An exploration of mental capacity assessment within acute hospital and intermediate care settings in England: a focus group study

Abstract

Purpose: To explore approaches to the assessment of mental capacity within acute hospital and intermediate care settings in England.

Methods: Two focus group interviews were conducted with multidisciplinary staff (n = 13) within a large hospital trust. Data were analysed using a Framework approach.

Results: Three main themes were identified: (i) the assessment process; (ii) staff experience of assessment; (iii) assessing capacity for patients with communication difficulties. Staff identified the main patient groups, patient decisions and professionals involved in capacity assessment. They described using both formal and informal approaches to assess capacity and specific methods to identify and support the needs of patients with communication difficulties during the assessment process. Most staff reported finding capacity assessment challenging, due to time pressures, a perceived lack of knowledge or skills and encountering practice that is not consistent with legal requirements. Staff stated a need for initiatives to facilitate and improve practice.

Conclusions: These findings provide confirmatory evidence that mental capacity assessment is complex and challenging and that staff would benefit from additional support and resources to aid their practice. It provides new evidence about the methods used by staff to assess capacity, particularly for patients with communication difficulties.

Implications for Rehabilitation

• This study contributes to our understanding of how staff assess capacity in hospital and intermediate care settings.

• Mental capacity assessment is a complex activity and many staff reported finding it challenging.

• Patients with communication difficulties need additional support during capacity assessments but may not always receive this.

• Current practice needs to be improved and staff need support and resources to achieve this.

Keywords:

• Decision-making
• communication disorders
• cognitive disorders
• stroke
• dementia
• Framework approach

Acknowledgements

We would like to thank the staff who agreed to take part in this study and Dr. Michelle Marshall, who kindly reviewed the data and the analytical framework.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.