Development, use and evaluation of a web based mental capacity assessment tool for staff working with people with learning disabilities

Published date18 April 2023
Date18 April 2023
Subject MatterHealth & social care,Learning & intellectual disabilities
AuthorKaren Dodd,Sai-Bo Cheung,Ashley Chapman
Development, use and evaluation of a web
based mental capacity assessment tool for
staff working with people with
learning disabilities
Karen Dodd, Sai-Bo Cheung and Ashley Chapman
Purpose This paper aims to describe the development, use and evaluation of a web-based mental
capacity assessment tool (MCA WAT) within the Learning Disabilities division of a Mental Health and
LearningDisabilities Trust in England.
Design/methodology/approach The MCA WAT was developed to ensure there was
contemporaneous recording of each capacity assessment; help staff improve their knowledge,
confidenceand satisfaction in completing assessmentsof capacity; and analyse the numberand type of
capacity assessments completed. Three questionnaires were developed: a 12-item multiple-choice
knowledgequestionnaire, a nine-item confidencequestionnaire and a 10-item satisfactionquestionnaire,
which reflect the fivecore principles of the MCA (2005). Eight-five health andsocial care staff who were
trained to use the MCA WAT and had used it at least once had their scoresfrom pre- and post-use of the
questionnaires analysed using Wilcoxon signed-ranks tests. Data on the use of the MCA WAT was
Findings Results showeda significant increase in knowledge,confidence and satisfaction from pre-to
post-questionnaires. Concerns remain regarding staff understanding of who is the decision maker and
the use of communicationaids to enhance capacity. These issues are beingaddressed through training
and updating the information boxes in the MCA WAT. TheMCA WAT has been used to complete 3,645
capacityassessments over a five-year time scale, coveringa wide range of decisions.
Originality/value This project demonstrates the effectiveness of a contemporaneous method of
conductingand recording MCA assessments.
Keywords Mental Capacity Act, Learning disability, Staff knowledge, Confidence, Satisfaction,
Capacity assessment
Paper type Research paper
The Mental Capacity Act (MCA) of 2005 covering England and Walesis designed to protect
vulnerable people who lack capacity and applies to everyone involved in their care,
treatment and support (Department of Health, 2005), and all professionals have a duty to
comply with the Code of Practice (The Department for Constitutional Affairs, 2007). Other
jurisdictions will have different frameworks. The Code of Practice (The Department for
Constitutional Affairs, 2007 p. 3) defines “a person who lacks capacity” to mean a person
who lacks capacity to make a particular decision or take a particular action for themselves
at the time the decision or action needs to be taken. The first principle of the MCA (2005) is
that “A person must be assumed to have capacity unless it is established that he lacks
capacity”. However, where capacity is in doubt, an assessment of capacity must be made
Karen Dodd is based at
Surrey and Borders
Partnership NHS
Foundation Trust, Epsom,
UK. Sai-Bo Cheung and
Ashley Chapman are both
based at Surrey and
Borders Partnership NHS
Foundation Trust, Chertsey,
Received 29 December 2022
Revised 17 March 2023
Accepted 17 March 2023
Funding: The development of
the web based tool was
received from the Nurse
Technology Fund.
PAGE 120 jADVANCES IN MENTAL HEALTH ANDINTELLECTUAL DISABILITIES jVOL. 17 NO. 2 2023, pp. 120-135, ©Emerald Publishing Limited, ISSN 2044-1282 DOI 10.1108/AMHID-12-2022-0046
before carrying out any care or treatment, with the more serious decisions e.g. medical
treatment or examination, necessitating a more formal assessment of capacity which is
accurately recorded. This is stressed in guidance documents and MCA policies fromhealth
and social care organisations e.g. SCIE (2022), NICE NG 108 (NICE, 2018) and MCA Code
of Practice (The Department for Constitutional Affairs, 2007). The MCA Code of Practice is
currently being revised to addressthe 2019 amendments to the MCA (MCA, 2019).
A number of systematic reviews have been published on different aspects of the MCA.
Jayes et al. (2020) conducted a systematic review of 20 studies that met their inclusion
criteria and described how health and social care professionals in England and Wales
assess mental capacity to identify ways to improve practice. They found that mental
capacity assessment practice in England and Wales varies and is not always consistent
with legal requirements, risking inconsistent and inaccuratejudgements about capacity and
exposure to legal action. They noted that interventions including assessment flowcharts,
checklists and documentationaids have been developed to help professionals to engage in
supported decision-making and improve assessments and documentation in line with legal
Jenkins et al. (2020) conducted a systematic review of 16 studies that met their inclusion
criteria to identify training strategies and determine how registered health and social care
practitioners change their practice after MCA training. The majority of studies in the review
provided evidence that MCA training has limitedimpact in real-world health and social care
settings. They concluded thattraining is most effective in situations when the trainee has the
opportunity to apply learning soon after training. Within training, realistic, complex and
challenging scenarios that relate to the trainees’ own practice dilemmas appear to be
significant in facilitating application of learning to practice. This was also found by Willner
et al. (2013), who concluded that learning through application is central to ensuring the
legislation is upheld by practitioners.
Scott et al. (2020) undertook a systematic review of practitioners’ knowledge and
experience of the MCA, with nine studies meeting their inclusion criteria. One of the themes
identified was the lack of knowledge, which included the absence of detailed specific
knowledge and difficulties with recording and documentation processes. This is endorsed
in the study by Willner et al. (2011), who found that only 25%of newly appointed health staff
could correctly identify thedecision maker, which is a key role under the MCA.
Chapman et al. (2020) reported onthe analysis of knowledge questionnaires, which showed
that there was high variability of MCA capacity assessment knowledge among staff from
both health and social care settings of a learning disabilities division of an NHS Trust.
Qualified staff and those from health services scored significantly higher across all
categories on the questionnaire compared to non-qualified and social care staff,
respectively. On average, allstaff scored poorly when asked to identify “who is the decision
maker?” in a case scenario question.
A number of studies have focused on issues related to recording of mental capacity
assessments. Phair and Manthorpe (2012) reported that nursing and medical staff in their
study in an acute hospital Trust had some knowledge of theAct, but the level of knowledge
varied, with almost two-thirds of respondents lacking confidence in their understanding of
the Act. Most participants feltthat the documentation provided by the Trust around the MCA
was complex and unwieldy, and they were generally unfamiliar with the MCA consent form.
In addition, specific communication needs of the person were neither recorded nor
communicated to the team.
Li et al. (2016) undertook a quality improvement project across all general adult psychiatric
inpatient wards and found that capacity and consent to treatment were not routinely
recorded. However, the frequency of recording improved through the use of teaching

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