The Independent Mental Capacity Advocacy (IMCA) service was created by the Mental Capacity Act 2005 (MCA) as a safeguard for people without capacity to make certain important decisions. The role of the IMCA has been to represent and support people without capacity and mainly without family or friends to support them, in important decisions. Staff who act as ”decision makers” with regard to this category of patient have a duty to consider and/or make a referral to the IMCA service in accordance with Chapter 10 of the MCA’s Code of Practice.

The first annual report of the IMCA service was published on 24 July 2008 and covered the period from April 2007 until March 2008.

The report noted that 5,175 people received representation from the IMCA service in the first year. 3,047 of the representations were for decisions on accommodation moves; 191 people were represented in care reviews; 671 represented in decisions about serious medical treatment and 675 were represented in adult protection proceedings.

The Department of Health’s assessment of the first year was that a great deal had been achieved. This included better decision making for the most vulnerable people and a new form of advocacy for people who lack capacity.

The department noted concerns about three issues:

• there was concern that referrals should be at a higher level for all decisions. There was suggestion that awareness of/compliance with the Act, is insufficient;

• referrals for serious medical treatment (see below) are particularly low across the whole country, raising concerns about the extent to which the NHS is, at present, complying with the requirements of the Act. It is worth noting that a referral to an IMCA is mandatory in these circumstances; and

• gate-keeping by IMCA organisations needs to be reviewed.

Serious medical treatment is treatment which involves giving new treatment, stopping treatment or withholding treatment, where there is a fine balance between the likely benefits and the risks; or where a decision between a choice of treatments is finely balanced; or what is proposed is likely to have serious consequences.

Whilst the report illustrates that the IMCA service is now up and running and that patients are being referred it is worth bearing in mind the role of the IMCA. Practitioners should familiarise themselves with Chapter 10 of the Code of Practice. The Code of Practice can be found at: