Mental Capacity (Amendment) Bill [ Lords ] (Fifth sitting)

Paul Williams Excerpts

Tuesday 22nd January 2019 Public Bill Committees

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Austin.

I rise to support my hon. Friend the Member for Worsley and Eccles South and to state that advocates are extremely important. They should be provided by default, with cared-for persons having the right to decline such representation if they wish. To illustrate my point, I will refer to a case study from POhWER, an organisation that provides advocacy support. Its advocate supported a cared-for person to go to court and stopped the local authority’s attempts to sell his home. Thankfully, the client then returned home.

The disconcerting scenario is as follows. The POhWER advocate, or the relevant person’s paid representative, visited a client in a care home where he was able to state that he did not want to be there, and wanted to go back to his own home. A discussion took place about requesting a review, accessing the court or liaising with a social worker. There were no conditions attached to the DoLS, but there was a lot of evidence and many statements confirming that the client did not want to be in the care home.

The cared-for person asked his advocate to have a chat with the social worker initially. The advocate contacted them to discover that although the client had not been in the placement for a long period, the local authority had placed his home on the market with the intention of funding his placement with the proceeds. That is an absolutely ridiculous scenario. It could happen to anyone here: unbeknown to us, the local authority could, without advocacy support, place our house on the market to fund a care placement with the proceeds of its sale. The client had no knowledge of this and there was no evidence at all that he had been consulted. He was very upset and wished to access court.

The court process determined that the cared-for person had substantial personal funds and a home that could easily be adapted for any mobility issues, with numerous bedrooms for live-in staff, whom he could afford to pay for himself. Thankfully, the judge ruled that he was to return home, in line with his wishes, given that he would have chosen that for himself if he had had full capacity to do so. Before the client moved back home, the new social worker who was appointed involved him in selecting the carers, who would live with him on rotation, and he had trial visits including some overnights. The return home was successful and the DoLS ended.

I hope that that example illustrates to the Minister and to Committee members that, without advocate intervention, the cared-for person’s home would have been sold without his knowledge, and his wishes and feelings would have been completely discarded and ignored. That is why it is very important that advocacy should be there by default.

[Dr Paul Williams (Stockton South) (Lab)]

It is a pleasure to serve under your chairmanship again, Mr Austin.

Like other hon. Members, I would like to share some cases to do with the issue of appropriate advocacy. Briefly, I will describe a simple intervention by an advocate who challenged assumptions made by care home staff and improved the quality of life of a person living with dementia. A relevant person’s paid representative was appointed for a woman who, it was reported, had been financially abused by her child following her diagnosis of dementia. She had been placed in a care home by the local authority because of safeguarding concerns.

Visits from the RPPR identified that the woman appeared to be happier now that she was not subject to the conduct and behaviour of her child. However, she had none of her own clothes, photographs or personal artefacts with her. When she was asked about that, she said that that made her feel sad. The RPPR made representations and said that if she had those possessions, she might be happier. Contact was made with her child. The intervention resulted in her child bringing items of clothing and photographs to the care home and also having some supervised contact with her mother. The woman told the representative that she was happy for that to continue.

The care home staff had initially provided information that the woman was content and did not need anything further, but the difference in her demeanour when she was wearing her own clothing and surrounded by personal artefacts was remarkable. She even wrote a note to her advocate, thanking her for supporting her and helping to get her child back in her life. Later on, her child wished to take her out of the care home, but the RPPR listened to the woman, who said she wanted to stay where she was, and supported her to make the decision to remain where she felt safe and comfortable.

That case illustrates why appropriate advocacy must be available to all who need it. The new legislation must ensure the right of the person to object to and challenge arrangements if they wish and to have the support and representation to do so. Support from an IMCA should not depend on a person’s best interests, as defined by other people. It should be a right that everyone is able to access an advocate, and people can then choose to opt out. That would improve the Bill by offering clarity to the cared-for person and the responsible body. I am happy to support the amendment.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I, too, want to support amendment 46. I would like to draw on a case study that has been provided by the organisation POhWER, which concerns an arranged marriage. I wish to draw the Committee’s attention to it because this occurs in the Birmingham area with remarkable frequency.

The case concerns a young woman who, for the purposes of the debate, I will call Layla. The authorities were contacted by her sister and advised that she was about to be taken to the airport and flown overseas for an arranged marriage. Her sister was extremely concerned that Layla did not understand what was happening and did not have the capacity to consent to sexual relations—many similar cases have been reported in the press. Having been alerted, the authorities decided on this occasion to step in, and Layla was given an emergency placement with a deprivation of liberty order while the matter was properly investigated. Following that, POhWER arranged for an advocate to be made available.

As the shadow Minister said, this is about the level of contact, because details are sometimes revealed during subsequent visits or after some time. During the advocate’s initial visit things seemed fairly straightforward, and the young woman did not express anxiety about being detained at the care home. She did not say she was unhappy, and there was no reason to suppose there was any great problem. During subsequent visits, however, it became clear that she was very bored and isolated, largely because most of the other residents were elderly, and although she was safe, she was in quite an inappropriate place.

The other day I spoke to a friend in Birmingham who works at a care home, and she told me a remarkably similar story. Because of the pressure on places and funding, it is not always possible for people—particularly if placed as a result of an emergency situation—to be given an ideal placement. It is therefore common for people to find themselves in a place that is safe, but that most of us might regard as not that appropriate in terms of its potential to allow them to improve or develop.

On this occasion, the advocate made representations to social services about the young woman’s ability to access a college place. Again, that request was initially ignored—throughout the Bill, we have spoken about the pressure on various authorities and the danger that if someone subject to a detention order is regarded as being in a safe place, attention will switch to the next emergency or crisis. By pursuing advocacy, we will ensure that we do not stop at that point and that we continue thinking about what is best for the person involved and what will improve their chances.

The advocate continued to make representations, and eventually the conditions of the DoL order were changed to require the young woman to be able to access a college place. As a consequence, she made phenomenally rapid progress and learned to read and write. She became better able to comment on what had happened with her family and to understand the nature of the arrangements under the DoL order. The end point of this was that, at a subsequent assessment and review, she was judged to have sufficient capacity to live independently by herself with minimal support, and she went on to gain paid employment.