The Mental Capacity Act 2005 created the Independent Mental Capacity Advocate (IMCA) service as a safeguard for people without the capacity to make certain important decisions. The Act also introduced a legal duty on NHS bodies and local authorities to refer eligible people to the IMCA service. The Department of Health (DH) has now reported on the third year of the service. There has been a 39.4 per cent increase in the number of people supported and represented by an IMCA compared with the previous year. This may be partly as a result of the range of decisions which IMCAs can be involved in being extended by the Deprivation of Liberty Safeguards, implemented on 1 April 2009. IMCAs can now get involved in decisions regarding adult protection situations and care reviews as well as serious medical treatment and a move to, or change in, long term accommodation. However, despite the increase in the use of the service, the DH reports that there are still wide disparities in the rate of IMCA instructions across different local authorities which cannot be wholly explained by population differences. There are, therefore, concerns that some people are not being referred to an IMCA even when serious medical decisions are being made. To find out more about the instructions that IMCAs received, please click here to access the report.