Best Interest Decision Making Practice

Having discovered horrendous poor practice in (Name of Town Removed by moderator) governance for Best Interest Meeting Governance I wondered what other areas are like?

Reasonable minimum practice should
a) produce guidance document in line with MCA 2005 on Best Interest Meetings and Decision making , to be published by every CCG and every Local Authority, preferrably jointly, and with a robust Equality Impact Assessment ie evidencing it is produced after consultation with service users, representative groups and other stakeholders, Hospital Trusts, Learning Disability services, specialist dementia services.
b) The document should have easy read summary/ introduction, checklist for chairs of meetings, checklist preparation for all/ any attendees
c) should be published in the public domain, on website
d) there is little reason why it should not be a joint document between CCG and LA as they should be working together anyhow, and can highlight and reduce potential conflict of interest between officers and their agencies and acting in the best interest of a person with reduced capacity for a specific decision.

Highlighting an example of poor practice resulting from poor governance, a young man with PMLD, decision over future place to live, no collation and circulation of any assessment, information beforehand. As meeting started, neither the chair or any of junior or senior officers from both LA and CCG questioned lack of any information. There was no clear identified named decision maker in the meeting or in minutes. Lots of outrageous, un-evidenced assertions were made, and with one exception, no one, not even the chair challenged them.

The bedrock to acceptable practice is the governance of guidance Document and training of staff in the MCA 2005 and application of the local Guidance document .

What is the experience in your area?

An acceptable inclusive easy to use Guidance Document? can you share good examples?
has there been evidenced consultation in its production and review? what has been most useful?

You are absolutely correct - having Guidelines are very important. It would be even better if they were co-produced with the statutory agencies and some carers - who are ususally involved in making best interest decisions. Despite having to admit I, as a carer have not read our local guidelines - therefore not sure we have some - practice seems to work well in this area - well, at least for my daughter it does. Most best interest decisions are made regarding her health or medical care and I think the discussion around why we decide what we decide is thorough. Sometimes I think we are required to record decisions too frequently - particularly around some medical treatment which she has every year - the rationale stays the same. But generally practice around health decisions is good. I would like to see more recording of the major decisions in other parts of her life - those involving non-health options - but that is not yet common practice here. A carer in Hull.

Personally best or good practice does not seem to exist. It has taken a considerable amount of time for a best interest meeting to be called. It appears that little or no training has been given to staff. Also where parents live apart and sometimes in different localities the whole family approach is not being implemented. So where geographical boundary are an issue for some families it can be very problematic getting any kind of support and even more problematic being involved in the process of creating a care plan.