Nageena Khalique QC is a barrister and Chair of the Committee for the National Institute for Health and Clinical Excellence (NICE) guidelines on supporting decision making. Here, she shares her thoughts on why its use is fundamental for health and care practitioners striving to support individuals who may struggle to make independent decisions about about their own care.
There is a growing number of people in England and Wales, estimated at around 2 million, who may lack capacity to make decisions for themselves because of illness, injury or disability. Concurrently, there are also concerns about variations in quality, consistency and availability of support to facilitate decision-making.
The new NICE guideline ‘Decision-making and mental capacity’ suggests ways to help people make decisions and maximise personal autonomy. It applies to a range of decisions including care, treatment, financial matters, day-to-day living and emergencies. It includes recommendations on advance care planning, which helps people plan future care when they lose capacity. NICE also makes recommendations for training and support for staff, interventions to improve decision-making capacity, advocacy and support for decision-making, and mental capacity assessment tools.
Different organisations may need different approaches to implementation, depending on their size and function. Sometimes individual practitioners may be able to respond to recommendations to improve their practice more quickly than large organisations.
Here are some pointers to help organisations put NICE guidelines into practice:
- Raise awareness through routine communication channels, such as email or newsletters, regular meetings, internal staff briefings and other communications with all relevant partner organisations. Identify things staff can include in their own practice straight away.
- Identify a lead with an interest in the topic to champion the guideline and motivate others to support its use and make service changes, and to find out any significant issues locally.
- Think about what data you need to measure improvement and plan how you will collect it. You may want to work with other health and social care organisations and specialist groups to compare current practice with the recommendations. This may also help identify local issues that will slow or prevent implementation.
- Develop an action plan with the steps needed to put the guideline into practice, and make sure it is ready as soon as possible. Big, complex changes may take longer to implement, but some may be quick and easy to do. An action plan will help in both cases.
- For very big changes include milestones and a business case which will set out additional costs, savings and possible areas for disinvestment. A small project group could develop the action plan. The group might include the guideline champion, a senior organisational sponsor, staff involved in the associated services, finance and information professionals.
- Implement the action plan with oversight from the lead and the project group. Big projects may also need project management support.
- Review and monitor how well the guideline is being implemented through the project group. Share progress with those involved in making improvements, as well as relevant boards and local partners.
Carry out a baseline assessment against the recommendations to find out whether there are gaps in current service provision.
The new NICE guideline comes at a time of imminent reform in the law as the Mental Capacity Act amendment Bill is scrutinised by parliament. While it will make some reforms, the empowering ethos and core principles originally introduced by the 2005 Act will continue.
People should be supported to make decisions for themselves when they have the mental capacity to do so, and to remain at the centre of the decision-making process when they do not. This guideline is aimed at helping health and social care professionals do that and improve the quality of the support they provide.
NICE provides a comprehensive programme of support and resources to maximise uptake and use of evidence and guidance. Click here to see their ‘into practice pages’ for more information.