Privacy and dignity
Moorfields Eye Hospital NHS Foundation Trust is committed to ensuring that our patients are treated in clean and pleasant hospital surroundings and that our staff will do all that they can to protect people's privacy and dignity.
10 points of dignity
- Have a zero tolerance of all forms of abuse
- Support people with the same respect you would want for yourself or a member of your family
- Treat each person as an individual by offering a personalised service
- Enable people to maintain the maximum possible level of independence, choice and control
- Listen and suppoort people to express their needs and wants
- Respect people's right to privacy
- Ensure people feel able to complain without fear of retribution
- Engage with family members and carers as care partners
- Assist people to maintain confidence and positive self-esteem
- Act to alleviate people's loneliness and isolation
Your rights to choice and control
video transcript
Introduction
Making everyday decisions about our own lives is something most of us take for granted
where I'm going what I want to do spending money or just looking after myself
But what happens if there's a time when we find it more difficult to make decisions
or if people think we can't make them what happens then?
This is what the mental capacity act is all about
The mental capacity act essentially protects my freedom my dignity
Well it's based on five principles
It's about being able to support vulnerable people and their families
It's very protective you have to be given support to make your decisions
and the thing I really like is the fact that they allow for the fact that you
could make unwise decisions
It's basically about human rights giving all people the right to have a voice
to express a preference
The mental capacity act supports anyone aged sixteen and over
It's made up of five key principles and some groups are adapting the language
to suit their own needs
We are making an easy read version of the five rules of the
Mental Capacity Act
Capacity means I can make my own decision and understand what it means to me
One two and three is all about me
Start by thinking I can make a decision
Do all you can to help me make the decision
You must not say that I lack capacity
just because my decision seems unwise
Four and five you do with me
if I lack capacity
Capacity
Use a best interest checklist for me
If I can't make a decision
You must check the decision made
does not stop my freedom
more than needed
Assume everyone has capacity
The mental capacity act is there to support us all
and the first of the five important principles is to assume
everyone has the capacity to make their own decisions
My name is Anital Puri and this is my mum Santosh Anand
Mummy tell them your name
Santosh Anand
Errm my mom has been recently diagnosed with dementia and I'm her main carer
it's just been a bit of shock being diagnosed with dementia
so we're trying to come to terms with that and trying to plan
things for the future
Mental capacity act is to assume that everybody has the capacity
until it's proven that they don't have the capacity
My mom still makes decisions for herself and we encourage that
that she continues to make her own decisions about herself
My name is Dorothy Runnicles I've been fortunate enough to be trained
as a social worker and as an academic
and I've worked, I've had family my own family so I had lots of life experiences along the way
to this 91st birthday which is coming up
Very often even as an age group you're judged
as not having capacity to deal with or participate or share
in decision making which is affecting you and you don't expect to be told that you
don't have a view and that your view is not important or to be ignored
but that's why capacity through the mental capacity act and its effect
on older people
is so important because it assumes that you do have capacity
it may vary as you grow older it may vary from day to day and it assumes that
you still have a point of view and control of our lives should be retained
Give the right support
and it can happen
The second principle of the mental capacity act is about giving
the right support to people to help them make their own decisions
My name is Claire I live on a farm
and also I've got a job
The mental capacity act has supported me to catch the bus from home
to the bus station and to get to work
At first my mum and dad they were just worried about me
because they always like to protect me
and take me to places
I said hard hard fire I would like to go and do them myself
Doing a risk assessment in Claire's own words
is a good way of supporting someone to make sense of information
so that they can make a decision
I've done myself a transport centred plan risk assessment
I designed it and I had a little help
and it's all come in my own words
This has helped me make a decision
It's what works good and not-so-good
Spending time to know right bus stop
People I am working with knowing when I arrive
This really helped my mum and dad and also me
It has helped me spread my wings
now it's brilliant that I can catch the bus
And whenever necessary support people to speak for themselves
by using advocates or representatives
My name is Larry, Larry Gardiner I'm 63 I was born in nineteen fifty two
I have altered states of consciousness and funny turns
I call them my funny turns
At the moment in the present situation
the kind of support that's necessary for me
to assert the rights
that the mental capacity act gives me
and to assert the presumption about my capacity to make a decision
often it actually needs an advocate
to partner with me to back me up
so if you ask me to make a decision and I just can't make one or
if you ask me to make a decision and I don't understand the requirement to make a decision
so I don't know that one is necessary then I think you can assume that
somebody needs to make a decision in my best interest
The Mental Capacity Act
Principle three of the mental capacity act is also very important
it states that what might seem like an unwise decision does not necessarily
indicate a lack of capacity
an example of this is when people have relationships
which some find difficult to support or accept
This is Michael Ratcliffe my husband
And this is Marlene my wife
We've been together nearly 29 years
Marlene do you remember when we first got together
Yes I can
yeah and they asked us to come into the office
becuase they were worried about our relationship
Yes
Can you remember what they were worried about
They thought I was going to get pregnant
what did you think of it?
I think they didn't treat us like adults
But I think people still don't take relationships
for people with learning disabilities like us seriously enough
It annoys me
Trying to think of a polite word
It really does annoy me when they do
when people do that
So do you think people understand what the
mental capacity act is? No, no, no
it gives you the power to make your own decisions and it also gives you
the right to make mistakes
The act actually helps us to make a decision
as long as people know what the act is about
It makes a difference does it? Yeah it does
In the whole of my life I don't think there's ever been a moment
when it wasn't possible for me to make a decision
I might have made one that nobody agreed with
I've been given medication against my will
and now if a clinician says I think we'd like you to try
these medicines and these are our reasons
if I don't agree with them
prescribing me this medicine and if I don't want to take it
I'm free not to take it just in the same way that you are
I have the right I have that right
Mental Capacity Assessment
At times it might be felt that someone
doesn't have the capacity to make a decision
When this happens a mental capacity assessment is done
This involves two key parts
The first is to determine whether the person can make
the actual decision at the time
And the second assesses whether
if they can't make the decision
this is due to something affecting their mental ability through a long-term
condition such as dementia or a learning disability or perhaps temporarily
such as unconsciousness or drunkeness
In these cases principle four of the
mental capacity act states that
any decision should always be taken in the best interests of the person
Best Interests
The best interest decision is a decision
that in our situation was made because my mum
didn't have capacity and the decision
that was being made was about her care
so whether she could stay at home or whether she would
need to go into residential care
The best interest meeting is a meeting where it brings all the different
parties together who's involved in the care of an individual
Being in a best interest meeting was very useful because
obviously for family it's very emotive
and we have our reasons and wishes which may be contrary to the individual
themselves so in the case my mum
we know even though she wanted to stay in her own home
it was increasingly more difficult to enable that to happen
We feel reassured that the decision has been made in my mum's best interest and it's helped us
it's quite a relief really knowing that she's actually in a care home
and she settled into a care home very well
Challenging Decisions
Principle five of the mental capacity act
requires us to look for less restrictive ways of meeting
someone's best interests
and this could mean challenging decisions taken by professionals
I'm Liz McNichol
I've been mam's carer for the last six year
When it was coming to the end of me looking after mam
mam was wandering she was just putting her coat on and going out and
taking herself for walks
and we don't know where she was going it was really frightening
They diagnosed her with vascular dementia
I'd always promised mam I wouldn't put her in a care home
Mam was always frightened of care homes
but when I taken her up to the bungalows the independent living bungalows
she loved it
and she said she could feel herself
wanting to live there and being looked after
and getting care
The first social worker involved decided that because of her dementia
Liz's mum needed a capacity assessment as they felt she might not have the capacity
to make the decisions about where she wanted to live
The process was mam had to have a capacity assessment
but the social worker said she failed the test
this led to the social worker advising that Liz's mum should go into a
residential care home and not into the independent living bungalows
This wasn't what Liz felt her mum wanted feeling it was a more restrictive choice
and not in her mum's best interests
We had to fight through the courts and it was hard
as soon as we had the right support it was great the second social worker was brilliant
The end was the judge
She had the best interest decision
stating that she could go into the bungalows then
That was was great because
then we knew things were starting to move forward
The main thing is mam being happy and content that's all we've ever wanted
Planning for the Future
The mental capacity act also supports people to think ahead and plan for the future
Older people are quite often fearful of acknowledging that they are having
to face incapacities
to older people my first bit of advice was get ready for older age
in any way you can now
don't pretend that you're not going to get old and you're not going to need
help guidance trusted friends professionals who really care about
what's happening to you
One way of planning for the future is to set up lasting powers of attorney
often known as an LPA
There are two types of LPA that can safeguard who can take decisions on your behalf
A health and welfare LPA allows someone you trust to
take decisions about your health and welfare such as going into a care home
or receiving medical treatment
A finance and property LPA allows someone to take decisions about your
money and finances on your behalf
I think it's an opportunity that people should think about seriously if they
should lose capacity and be unable to make decisions
about their financial situation
why not now early on when everything is completely calm and straightforward just
sort that out
and what an LPA gives you the opportunity to do is to ask people that
you trust to have some say over your financial matters
Having an LPA gives me the confidence that if there comes a time when I no longer have capacity
that my financial affairs and properties and so on everything from depositing a cheque
paying a bill through to - I don't know
selling a house
will be able to be taken forward by the people that that that I have
put in charge of my financial affairs and it won't be difficult for them
they'll just be able to take it forward and it won't be a stress
I presume when I if I lost capacity it would be an uncomfortable position for people around me
and at least this won't be difficult for them
I think taking out an LPA to some extent is a sort of generous gesture to those
around you because it may not affect me directly by that point I won't really
know I think if if the LPA needs to be used
But I hope it will make things more more comfortable for people around me
Advance Decisions
Taking out an advanced decision about any medical treatment you may not want to
receive in the future is another way of protecting yourself over any decisions
taken on your behalf
An advanced decision to refuse treatment at the end of your life
Is a document where you can say what you
don't want to happen at the end of your life under different sets of circumstances
you can put all the circumstances you like and you can say yes that's okay
or no that's not ok so at least my wishes are laid down even if that means
that my life is shortened
I'd rather have a shorter life in a happier and more comfortable state
than a longer life that's my choice
Well you can do it anytime I wish I'd done it earlier and it's
important to do it while you can because you have to do it while you're of sound mind
I put on my children's details in because it needs to be clear who to
contact in the event of things going horribly wrong
it makes it easier for them to make the best choices for me
Under the mental capacity act
you have to act in the best interests of the person that no longer has capacity
and I will have given them as much guidance as I can as to how
I see my best interests so their decisions should be easier and smoother
once it's done then I think there's a lot of peace of mind that comes from that
Life can be unpredictable and planning ahead can make taking difficult decisions in the future
much easier
Future is scary for us and we are all going to sit down as a family
and we're going to talk about Lasting Power of Attorney any advance decisions
and then I would know once she doesn't have the capacity then
I know I'm fulfilling her wishes
I think very few people understand what the whole act is about and how it
can have an impact on their day-to-day life and can help them make decisions
on a long-term basis as well that's why I think it's very very important before
the time it's to late
The mental capacity act is there for everyone
make sure it supports you when you need it.
Useful contact numbers
Moorfields Direct telephone helpline: 0207 566 2345: 9am - 9pm, Monday to Friday and 9am - 5pm on Saturdays.
Patient advice and liaison service (PALS): 0207 566 2324/5
Support groups
Contact the Elderly provides a lifeline of friendship. Once a month on a Sunday afternoon a volunteer driver will transport one or two older people to a volunteer host's home where a small group can enjoy warm hospitality and a cup of tea. The driver then takes the person home at the end of the day. Phone: (Freephone) 0800 716 543
Age UK offers a telephone befriending service which provides a weekly telephone call (usually lasting 20 minutes) from a trained and supported volunteer. They can also offer a Good Day Call which is a short telephone call several times a week, at a convenient time for an initial period of 8 weeks. This is especially beneficial if a person has experienced a recent bereavement or just been discharged from hospital.Phone: 020 7820 6770
Home Library Service may be offered by some libraries. A regular visit can be provided, usually every 4 weeks to someone's home. The person can request what reading material, music and films are available and these can then be requested and exchanged during the next visit. The service is free and specific titles can be requested. Some libraries in boroughs offer computer training, helping people to become computer literate.