Appendix– Definitions

Advocate

Advocates represent people’s wishes by supporting them to speak or by speaking up on their behalf. They are independent of the council.

Advocates help people to express their needs and make decisions about the options available to them. 

They make sure that the council follows the correct procedures and can challenge decisions made by councils and other organisations.

The council commissions four types of Independent advocacy:

• Care Act Advocacy
  
  
• Mental Capacity Advocacy 
  
  
• Mental Health Advocacy
  
  
• Health Complaints Advocacy

Appropriate person

In the context of this policy, an ‘appropriate person’  is someone who:

• is willing to act an informal representative for someone likely to have substantial difficulty in being involved in Adult Social Care processes and
  
  
• the council agrees is appropriate to do so.

The ‘appropriate person’ needs to be able to understand Adult Social Care processes when explained to them, know the person who needs support well and be able to set aside their own views. 

The council has to agree that someone (usually a family member or friend) can act as the ‘appropriate person’.

Assessment

An assessment is how the council works out what someone’s social care needs are. It is a conversation between the council and the person (and sometimes other people who know them well or their representative).

The assessment looks at how people manage everyday activities such as looking after themselves, household tasks and getting out and about. 

Unpaid carers can have a carer’s assessment of their own needs, separate from the needs of the person they care for. Carer assessments look at what might help the carer’s health or managing other aspects of their lives.

Best interests decision

If someone cannot make a particular decision for themselves (for example about their health or their finances), the council will make a decision based on what is in the person’s best interests.

The law does not define what ‘best interests’ are but sets out what has to be taken into account when deciding what is best for someone. 

This includes the person’s wishes and feelings, what is important to them, what close family members and friends think the person would want, and all the person’s circumstances.

Care Act Advocate

Local authorities have a duty under the Care Act 2014 to involve people in decisions about their care and support needs.

There is a duty to arrange an independent Care Act Advocate for anyone who has no ‘appropriate person’ to  act as their informal representative if they are likely to have 'substantial difficulty' in being involved in:

• their assessment
  
  
• making or revising their plan
  
  
• a safeguarding enquiry or a Safeguarding Adults Review

Independent Care Act Advocates support:

• adults who need care and support
  
  
• carers
  
  
• young people under 18 including young carers who are moving to Adult Social Care (often called transition)

Carer/young carer

Carer: Somebody, of any age, who provides support or who looks after a family member, partner or friend who needs help because of frailty, physical or mental illness, or disability. This would not usually include someone paid or employed to carry out that role, or someone who is a volunteer.

Young Carer: someone aged 18 or under who helps look after a relative with a disability, illness, mental health condition, or drug or alcohol problem. This includes a sibling with a disability or mental health condition.

Commissioning

Commissioning is how the County council plans services for people who live in Gloucestershire. It doesn’t always mean paying for services but making sure that services people need are available in Gloucestershire.

Consent

Consent is a freely given and informed decision to agree to an act taking place.  This is usually given by the person concerned but it may be given by another person:

• where they are authorised to provide consent for an adult who lacks capacity (such as LPA, Deputyship, Court Order).
  
  
• with parental responsibility for a child or young person, where the young person (over 16) lacks capacity for that decision.

Deprivation of liberty

Deprivation of liberty is when someone in a care home or hospital who lacks capacity about their living arrangements is:

• under continuous supervision and control, and 
  
  
• not free to leave.

In Gloucestershire, deprivation of liberty must be authorised by the County council (the Supervisory Body). A standard authorisation is only granted when all necessary procedures and assessments are complete so that people don’t have their liberty taken away without good reason.

Independent Health Complaints Advocate

 
(IHCA)

Health Complaints Advocacy Services are independent of the NHS and help people to use the NHS complaints process which covers all NHS funded treatment such as:

• hospitals, GPs, ambulance services, district nurses and mental health services
• dentists (if treated as an NHS patient)
• pharmacists (if someone had an NHS prescription)
• opticians ( if treated as an NHS patient)
• a private hospital (if the NHS paid for treatment)
• a care home (if the NHS pays all or part of someone’s care home fees)

Health Complaints Advocacy Services:

• provide information about how to make a complaint
  
  
• explain the NHS complaints process
  
  
• signpost people to other organisations that can help if the advocate can’t
  
  
• provide information packs to help people make the complaint themselves
  
  
• provide an Advocate if the person needs more help

Independent Mental Capacity advocate 

(IMCA)

This is a person who supports and represents someone who lacks capacity to make a specific decision, where that person has no one else who can support them (exception for Safeguarding situations). They make sure that where significant decisions for a person who lacks capacity are made, that the person has independent representation. 

Local authorities have a duty to appoint an IMCA when decisions have to made about:

• Long term accommodation
  
  
• Serious medical treatment
  
  
• Safeguarding
  
  
• Deprivation of Liberty Safeguarding (DoLS)

Independent Mental Health Advocate

(IMHA)

An IMHA is an advocate specially trained to help people know their rights under the Mental Health Act 1983 (MHA) and help them while they are detained or under a section of the MHA. IMHA listen to what people want and speak for them.

People have a legal right  to have an IMHA if they are:

• detained in hospital under a section of the MHA. In England, people cannot have an IMHA if they are under sections 4, 5, 135 and 136 of the MHA.
  
  
• under MHA guardianship, conditional discharge and community treatment orders (CTOs)
  
  
• discussing having certain treatments, such as electroconvulsive therapy

In Gloucestershire, IMHA are also offered to:

• carers of the people listed above
  
  
• informal patients in mental health hospitals
  
  
• people using the services of a Mental Health Acute Response Service
  
  
• people receiving section 117 after care services

IMHA are usually arranged by Mental Health professionals but may occasionally be arranged by Adult Social Care staff for people living in the community who qualify for an IMHA.

Mental Capacity

A person’s ability to make a specific decision at a specific time.

A person may lack capacity because of a wide range of conditions including dementia, a learning disability, mental health problems, a brain injury or stroke. Just because a person has a diagnosis does not mean they lack capacity.  

A lack of capacity can be temporary, for example when someone has been in an accident and is unconscious.

A legal definition is contained in Section 2 of the Mental Capacity Act 2005.

Plan

A written plan is agreed after the council has made an eligibility decision and has agreed to meet needs. The plan shows how the person wants their needs to be met.

The plan may be known as a care plan or a care and support plan.

Plans are reviewed regularly in case needs have changed. If they have, needs will be re-assessed and the plan revised.

Relevant Person’s Representative (RPR)

When there is a deprivation of liberty, people can be supported by an RPR (usually a family member).  The person can choose their own RPR if they have the capacity to do so.

An RPR must be:

• aged 18 or over
  
  
• willing to be the RPR
  
  
• able to keep in touch with the person
  
  
• physically well enough to carry out their role
  
  
• an independent person. This means they cannot be a professional or paid carer 

Safeguarding

Safeguarding adults is about keeping adults with care and support needs who may be at risk safe from abuse, neglect  or being exploited, and ensuring that people deemed to be  'unsuitable' do not work with them.

The County council investigates if it receives information which suggests that someone is being abused, neglected or at risk. A protection plan is put in place if abuse is happening. 

The County council works with other organisations to protect adults with care and support needs from abuse and neglect through the Gloucestershire Safeguarding Adults Board. 

Section 39A Independent Mental Capacity Advocate (IMCA)

The 39A IMCA's role is to represent the person in the assessments which will be carried out in relation to deprivation of liberty.

They may only be instructed when a standard authorisation is not in place. There are two possibilities:

• A request has been made for a standard authorisation. 
• A best interests assessor has been appointed by the supervisory body to check whether a person is being unlawfully deprived of their liberty. 

In both cases the person should have no one appropriate to consult.

Section 39C Independent Mental Capacity Advocate (IMCA)

The 39C IMCA role can be understood as covering gaps in the appointments of relevant person’s representatives. The role ends when another relevant person’s representative is appointed.

Section 39 D Independent Mental Capacity Advocate (IMCA)

39D IMCAs are only available when a DoLS standard authorisation is in place and the person has an unpaid relevant person’s representative.

Where a person has an unpaid representative, a 39D IMCA must be instructed if:

• he Relevant Person asks the supervisory body for the support of a 39D IMCA
  
  
• Their representative asks the supervisory body for the support of a 39D IMCA
  
  
• The supervisory body believes that the Relevant Person or their representative would benefit from the support of a 39D IMCA

Standard Authorisation:

This is the formal agreement to deprive a relevant person of their liberty in the relevant hospital or care home, given by the Supervisory Body, after completion of the statutory assessment process.

Substantial difficulty

By ‘substantial difficulty’, we mean when someone is likely to have problems with one or more of these:

• understanding information about social care decisions
  
  
• remembering information
  
  
• using the information to be involved in the decisions
  
  
• being able to tell other people their views, wishes and feelings

Supervisory Body

A local authority that is responsible for considering deprivation of liberty applications, commissioning the assessments, and where all the assessments agree, authorising deprivation of liberty.

Transition

Transition is when young people with health or social care needs move from children's services to adult services.

Transition needs to be carefully planned so that there are no gaps in the care young people receive. Young people and their families should be fully involved in the process of planning what support a young person will need when they turn 18. 

Carers may need support too. Young carers caring for adults may become eligible for support under the Care Act when the young carer turns 18.