Abstract

The University of Lincoln was commissioned in December 2014, by NHS England, to undertake an external evaluation of the Mental Capacity Act Improvement Programme for Leicester, Leicestershire, and Rutland and Lincolnshire. This evaluation was carried out at a project level and covered the months of January – August 2015.
The brief from NHS England was for a programme of work that would lead to improvements in the implementation of the MCA in the region. The programme mandate specified four key benefits that it was hoped would be realized through successful delivery of the projects that make up the programme. In summary, these were:
1. Improved user (patient, service user, carer and public feedback systems)
2. Improved quality of service and professional practice (staff sharing best practice and drawing on user feedback)
3. Greater compliance across a wider group of professionals: targeting previously ‘hard to reach’ professional groups.
4. Greater assurance of MCA compliance: creating new and supporting existing best interests assessors, supervisors and frontline champions.
The aim of the evaluation was to evaluate the MCA Programme and its projects against national and local requirements.
The objective for the entire Programme and each of its projects (of which the evaluation was one) was to:
1. Provide baseline and platform of national and local best practice, upon which to justify and measure success;
2. Stimulate exchange of information, action learning and feedback;
3. Assess and confirm benefits realization and audit outputs;
4. Deliver evidenced advice to support mainstreaming of Programme deliverables and / or adjusting future approaches and practice beyond the life of the Programme.

Overall, the projects would seem to have been a success. The evaluators were impressed by the enthusiasm, hard work and commitment of the project teams, and by the positive reception of staff for the training. There is some concern as to the viability of the projects longer term with regards funding, however it is clear that there is a lot of work to be done yet. Evidence of impact is currently limited, given the relative early stage of development.
The framework offered by the MCA was welcomed as a way to protect and uphold the rights of individuals who have compromised or absent-decision-making capacity, be that absence a result of mental ill health, dementia or learning disabilities (Taylor 2014). Millions of pounds have been made available to train health professionals in the principles of the MCA it has yet it remains poorly understood and implemented in clinical practice.