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Mental health - NHS & choices

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kevin's picture
Joined: 09/03/2009
anonymous (not verified)
anonymous's picture

The Act affects everyone aged over 16 and provides a statutory framework to empower and protect people who may not be able to make some decisions for themselves. This includes people with dementia, learning disabilities, mental health problems and stroke or head injuries.

The Act covers a whole range of decisions about an individual's property and affairs, healthcare treatment and where they live, as well as everyday decisions about personal care or what they eat, and is effective when the individual lacks the capacity to make the decisions themselves. It makes it clear who can take decisions, in which situations and how they should go about this.

It enables people to plan ahead for a time when they may lose capacity.

The Act specifically provides instructions for people making decisions about your personal best interests to make sure they consult with anyone you have named as someone to consult and anyone who has a caring role or is interested in your welfare. This will include informal carers, family and friends and others who care for you in a professional or voluntary capacity, including any kind of existing advocate. Anyone appointed under a Lasting Power of Attorney and any deputy appointed by the court.

The Act also sets out the requirement of the person making decisions on your behalf to consider any written statements made by you whilst you had the capacity to make your own decisions. Your written statements can include details about what sort of care or treatment you would wish to have in the case of future illness or what emotional bonds or family obligations need to be taken into consideration when deciding how to spend your money or where you would like to live.

Lasting Powers of Attorney

The whole of the Enduring Powers of Attorney Act 1985 has been replaced under the act so that you can now set up two types of Lasting Power of Attorney (LPA)

  • a Personal Welfare LPA
  • a Property and Affairs LPA

The Lasting Power of Attorney allows you to plan ahead by choosing one or more people to make decisions on your behalf regarding your personal healthcare and welfare or to make decisions on your behalf regarding your property and financial affairs, when you no longer have the capacity to do so yourself.

Provision has been made in the Act for 'Advance decisions' to refuse treatment.

"Advance decisions", formerly known as "living wills" are decisions made by people aged over 18 and with the mental capacity to do so, to specify what treatments they would like to be carried out or to continued and which treatments should not be carried out or continued, in the event that they lack the capacity to consent to the treatment at the time.

An advance decision (living will) informs medical staff about how you wish to be treated should you no longer be able to communicate your wishes to your medical team. It is important that your wishes and feelings are upheld or taken into consideration for your best interest to be determined.

Uniquely, and for the first time ever, patients will be able to also include value statements and additional directions relevant to decisions about their health and welfare in the future. This can vary from stating their personal values and beliefs to expressing their preferred place of care and death.

Where written statements are well-thought out and considered, they are likely to carry particular weight for the purposes of best interests determinations.

A new Court of Protection governs

The Act provides for a new Court of Protection to make decisions in relation to the property and financial affairs and healthcare and personal welfare of adults (and children in a few cases) who lack capacity. The Court also has the power to make declarations about whether someone has the capacity to make a particular decision.

If you have not specified who or whom you would like to make decisions on your behalf, the Court of Protection will appoint someone for you. This person must act lawfully and in accordance with the Mental Capacity Act 2005.

The Court has the same powers, rights, privileges and authority in relation to mental capacity matters as the High Court. It is a superior court of record and is able to set precedents. Under the Act it has established a new statutory official, the Public Guardian, to support the work of the court.

We have provided important links to a number of websites that provide further more specific information on the issues arising from the Mental Capacity Act 2005 below. Please ensure you are fully aware of the implications of setting up any documents giving other authority over your affairs and if you do decide to set up these documents or statement, please ensure they are prepared in the correct format, so that they will be recognised by the Court if they should ever be needed.

Useful information:

Office of Public Sector Information

Read the full copy of Mental Capacity Act 2005 and the Explanatory Notes at the Office of Public Sector Information website:<

Dignity In Dying

For further information on 'Advance Decisions' we suggest you contact 'Dignity in Dying' their website is< or alternatively speak to your solicitor.

The Public Guardian

The Office of the Public Guardian will help those seeking guidance or information on the Act and provides detail of the fees charged by the Court of Protection,<

Lasting Power of Attorney (LPA)

For further information and detailed guidance on LPA's visit the guidance booklets section of the Office of the Public Guardian's website.<

anonymous (not verified)
anonymous's picture

As details of the approaches to be taken by the payment by results drug and alcohol recovery pilots are being developed, supporting material has today been published.

The pilots, which began in April with the launch of a co-design group, are the result of a commitment in the cross Government Drug strategy that was launched last December. The new approach looks to further incentivise  providers to support adults with drug or alcohol dependency to recover.

This approach is innovative. Previous Department of Health approaches have largely focused on payment for activity and outputs but, under these pilots, providers are no longer paid simply on activity, providers are now rewarded for the outcomes achieved for the individual. 

The aim is to test whether such an approach can help more people to break the cycle of dependence and achieve long-term recovery, with recovery having an impact not only for the individual, but also for their families and communities too. 

The pilots

The eight local areas selected to pilot the new approach were announced on 8 April 2011:

  • Bracknell Forest
  • London Borough of Enfield
  • Kent
  • Lincolnshire
  • Oxfordshire
  • Stockport
  • Wakefield
  • Wigan

Updates on the progress of the pilots as they develop will be published. You can read the news stories to date in the news section below

The pilot bids

Following a request for initial expressions of interest in December 2010 through an ‘invitation to participate’, 29 applications were received.

Of these, 16 were shortlisted. Representatives from these shortlisted areas were invited to a workshop to talk through the remit of the pilots in more detail ahead of submitting a fuller, second stage application.

Full applications were received from 12 areas and 8 of these were of high enough quality and had suitably innovative approaches to be taken forward.

The documents that formed the winning bids are available at the links below.


A co-design approach

The detail of the approaches are currently being developed in partnership between the pilot areas and central Government through a co-design group. Central government have developed a framework within which the pilot areas are developing their individual models.

Input is also being sought from experts from the broader recovery sector during this initial co-design period. 

The pilots will focus on delivery within the following four high-level outcomes:

  • free of drug(s) of dependence
  • reduced re-offending or continued non-offending
  • in employment
  • improved health and well-being

The first challenge for the co-design approach is to agree a more detailed definition of these outcomes, and draft outcome definitions were published earlier this month.

The pilots will use the same definition for each of the outcomes, but weighting of payments for each outcome will be set locally, allowing areas to reflect their different circumstances and focus on specific outcomes.


Governance of the pilots

The pilot areas are being supported by a cross-government team with representatives from the Department of Health and from the:

  • Department of Work and Pensions
  • Ministry of Justice
  • Home Office
  • National Treatment Agency for Substance Misuse

The project is also being overseen centrally by an Officials Steering Group and supported by a Co-design Group, see below for more information on these. Papers and minutes of the meetings of these groups are available.

Officials Steering Group

A national Steering Group comprising senior officials from cross-government departments was established to oversee and guide the pilots. 

The membership comprises:

  • Deputy Director of Drugs and Alcohol, Department of Health – Chair
  • Deputy Director Reducing Re-Offending, Ministry of Justice
  • Deputy Director, Reducing Re-Offending, Home Office
  • Deputy Director, Labour Market Inclusion Division, Department for Work and Pensions
  • Chief Executive, National Treatment Agency

Co-Design Group

The Co-Design group supports the pilot areas in developing the outcome domains and providing advice on cross-cutting issues. The terms of reference and membership are available below.

Originally this group was constituted as a National Expert Group in January 2011, on a time-limited basis, to support the project up to the selection of the pilot sites in April 2011. It was tasked with advising the Steering Group on the development of the outcome domains.

Membership was invited from payment by results experts from relevant Government Departments, together with those representing expertise in each of the outcome domains. This included clinical, academic and employment experts among others.

Following selection of the pilot sites, the Expert Group was reconstituted and re-named the Co-Design Group. This was done to include representatives from all the pilot sites in the group and to reflect the new focus of designing the detail in partnership.



The pilots programme will be subject to rigorous independent evaluation.  A selection decision is expected to be made by the end of August, with a view to appointing an evaluation team to start in October.

The applications have been submitted to scientific peer review and review by lay assessors.  An independent commissioning panel comprising leading academic experts and a patient and public involvement in research representative will meet to consider the applications and make recommendations to the Department of Health. 

Observers from the Department of Health, the Department for Work and Pensions, the Home Office and the Ministry of Justice will also be in attendance. 

This follows the issuing of an invitation to tender for the evaluation by the Department, which closed last month.


The Drug Strategy

The Drug Strategy, published December 2010, set out a vision for a locally-led recovery-orientated drug system with the aim of not only supporting people to tackle their dependency, but helping them to recover and rebuild their lives. 

It recognised that an individual’s dependence on drugs and alcohol cannot be tackled in isolation and sought to put the individual at the heart of any recovery system by commissioning a range of services at the local level to provide tailored packages of care and support.

The Department of Health jointly leads on the recovery strand of the Strategy with the Department for Work and Pensions and the Ministry of Justice.


Contact us

The drugs recovery team is keen to hear from any local areas that are independently adopting a payment by results approach. The team is particularly interested to hear about the model you have adopted, its impact and any best practice examples.


anonymous (not verified)
anonymous's picture

The aim of this guide is to provide an introduction for newcomers to PbR. The version available via the link below is an update to the guide published September 2010; and reflects changes to PbR arrangements in 2011-12.

Please note: this document is for print purposes only, as it has not been fully tagged for accessibility.<

anonymous (not verified)
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Improving the experience of care for people using adult NHS mental health services


This clinical guidance offers evidence-based advice on ensuring a good experience of care for people who use adult NHS mental health services.

We have also published a quality standard describing high-quality care for adults using mental health services in the NHS in England.

Guidance documents


Implementing this guidance<