well as common challenges and dilemmas.

Chapter 6: Evidence-informed practice

This chapter enables BIAs to explore the influences and context for their decisions, and offers tools and models to aid reflection and critical thinking with examples of BIA decision making. It also offers theoretical and research contexts for commonly encountered conditions in BIA practice such as dementia, learning disabilities, autism and acquired brain injury.

Chapter 7: Ethical dilemmas in BIA practice

This chapter explores the challenges of making decisions as a BIA when there are no clear ‘right’ answers, professional responsibilities towards professional practice and ethical models to assist with making difficult and complex decisions.

Chapter 8: BIA recording

This chapter focuses on the detail of how BIA assessments and decisions are recorded, including guidance on how to ensure that recording meets the requirements of case law and supervisory bodies. It includes areas where BIAs often seek advice, including getting the details right, writing the appropriate amount, writing conditions and recommendations, and including other views.

Part 3: Developing good practice for the future

Chapter 9: BIA continuing professional development

This chapter explains the qualifying requirements for BIAs, as well as their statutory and professional CPD requirements, and offers suggestions for support and re...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• About the authors
• Acknowledgements
• Abbreviations and acronyms commonly used in BIA practice
• DoLS mapping
• 1: Introduction
• Part 1: Context for practice
• Part 2: Assessments, challenges and dilemmas
• Part 3: Developing good practice
• References
• Statute and case law