The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [22]
Patients may have capacity to consent to some interventions but not to others, or may have capacity at some times but not others. Under the Mental Capacity Act, a person must be assumed to have capacity unless it is established that they lack capacity (DH 2009). If there is any doubt, then the healthcare professional should assess the capacity of the patient to take the decision in question (NMC 2010). This assessment and the conclusions drawn from it should be recorded in the patient’s notes. Guidance on assessing capacity is given in Chapter 4 of the Mental Capacity Act Code of Practice (2005).
Capacity should not be confused with a healthcare professional’s assessment of the reasonableness of the person’s decision (DH 2009). A person is entitled to make a decision which may be perceived by others to be unwise or irrational, as long as they have the capacity to do so (NMC 2010). All practical and reasonable measures should be taken to assist the person in making the decision.
Working with patients with learning disabilities
Two significant reports produced in the last few years have an important message for all providers of care to people with learning disabilities: in particular, Death by Indifference (Mencap 2007) and the Local Government and Parliamentary Health Service Ombudsmen’s response to this report, Six Lives: The Provision of Public Services for People With Learning Disabilities (House of Commons 2009). These identified many deficits in health and social care provision to six patients with learning disabilities. As a result of these reports, hospitals and other care providers are being asked to look at how they meet the needs of patients with learning disabilities and ensure there are clear and robust systems for identifying and addressing the needs of this patient group.
It is important to recognize that people with learning disabilities may have additional needs when attending or coming into hospital. We need to work with the patient, their family and carers to identify what additional care and support the patient requires. In doing so, we need to consider the implication of the Mental Capacity Act principles, in particular the presumption of capacity. The information then needs to be shared with all staff who provide care to the patient. This will enable continuity of care and prevent the patient or their carers from having to continually repeat the information to new care providers.
Hospitals need to work with their community partners to facilitate good communication between them both before and after admission and through any ongoing care for people with learning disabilities. For instance, if a patient with learning disabilities is to be admitted to hospital and the Community Learning Disability Nurse has a care plan on how to manage the patient’s epilepsy or what their likes and dislikes are, then sharing that information and using the community nurse specialist’s professional knowledge and expertise can only help to improve the care provided to the patient. It is therefore beneficial to nurses to know what their local organization arrangements are as well as what community services are available for people with learning disabilities.
Equality and diversity
Another characteristic of the UK population is the diversity of colour, nationality, ethnic origin, religious beliefs and faith, sexual orientations and marital and partnership status. In April 2010, the Equality Act received Royal Assent, providing streamlined law that can be used more effectively to tackle inequalities and discrimination. This law is particularly applicable to all public bodies, including the NHS. There is an expectation that there will be an explicit commitment to equality, diversity and human rights throughout the health and social care system. At strategic level, this means moving towards a single equality scheme; that is, a patient-centred and multifaceted approach is taken to the provision of all services, processes and policy development