Equality Impact Assessment

Overview:

Assessment Name: Tender for IMCA and Paid Representative service
Department: Adult Services Date Created: 01/08/2011
Lead Author: Chris Lucas Lead ID: SSHQOPCL
Additional Authors (if applicable): Paula Hallam
 
 
 
 
Aims and Objectives: Independant Mental Capacity Advocacy (IMCA) and Relevant Persons Representative (RPR) services provide advocacy and representation to a very disadvantaged group of people who lack capacity to make certain decisions for themselves and additionally have no friends or family members to speak on thier behalf.

The provision of these services is a statutory requirement under the Mental Capacity Act 2005 and this contract meets Hampshire County Council's statutory obligation in this respect.

These services have been provided as two seperate contracts, one for IMCA, one for Paid RPR, but from October 2012 we intend to provide them as a single contract, which should offer better flexibility and choice for people using the service as well as allowing us to better match the size of the contract to demand.

Main Activities: IMCAs will support the process of making decisions about a person's permanant accommodation or serious medical treatment, where that person lacks the Mental Capacity to make the decision for themselves. A decision will be made in the persons 'best interests' and the IMCA will represent the person and produce a report to assist decision making, where that person has no other unpaid person speaking on thier behalf.

The IMCA may also represent a person who lacks capacity to make decisions about Safeguarding procedures, even if they have family or friends involved in thier life.

IMCAs are also involved in advocating on behalf of people who are being assessed under the Deprivation of Liberty Safeguards in a care home or a hospital.

The Paid RPR service will take on the role of RPR when someone has a Deprivation of Liberty Safeguards (DOLS) Standard Authorisation in place and they do not have an unpaid person - family or friend - who can monitor thier placement and help them appeal against the DOLS, either by asking for a review of the assessments or by making an application to the Court of Protection.

IMCAs also support unpaid RPRs to undertake the role.

Who's intended to benefit: People over the age of 16 who lack capacity to make decisions about permanant accommodation, serious medical treatment and safeguarding procedures can benefit from IMCA services.

People subject to DOLS Standard Authorisations in care homes and hospitals will benefit from IMCAs and from Paid RPRs.

Relatives or friends of people who are subject to DOLS Standard Authorisations who take on the role of RPR will benefit from IMCA services.

Summary of Report:

Summary of Main Findings: Independant Mental Capacity Advocacy (IMCA) and Relevant Persons Representative (RPR) services provide advocacy and representation to a very disadvantaged group of people who lack mental capacity to make certain decisions for themselves and additionally have no friends or family members to speak on thier behalf.

The services have previously been provided as two seperate contracts but from October 2012 are being commissioned as one service, the size of which has been estimated based upon the uptake of the service so far.

The assessment indicates that referral for IMCA services for people with mental health problems other than dementia and for people with physical illness are lower than the national average, so we will seek to address this by promoting the services appropriately, or clarify why referral rates for Hampshire are different to the national averages.

Age:

What do you know about the breakdown of people who use your services compared to the community profile: The majority of the provisions of the MCA2005 apply to people from the age of 16 and all apply to adults over the age of 18.

Any person with an 'impairment or disturbance of the mind or brain' who is assessed as being unable to make a decision relating to permanent accommodation, serious medical treatment or adult protection procedings could access an Independant Mental Capacity Advocate (IMCA.)

In practice, locally the service has been used for people over the age of 18 and 56% of the referrals have been for older people with dementia.

Nationally the figures have been consistant in the first three years of the scheme, with people over the age of 80 accounting for a third of all referrals to IMCA services and people between the ages of 66 and 79 accounting for a quarter of applications.

Will some people be able to use or benefit from the service: The Deprivation of Liberty Safeguards (DOLS) IMCA service and Paid Representative (RPR) service will only be available for people undergoing a DOLS assessment or subject to DOLS authorisations and will therefore be over the age 18.

IMCA services could be instructed for people under the age of 18 (16 - 17) but nationally these referrals have been insignificant (nationally only 9 referrals in 2009/10)

How could the iniative improve equality of access: IMCA and RPR provide representation to people who lack capacity to make certain decisions and have no one to advocate for them in an unpaid role.

Referrals relating to DOLS are made by the DOLS team and should be identified by thier processes.

General IMCA referrals may be made by any decision maker, usually the professional involved. Access can be improved by including information about the role of the IMCA in MCA training and by advertising the referral process and contact details within hospitals and health settings, residential care settings and Adult Services teams.

Disabled People:

What do you know about the breakdown of people who use your services compared to the community profile: Referrals to the IMCA service are classed in relation to the cause of the mental impairment, ie learning disability, physical disability, mental health or older persons, including dementia.

Local referral figures have shown 56% of IMCAs referred for older persons, 36% for adults with learning disabilities, 4% for adults with physical disabilities and 4% for adults with mental health problems.

Nationally in year 3, the referrals for dementia accounted for 37.6% with mental health problems other than dementia accounting for 12.3%. Learning diabilities, including cognitive impairment and autistic spectrum disorders accounted for 33.7% of referrals.

Aquired Brain Injury, unconsciousness and serious medical illness accounted for 8% of referrals.

This would suggest that in Hampshire there is an over representation of referrals for people with dementia and an under referral of adults with mental health problems other than dementia and people with organic/physical health issues.

Will some people be able to use or benefit from the service: These services are only available to people who have 'impairment or disturbance of the mind or brain' and are lacking capacity to make a specific decision about permanant accommodation, serious medical treatment or safeguarding procedings.

People who have capacity to make these decisions for themselves will not be able to access these advocacy services.

The DOLS IMCA and RPR services are only available to people who have a Mental Disorder, so anyone who does not will not be subject to DOLS in a care home or hospital and will not access these services.

How could the iniative improve equality of access: IMCA and RPR services are predominantly referred to for adults with learning disabilities and older people with dementia.

Further awareness work may be required amongst mental health professionals and people working with younger adults with organic causes of mental disorder such as Strokes.

Faith:

What do you know about the breakdown of people who use your services compared to the community profile: This information is not currently available
Will some people be able to use or benefit from the service: A person's faith would not effect thier access to these services
How could the iniative improve equality of access: Providers should demonstrate that they are sensitive to the needs of people from differing faiths and would be able to make adjustments to how services are delivered should this be necessary to meet these needs. To the best of our knowledge, faith has not been a bar to accessing these services in Hampshire since they were introduced.

Gender:

What do you know about the breakdown of people who use your services compared to the community profile: Nationally, 53% of IMCA referrals relate to woman, which is slightly higher than the percentage of women in the adult population (51%).The department of health relate this variation to the high age profile of IMCA referrals and the corresponding higher life expectancy of woman.

Nationally there appears to be a high proportion of women referred for safeguarding issues (over 60%) and a low proportion of women referred for serious medical treament decisions (46%)

Will some people be able to use or benefit from the service: A persons gender should not be a bar to accessing these services.

How could the iniative improve equality of access: Locally, there have been a small number of cases where a person recieving an RPR service has requested a Representive of a particular gender and ensuring that these requests can be met would be helpful.

The change to one contract covering both IMCA and Paid RPR services should improve the ability of the service to respond to such requests, particularily for Paid RPRs as the current provider employs a single worker, meaning limited flexibility. If Paid RPR were part of a larger IMCA service, there should be benefits of scale, particularily wider choice of advocate and better coverage in case of annual leave or sickness.

Race:

What do you know about the breakdown of people who use your services compared to the community profile: Nationally the ethnicity of people referred for IMCA services has been broadly in line with the population breakdown for England.
Will some people be able to use or benefit from the service: A person's background should not be a bar to accessing these services.
How could the iniative improve equality of access: Providers should demonstrate that they are sensitive to the needs of people from differing backgrounds and would be able to make adjustments to how services are delivered should this be necessary to meet these needs.

Gay, Lesbian, Bisexual:

What do you know about the breakdown of people who use your services compared to the community profile: We do not currently have this information
Will some people be able to use or benefit from the service: A person's sexuality should not be a bar to accessing these services.
How could the iniative improve equality of access: Data could be collected and compared to national population statistics to clarify that no significant variations in levels of referrals are occuring.

Socio Economic Factors:

What do you know about the breakdown of people who use your services compared to the community profile: We do not currently have this information

People being referred will have some level of 'impairment or disturbance of the mind or brain' and will usually be accessing health or social care services. Where socio economic factors effect access to these services, we would expect to see these factors reflected in referral rates to IMCA and RPR services.

The high levels of referrals for people with learning disabilities - 36% in Hampshire - will demonstrate a link to education and achievement for some people.

Local referral rates have shown a bias toward referrals in the south east and southwest areas of the county, which may correlate with areas that have high densities of residential services for people with dementia and learning disabilities.

Will some people be able to use or benefit from the service: A person's economic status should not limit thier access to these services. The person using these services does not have to pay for or contribute toward them or be financially assessed as they are paid for by the local authority and central government have provided funding to ensure these services are available.
How could the iniative improve equality of access: There should be appropriate promotion of the service to ensure that it is accessable to all appropriate people.

Rural Isolation:

What do you know about the breakdown of people who use your services compared to the community profile: We do not currently have this information

Will some people be able to use or benefit from the service: Peoples location should not be a bar to using IMCA or RPR services, especially as we would expect advocates and Representatives to travel to wherever the individual currently is.
How could the iniative improve equality of access: There should be appropriate promotion of the service to ensure that it is accessable to all appropriate people.

Other groups affected:

Are there other groups affected not already mentioned: Offenders who come under the scope of the MCA can benefit from this service equally with other people subject to the MCA.

IMCAs and RPRs are usually provided to people who do not have unpaid carers or interested parties available to tem. The exception to this is when there are Safeguarding procedings. There will be very limited impact upon carers.

Conclusions of Potential Impact:

Possible Impact: IMCA and RPR services provide advocacy and representation to a very disadvantaged group of people who lack capacity to make certain decisions for themselves and additionally have no friends or family members to speak on thier behalf.

Referrals are dependant upon professionals working with these people being aware of the existance of IMCA and of when referrals should be made.

If any groups are disadvantaged is this likely to be unlawful: Referral to IMCA services is a statutory requirement under the MCA and if appropriate referrals were not to be made for certain individuals or groups then this would be unlawful
Group Affected: The statistics show that older people with dementia and people with learning disabilities represent the highest proportion of referrals.

People who have mental health problems other than dementia and people with physical health problems appear to have lower rates of referral to IMCA services in Hampshire than the national average.

Evidence: Local referral figures have shown 56% of IMCAs referred for older persons, 36% for adults with learning disabilities, 4% for adults with physical disabilities and 4% for adults with mental health problems.

Nationally in year 3, the referrals for dementia accounted for 37.6% with mental health problems other than dementia accounting for 12.3%. Learning diabilities, including cognitive impairment and autistic spectrum disorders accounted for 33.7% of referrals.

ABI, unconsciousness and serious medical illness accounted for 8% of referrals.

This would suggest that in Hampshire there is an over representation of referrals for people with dementia and an under referral of adults with mental health problems other than dementia and people with organic/physical health issues.

Further Actions to be taken:

Action: 1) Further promotion of IMCA services is likely to be required amongst professionals working with people who have mental health problems other than dementia and people with physical health problems.

2) The provider of the service will be required to collect referral data to inform future EIAs, including informatuion on faith, sexual orientation and rural isolation, this information will be fed back to the commissioner at contract reviews.

3) The services (IMCA and Paid RPR) are currently provided under two contracts and we are combining these into one service from October 2012. Any impact of this change should be closely monitored.

Responsibility: Commissioner of service in Hampshire County Council

Providers of service

Timescale: The duration of this contract.
Expected Outcomes: Better correlation between Hampshire referral rates and the national rates of referral for different client groups, or a better understanding of any ongoing variations.

Review Summary:

Review Update:  
Review Date: 01/04/2013 Date sent to Web Editor: 10/08/2011 11:55:03