On 14 February 2014 the Department of Health published a detailed report on “The sixth year of the Independent Mental Capacity Advocacy (IMCA) Service: 2012/2013”. There has been a year-on-year increase in the number of instructions to the IMCA service since it began in 2007 (when there were 5,266 referrals). There were a total of 12,381 eligible instructions for the IMCA service in England in 2012-2013, which represented a 4% increase on the total number of eligible referrals in the previous year. The subject matter of the instructions in 2012/2013 (and the increase or decrease since 2011/2012) was as follows:

  • Accommodation decisions: 5,353  (an increase of 9%);
  • Serious  medical  treatment  decisions:1,907 (an increase of 9%);
  • Care reviews: 1,203 (an increase of 16%);
  • Adult  protection/Safeguarding: 1,482  (a decrease of 3%);
  • Deprivation of  Liberty  Safeguards: 1,907 (a decrease of 3%)

The report found it is likely that the duties under the MCA are still not well embedded in  some local authority areas as there continues to be wide disparities in the rate of IMCA instructions across different local areas which cannot wholly be explained by population differences. The report contains detailed tables showing the number of instructions by local authority between 1 April 2012 and 31 March 2013.

The key recommendations from the report may be summarised as follows:

  1. Commissioners should recognise that the number of people statutorily eligible for the IMCA service continues to increase on a year-by-year basis;
  2. Local authorities and IMCA organisations should carry out self-audits of recent accommodation moves, and ensure that people’s wishes and feelings have been considered and the issue of ‘less restriction’ has been fully reflected in all decisions;
  3. IMCA organisations, local authorities and the NHS should continue to be alert to possible Deprivations of Liberty (DoLs). IMCA organisations should alert local authorities and the NHS for the need either to prevent a DoL by changing the care plan, or applying the DoL safeguards, in a care home or hospital. If the possible DoL is the result of a care package in the community, a referral to the Court of Protection is required;
  4. Local authorities should carry out a small audit of recent reviews, to establish whether all those who would benefit from IMCAs in their reviews did in fact receive one;
  5. Mental Capacity Act leads in clinical commissioning groups should monitor compliance with the requirement for referrals to IMCAs for each of their providers, as part of their MCA responsibilities;
  6. Local authority safeguarding coordinators should consider the statistics in this report and report to their Safeguarding Adults Boards on whether sufficient number of IMCA referrals are being made in their areas;
  7. Supported decision making should be adopted more widely within safeguarding practice, to assist more people to make their own decisions about their safeguarding plans. Consideration should be given to whether there is any alternative, less restrictive safeguarding action available before a care plan or a protection plan is made;
  8. IMCAs and commissioners should audit a sample of IMCA reports;
  9. IMCAs should follow Court of Protection advice in published judgments on identifying a possible DoL and on applying the MCA principles in relation to all care planning.