IMCA/RPR

Independent Mental Capacity Advocates (IMCA) help people who are assessed to lack capacity about medical treatment or where they live and have no family or friends that it would be appropriate to consult with about those decisions.

What is the Mental Capacity Act 2005?

The Mental Capacity Act 2005 is a comprehensive legal framework for decision making for people who lack capacity to make particular decisions for themselves. It is accompanied by a Code of Practice and is based on common law and good practice. It puts the needs and wishes of the person at the centre of any decision making process.

What is the IMCA service?

The IMCA service is available for people over 16 who fit certain criteria and who are facing a specific issue where a decision has to be made in their best interests.

The person must:

have been deemed to lack capacity, at that time, for the particular decision
be unbefriended (have no relative or friend that it would be appropriate to consult with about those decisions)

When is an IMCA needed?

An IMCA is needed when a decision needs to be made about any of the following:

an NHS body is providing, withdrawing or stopping serious medical treatment
an NHS body or local authority is proposing a stay in a care home of more than 8 weeks
a person will stay in hospital longer than 28 days
referrals may also include safeguarding adult cases or accommodation reviews

If the above applies then a decision maker must, by law, refer to the IMCA Service.

The Act also now allows IMCA’s to be involved, under certain circumstances, when an application is made to deprive someone of their liberty. Please see

An IMCA is:

independent of the person making the decision
able to meet the person in private
able to see all relevant health, social services and care home records
able to request an additional medical opinion
someone who has completed the national IMCA training

What does an IMCA do?

supports and represents the person in the decision making process
find out the person’s past and present wishes, feelings, values
evaluate information including accessing and copying relevant social and medical records
evaluate alternative courses of action
consult with others involved in the person’s life
seek a further medical opinion if necessary
check the Mental Capacity Act principles and best interest check list are being followed
prepare a report, which the decision maker has a legal duty to consider
challenge the decision (including capacity) if necessary, informally first and through Court of Protection as a last resort

When should a referral not be made?

When serious medical intervention is needed immediately
When treatment is regulated by Part 4 of the Mental Health Act
Where accommodation is needed urgently
Where restrictions are placed on an individual’s accommodation under the mental health act

Who is the decision maker?

The decision maker is the person who has the ultimate responsibility for making the best interest decision. This is usually a consultant for serious medical treatment decisions or a care manager for accommodation decisions. Before being referred the client must have been assessed and deemed to lack capacity (as required by the Mental Capacity Act). Referrals are not accepted without the decision maker’s knowledge. IMCA’s work directly to the decision maker and copies of their confidential reports are forwarded to the decision maker only.

How do I make a referral?

The decision maker or appointed staff member should make the referral directly to our service.

To make a referral for an IMCA in the London Borough of Bromley, please click here.

RPR Service

We provide paid Relevant Person’s Representative’s (RPR), if there are no relatives or friends available or appropriate to fulfil this role.

Eligibility:

aged over 18
live in a care home or hospital
referred by DoLS office with a form 5
have a DoLS authorisation in place
lacks capacity in relation to their care and/or treatment/accommodation.

Referrals for the RPR service can only be made by the Bromley DOLS office. You can contact us for more information by clicking here.

IMCA DOLS

Deprivation of Liberty Safeguards (DOLS)

Sometimes a vulnerable person who lacks capacity needs to be restricted in order to provide treatment or care which is necessary in their best interests to protect them from harm. The degree and level restrictions may amount to a deprivation of liberty (DOL).

On 1st April 2009 it became a requirement by law to apply for an authorisation in order to deprive someone of their liberty. To do this the managing authority (the hospital or care home which is, or will be, depriving the person of their liberty) must put in an application to the supervisory body. The supervisory body (SB) will then carry out a series of 6 assessments to decide if it is right to deprive the person (known as the relevant person) of their liberty.

Under certain circumstances, a DOLS IMCA can be instructed to act in a number of different ways. When there is no family member, friend or appropriate person (known as the relevant person’s representative – RPR) to support the relevant person (RP) through this process the SB will appoint a DOLS IMCA. Once the application has been approved the SB can also instruct a DOLS IMCA either to support the RP, the relevant person’s representative (RPR) – or both, or to act as the RPR themselves if no representative is available.

What is a DOLS IMCA?

A DOLS IMCA is a specialist advocate. They work with people from all vulnerable client groups with all nature of impairments that can leave someone lacking capacity. They are independent of the SB, and they safeguard the rights of people who lack capacity. The role of a DOLS IMCA is different to that of a general IMCA in 3 ways:

they only deal with issues relating to deprivation of liberty applications/authorisations
DOLS referrals to our service are received by us directly from the SB – after they receive an application for DOL from the MA
the relevant person must be 18 years old or over./li>

What will the DOLS IMCA do?

The SB can instruct a DOLS IMCA to take on one of the following roles:

Section 39A DOLS IMCA

To act when the RP is unbefriended (has no RPR). The SB will instruct a DOLS IMCA to represent the person during the assessment process, with a particular focus on the ‘best interest’ assessment. The assessment process must be completed within 7 days for urgent authorisations, where a DOL is already happening or 21 days for a standard authorisation where there is a proposed DOL. The 39A DOLS IMCA role is similar to the original IMCA role including:

enabling RP participation
seeking and evaluating information
finding alternatives, challenging (if appropriate)
submitting a report to the SB around the values, wishes and beliefs of the RP in relation to the decision

The 39A DOLS IMCA also has additional rights and responsibilities including access to authorisations and assessments plus the right to take the RP’s DOLS case to the Court of Protection.

Section 39C DOLS IMCA

To act, after the authorisation has been granted, as the RPR (where none is available). The IMCA will represent and assist the RP during the period of the authorisation.

Section 39D DOLS IMCA

To support the RP, the RPR or both – after the authorisation has been granted. The IMCA will represent and assist the person, their representative, or both during the authorisation period.

To refer for an RPR or an IMCA DoLS, we need the following information from the DoLS Office:

RPR

DoLS office to send Form 11, plus forms 1, 3, 4 and 5 to referrals@advocacyforall.org.uk

IMCA DoLS

DoLS office to send Form 11 and Form 1 to referrals@advocacyforall.org.uk