Canllawiau

Gwneud penderfyniadau: Canllaw i bobl sy’n gweithio ym maes iechyd a gofal cymdeithasol

Diweddarwyd 10 May 2023

Applies to England and Wales

Gwneud penderfyniadau

Canllaw i bobl sy’n gweithio ym maes iechyd a gofal cymdeithasol

Helpu pobl sy’n methu gwneud rhai penderfyniadau drostyn nhw eu hunain

Diolchiadau

Y Rhaglen Gweithredu Galluedd Meddyliol (MCIP) sydd wedi cyhoeddi’r llyfryn hwn. Mae’r Rhaglen Gweithredu Galluedd Meddyliol yn rhaglen lywodraethu ar y cyd rhwng y Weinyddiaeth Gyfiawnder, yr Adran Iechyd, Swyddfa’r Gwarcheidwad Cyhoeddus a Llywodraeth Cynulliad Cymru a sefydlwyd i weithredu’r sefydliad, y prosesau a’r gweithdrefnau i lansio’r Ddeddf Galluedd Meddyliol.

Rydym yn ddiolchgar iawn i Sheila Scott, Prif Weithredwr National Care Association, a ysgrifennodd y llyfryn hwn gyda chymorth Zoe Sampson, Ruth Scott a Viv Shepherd, gyda chefnogaeth Nadra Ahmed a Dick Barton a thri grŵp ffocws.

Rydym hefyd yn ddiolchgar iawn i’n Grŵp Cynghori, a oedd yn cynnwys sefydliadau sy’n gweithio gyda phobl sy’n gweithio ym maes iechyd a gofal cymdeithasol neu’n eu cynrychioli. Maen nhw wedi cyflawni rôl bwysig wrth rannu eu barn a’u safbwyntiau ar y llyfryn, a’n helpu i bwyso a mesur ein gwaith.

Adran 1. Cyflwyniad

Gwybodaeth am y llyfryn hwn

Mae’r llyfryn hwn yn rhoi gwybodaeth i chi am y Ddeddf Galluedd Meddyliol, sy’n berthnasol i Gymru a Lloegr ac yn effeithio ar y ffordd rydych chi’n gweithio.

Mae’r Ddeddf Galluedd Meddyliol (y Ddeddf) yn berthnasol i bawb sy’n gweithio ym maes iechyd a gofal cymdeithasol ac sy’n ymwneud â gofal, triniaeth neu gymorth i bobl 16 oed a hŷn sy’n byw yng Nghymru a Lloegr ac sy’n methu gwneud pob penderfyniad neu rai penderfyniadau drostyn nhw eu hunain. Gallai’r anallu i wneud penderfyniad gael ei achosi gan salwch seiciatrig (er enghraifft, dementia), anabledd dysgu, problemau iechyd meddwl, anaf i’r ymennydd neu strôc.

Mae’r Ddeddf yn effeithio ar bobl sy’n gweithio ym maes iechyd a gofal cymdeithasol fel meddygon, nyrsys, deintyddion, seicolegwyr, therapyddion galwedigaethol, therapyddion lleferydd ac iaith, gweithwyr cymdeithasol, rheolwyr cartrefi gofal a phreswyl, staff gofal (gan gynnwys gweithwyr gofal cartref), gweithwyr cymorth (gan gynnwys pobl sy’n gweithio ym maes tai â chymorth) ac ar unrhyw weithwyr iechyd a gofal cymdeithasol eraill, ac mae angen iddyn nhw wybod am y Ddeddf.

Er y dylai’r llyfryn hwn roi trosolwg eang i chi o’r Ddeddf a’i phrif oblygiadau i chi yn eich gwaith, dylech gyfeirio at y Cod Ymarfer ar gyfer y Ddeddf Galluedd Meddyliol (edrychwch ar ran 3), sy’n cynnwys gwybodaeth a chanllawiau mwy manwl. Mae rhestr o ffynonellau gwybodaeth manylach hefyd, a rhestr o gysylltiadau defnyddiol yng nghefn y llyfryn hwn.

Nid yw’r llyfryn hwn yn sôn am drefniadau cadw (detention) na thriniaeth orfodol o dan Ddeddf Iechyd Meddwl 1983. Mae Deddf 1983 yn ymwneud yn bennaf â phobl sydd wedi cael gwybod bod ganddyn nhw broblem iechyd meddwl, sy’n golygu bod rhaid iddyn nhw fod o dan drefniadau cadw neu gael eu trin er budd eu hiechyd neu eu diogelwch eu hunain neu gyda’r bwriad o amddiffyn pobl eraill.

Adran 2. Beth yw galluedd meddyliol?

Mae cael galluedd meddyliol yn golygu bod person yn gallu gwneud ei benderfyniadau ei hun. Mae’r Ddeddf Galluedd Meddyliol yn dweud nad yw person yn gallu gwneud penderfyniad penodol os nad yw’n gallu gwneud un neu fwy o’r pedwar peth canlynol.

• Deall yr wybodaeth mae’n ei derbyn.
• Dal gafael ar yr wybodaeth honno’n ddigon hir i allu gwneud y penderfyniad.
• Pwyso a mesur yr wybodaeth sydd ar gael i wneud y penderfyniad.
• Cyfleu ei benderfyniad – gallai hyn fod drwy siarad, defnyddio iaith arwyddion neu hyd yn oed symudiadau syml yn y cyhyrau, fel blincio neu wasgu llaw.

Mae pob un ohonom yn cael trafferth gwneud penderfyniadau o bryd i’w gilydd, ond mae’r Ddeddf Galluedd Meddyliol yn golygu mwy na hynny. Mae wedi cael ei chynllunio’n benodol i ymdrin â sefyllfaoedd lle mae rhywun yn methu gwneud penderfyniad oherwydd bod, er enghraifft, salwch neu anabledd yn effeithio ar y ffordd mae ei feddwl neu ei ymennydd yn gweithio, neu oherwydd effeithiau cyffuriau neu alcohol.

Gallai diffyg galluedd meddyliol ddeillio o’r canlynol:

• strôc neu anaf i’r ymennydd;
• problem iechyd meddwl;
• dementia;
• anabledd dysgu;
• dryswch, teimlo’n swrth neu fod yn anymwybodol oherwydd salwch neu’r driniaeth ar ei gyfer; neu
• gamddefnyddio sylweddau.

Mae’r math o benderfyniadau sy’n dod o dan y Ddeddf yn amrywio o benderfyniadau o ddydd i ddydd fel beth i’w wisgo neu ei fwyta, i benderfyniadau mwy difrifol ynghylch ble i fyw, cael llawdriniaeth neu beth i’w wneud ag arian ac eiddo person.

Penderfyniadau nad ydynt yn dod o dan y ddeddf newydd:
Ni all rhai mathau o benderfyniadau (fel priodas neu bartneriaeth sifil, ysgariad, perthynas rywiol, mabwysiadu a phleidleisio) fyth gael eu gwneud gan berson arall ar ran person sydd â diffyg galluedd. Y rheswm am hynny yw bod y penderfyniadau neu’r gweithredoedd hyn naill ai mor bersonol i’r unigolyn dan sylw neu oherwydd eu bod o dan reolaeth deddfau eraill, ac nid yw’r Ddeddf Galluedd Meddyliol yn newid hyn

Mae’r Ddeddf Galluedd Meddyliol yn berthnasol i sefyllfaoedd lle mae person yn methu gwneud penderfyniad penodol ar adeg benodol oherwydd, er enghraifft, bod salwch neu anabledd yn effeithio ar ei feddwl neu ei ymennydd, neu oherwydd effeithiau cyffuriau neu alcohol. Er enghraifft, efallai y bydd rhywun yn methu gwneud penderfyniad pan fydd yn dioddef o iselder, ond efallai y bydd yn gallu gwneud y penderfyniad pan fydd yn teimlo’n well.

Efallai nad oes gan y person y galluedd i wneud penderfyniad penodol ar adeg benodol, ond nid yw hyn yn golygu nad oes gan berson unrhyw alluedd i wneud unrhyw benderfyniadau o gwbl. Er enghraifft, efallai nad oes gan berson ag anabledd dysgu y galluedd i wneud rhai penderfyniadau mawr, er enghraifft ble dylai fyw, ond nid yw hyn o reidrwydd yn golygu nad yw’n gallu penderfynu beth i’w fwyta, ei wisgo a’i wneud bob dydd.

Mae’n bwysig iawn eich bod yn cofio bob amser nad yw diffyg galluedd yn gyflwr parhaol o bosibl. Dylai asesiadau galluedd fod yn benodol o ran amser a phenderfyniad (edrychwch ar ran 6 y llyfryn hwn sy’n rhoi manylion am asesu galluedd).

Adran 3. Beth yw’r Ddeddf Galluedd Meddyliol, a pha newidiadau mae’n eu cyflwyno?

Beth yw’r Ddeddf Galluedd Meddyliol?

• Mae’r Ddeddf Galluedd Meddyliol yn berthnasol yng Nghymru a Lloegr i bawb sy’n gweithio ym maes iechyd a gofal cymdeithasol ac sy’n ymwneud â thrin, cynorthwyo neu ofalu am bobl dros 16 oed sydd â diffyg galluedd o bosibl i wneud penderfyniadau drostyn nhw eu hunain.
• Mae’n seiliedig ar arferion gorau ac yn creu un fframwaith cydlynol ar gyfer delio â materion galluedd meddyliol a system well i ddatrys anghydfodau, delio â materion llesiant personol ac eiddo a materion pobl sydd â diffyg galluedd.
• Mae’n rhoi’r unigolyn sydd â diffyg galluedd wrth galon y broses o wneud penderfyniadau, ac yn rhoi pwyslais cryf ar gynorthwyo a galluogi’r unigolyn i wneud ei benderfyniadau ei hun. Os nad yw’n gallu gwneud hyn, mae’r Ddeddf yn pwysleisio y dylai’r unigolyn fod yn rhan o’r broses benderfynu hyd ag y mae modd.
• Mae’n cyflwyno mesurau diogelu newydd pwysig ar gyfer pobl sydd â diffyg galluedd a’r bobl sy’n gweithio gyda nhw, yn eu cynorthwyo neu’n gofalu amdanyn nhw.
• Mae’n seiliedig ar bum egwyddor allweddol sy’n gorfod bod yn sail i bopeth rydych chi’n ei wneud wrth ddarparu gofal neu driniaeth i berson sydd â diffyg galluedd (edrychwch ar ran 4 y llyfryn hwn).
• Mae Cod Ymarfer yn bodoli sy’n egluro sut mae’r Ddeddf yn gweithio o ddydd i ddydd.

Y Cod Ymarfer

Mae’r Cod yn egluro sut mae’r Ddeddf yn gweithio o ddydd i ddydd, ac yn rhoi arweiniad i bawb sy’n gweithio gyda phobl sydd â diffyg galluedd. Mae’r Cod yn egluro’n fanylach beth yw prif nodweddion y ddeddfwriaeth, a rhai o’r camau ymarferol y mae angen i bobl sy’n defnyddio ac yn dehongli’r ddeddf newydd eu hystyried. Os ydych chi’n gweithio gyda phobl sydd â diffyg galluedd a’ch bod yn weithiwr proffesiynol a/neu’n cael eich talu am y gwaith rydych chi’n ei wneud, mae gennych chi ddyletswydd gyfreithiol i ystyried y Cod.

Mae ystyried yn golygu rhoi sylw i’r Cod a gallu dangos eich bod yn gyfarwydd â’r canllawiau ynddo, ac os nad ydych yn dilyn y Cod dylech allu rhoi rhesymau cadarn dros beidio.

Mae’r Cod Ymarfer ar gael ar-lein yn
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Pa newidiadau y mae’r Ddeddf Galluedd Meddyliol yn eu cyflwyno?

• Rhaid rhagdybio bob amser fod gan bobl rydych chi’n darparu gofal neu driniaeth ar eu cyfer y galluedd i wneud penderfyniadau drostyn nhw eu hunain.
• Un prawf clir ar gyfer asesu a oes gan berson ddiffyg galluedd i wneud penderfyniad (edrychwch ar ran 6).
• Rhestr wirio o ffactorau allweddol sy’n fan cychwyn i’ch helpu i benderfynu beth sydd er ‘lles pennaf’ person sydd â diffyg galluedd (rhan 7).
• Nifer o ffyrdd y gall pobl ddylanwadu ar yr hyn sy’n digwydd iddyn nhw os byddan nhw’n methu gwneud penderfyniadau penodol yn y dyfodol, gan gynnwys penderfyniadau ymlaen llaw i wrthod triniaeth feddygol, datganiadau am ddymuniadau a theimladau, a chreu Atwrneiaeth Arhosol (LPA) (rhan 10).
• Eglurhad o’r camau y gallwch chi eu cymryd os oes gan rywun ddiffyg galluedd, a’r mesurau diogelu cyfreithiol sy’n rheoli hyn (rhan 9).
• Dyletswydd i chi ymgynghori, pan fydd yn ymarferol ac yn briodol, â phobl sy’n ymwneud â gofalu am y person sydd â diffyg galluedd ac unrhyw un sydd â diddordeb yn llesiant y person dan sylw (er enghraifft aelodau o’r teulu, ffrindiau, partneriaid a gofalwyr), ynghylch penderfyniadau sy’n effeithio ar y person dan sylw (rhan 7). Os oes Atwrnai o dan Atwrneiaeth Arhosol (rhan 10), Dirprwy a benodwyd gan y Llys (rhan 12) neu berson a enwyd, mae gennych hefyd ddyletswydd i ymgynghori â nhw.
• Mae gwasanaeth eirioli, sef gwasanaeth Eiriolwr Galluedd Meddyliol Annibynnol (EGMA), yn dod yn rhan o’r broses mewn amgylchiadau penodol lle nad oes neb priodol i ymgynghori â nhw (rhan 8).
• Trosedd newydd am gam-drin pobl sydd â diffyg galluedd neu eu hesgeuluso’n fwriadol (rhan 9).
• Mesurau diogelu newydd ar gyfer cynnal ymchwil sy’n cynnwys pobl sydd â diffyg galluedd (rhan 13).
• Llys Gwarchod newydd a swyddog cyhoeddus newydd (y Gwarcheidwad Cyhoeddus) sy’n cael cefnogaeth gan Swyddfa’r Gwarcheidwad Cyhoeddus (rhan 12).

Adran 4. Pum egwyddor y Ddeddf Galluedd Meddyliol

Mae gan y Ddeddf Galluedd Meddyliol bum egwyddor allweddol sy’n pwysleisio cysyniadau sylfaenol a gwerthoedd craidd y Ddeddf. Rhaid i chi gadw’r rhain mewn cof bob amser pan fyddwch yn gweithio gyda phobl sydd â diffyg galluedd, neu’n darparu gofal neu driniaeth ar eu cyfer.

Dyma’r pum egwyddor:

1. Mae gan bob oedolyn yr hawl i wneud ei benderfyniadau ei hun, a rhaid cymryd bod gan yr oedolyn y galluedd i wneud hynny oni phrofir yn wahanol. Mae hyn yn golygu na allwch chi gymryd yn ganiataol bod rhywun yn methu gwneud penderfyniad drosto’i hun dim ond oherwydd bod ganddo gyflwr meddygol neu anabledd penodol.
2. Rhaid helpu pobl gymaint â phosibl i wneud penderfyniad cyn i unrhyw un ddod i’r casgliad nad ydyn nhw’n gallu gwneud eu penderfyniad eu hunain. Mae hyn yn golygu y dylech wneud pob ymdrech i annog a helpu’r person i wneud y penderfyniad drosto’i hun. Edrychwch ar ran 5 y llyfryn hwn i gael rhagor o wybodaeth am sut i wneud hyn. Os bydd diffyg galluedd yn cael ei gadarnhau, mae’n dal yn bwysig eich bod yn cynnwys y person i’r graddau y bo modd wrth wneud penderfyniadau.
3. Mae gan bobl hawl i wneud penderfyniadau y gallai eraill eu hystyried yn benderfyniadau ecsentrig neu annoeth. Mae gan bawb eu gwerthoedd, eu credoau a’u dymuniadau eu hunain, sydd o bosibl yn wahanol i rai pobl eraill. Ni allwch eu trin fel pobl sydd â diffyg galluedd am y rheswm hwnnw.
4. Rhaid i unrhyw beth a wneir ar gyfer neu ar ran person sydd â diffyg galluedd meddyliol gael ei wneud gyda lles pennaf y person dan sylw mewn golwg. Edrychwch ar ran 7 y llyfryn hwn i gael rhagor o wybodaeth am sut i benderfynu beth sydd er lles pennaf y person rydych chi’n darparu gofal neu driniaeth ar ei gyfer.
5. Dylai unrhyw beth a wneir ar gyfer neu ar ran pobl sydd â diffyg galluedd gyfyngu cyn lleied â phosibl ar eu rhyddid a’u hawliau sylfaenol. Felly, pan fyddwch chi’n gwneud unrhyw beth ar gyfer neu ar ran person sydd â diffyg galluedd, rhaid i chi ddewis yr opsiwn sydd er lles pennaf y person ac ystyried a allech chi wneud hyn mewn ffordd sy’n amharu llai ar ei hawliau a’i ryddid i weithredu.

Adran 5. Helpu pobl i wneud penderfyniadau drostyn nhw eu hunain

Pan fydd angen i berson yn eich gofal wneud penderfyniad, rhaid i chi gychwyn gyda’r rhagdybiaeth bod gan y person y galluedd i wneud y penderfyniad dan sylw (egwyddor 1). Dylech wneud pob ymdrech i annog a helpu’r person i wneud y penderfyniad ei hun (egwyddor 2), a bydd yn rhaid i chi ystyried nifer o ffactorau i gynorthwyo’r broses benderfynu.

Gallai’r rhain gynnwys:

• A oes gan y person yr holl wybodaeth berthnasol y bydd ei hangen arno i wneud y penderfyniad? Os oes dewis, a roddwyd gwybodaeth am yr opsiynau eraill?
• A fyddai’n bosibl egluro neu gyflwyno’r wybodaeth mewn ffordd sy’n haws i’r person ei deall? Dylid rhoi cymorth i gyfleu gwybodaeth lle bynnag y bo angen. Er enghraifft, efallai y bydd person ag anabledd dysgu yn ei chael yn haws cyfathrebu gan ddefnyddio lluniau, ffotograffau, fideos, tapiau neu iaith arwyddion.
• A yw dealltwriaeth person yn well ar adegau penodol o’r dydd, neu a oes man penodol lle mae’n teimlo’n fwy cyfforddus ac yn gallu gwneud penderfyniad? Er enghraifft, os bydd person yn teimlo’n swrth yn sydyn ar ôl cymryd ei feddyginiaeth, ni fyddai hyn yn amser da i’r person wneud penderfyniad.

All unrhyw un arall helpu neu gynorthwyo’r person i ddeall gwybodaeth neu i ddewis? Er enghraifft, perthynas, ffrind neu eiriolwr.

Enghraifft:

Cafodd Michael strôc 3 blynedd yn ôl. Mae wedi bod yn wael, ac mae yn yr ysbyty erbyn hyn. Mae’r meddyg yn dymuno cynnal rhagor o brofion, sy’n golygu cael anesthetig cyffredinol.

Mae’r meddyg yn trafod y driniaeth gyda Michael, sy’n mynd yn bryderus ac yn gofyn dro ar ôl tro pam mae angen anesthetig arno. Nid yw hyn yn argyfwng, ond mae’r meddyg yn teimlo efallai nad oes gan Michael y galluedd i gydsynio, oherwydd ei bod yn ymddangos nad yw’n gallu deall a chofio’r hyn y mae’r meddyg yn ei ddweud. Felly mae’r meddyg yn ymgynghori â gwraig Michael sy’n esbonio bod Michael, ers y strôc, yn mynd yn bryderus pan fydd oddi cartref a phan nad oes ganddo bobl a phethau mae’n gyfarwydd â nhw o’i gwmpas. Mae’n dweud wrth y meddyg y byddai’n help pe bai hi’n bresennol pan fyddai’r meddyg yn egluro’r profion i Michael, gan ei bod hi’n gallu tawelu ei feddwl ac esbonio pethau iddo.

Mae’r meddyg yn trafod y profion eto gyda Michael pan fydd ei wraig yn bresennol. Mae Michael yn gyndyn o gytuno i gael yr anesthetig i ddechrau, ond mae ei wraig yn egluro y bydd hi yno pan fydd yn deffro, ac na fydd yn gorfod aros yn yr ysbyty dros nos. Gyda help ei wraig, mae Michael yn deall beth mae’r meddyg yn ei ddweud, ac yn gallu gwneud penderfyniad a chydsynio i’r profion.

Os bydd person yn gwneud penderfyniad sy’n ecsentrig neu’n annoeth yn eich barn chi, rhaid i chi gofio nad yw hyn o reidrwydd yn golygu nad oes gan y person y galluedd i wneud y penderfyniad (Egwyddor 3).

Enghraifft:

O ganlyniad i ddamwain car ychydig flynyddoedd yn ôl, mae Margie wedi cael ei pharlysu, ac mae wedi cael niwed i’r ymennydd hefyd.

Mae Margie wedi cael iawndal sylweddol am ei hanafiadau.

Mae hi eisiau defnyddio rhan o’r arian ar lawdriniaeth gosmetig.

Mae ei theulu’n cytuno ei bod hi’n deall goblygiadau ariannol gwario cyfran o’r iawndal ar lawdriniaeth gosmetig. Ond, maen nhw’n poeni nad yw hi’n deall y risgiau a ddaw gyda’r driniaeth.

Mae’r llawfeddyg cosmetig wedi cael sawl ymgynghoriad â Margie. Mae hi wedi dweud yn glir ei bod hi’n deall y goblygiadau corfforol yn ogystal â’r rhai ariannol, ac mae hi’n benderfynol o gael y llawdriniaeth. Mae hi’n credu y bydd yn cynyddu ei hunan-werth a’i hyder, a bod y manteision hyn yn drech na’r risgiau posibl.

Mae’r llawfeddyg hefyd yn gofyn i gydweithiwr drafod goblygiadau’r llawdriniaeth â Margie. Mae ei gydweithiwr yn dod i’r casgliad bod gan Margie y galluedd i wneud y penderfyniad, ac mae’n gwneud nodyn yn y cofnodion iechyd.

Pan fydd rheswm dros gredu nad oes gan berson y galluedd i wneud penderfyniad, disgwylir i chi ystyried y canlynol:

• A yw popeth posibl wedi cael ei wneud i helpu a chynorthwyo’r person i wneud penderfyniad?
• Oes angen gwneud y penderfyniad hwn ar unwaith?
• Os na, a oes modd aros nes bod gan y person y galluedd i wneud y penderfyniad drosto’i hun? Er enghraifft, efallai fod person yn teimlo’n swrth neu’n ddryslyd oherwydd ei feddyginiaeth.

Os oes amheuaeth o hyd ynghylch gallu’r person i wneud penderfyniad, mae angen i chi symud ymlaen i gam nesaf y broses o asesu galluedd, fel y nodir yn rhan 6 y llyfryn hwn.

Adran 6. Asesu galluedd

Dylech bob amser gychwyn gyda’r rhagdybiaeth bod gan y person y galluedd i wneud y penderfyniad dan sylw (egwyddor 1). O dan y Ddeddf Galluedd Meddyliol, mae’n rhaid i chi asesu galluedd cyn rhoi unrhyw ofal neu driniaeth ar waith. Wrth gwrs, po fwyaf difrifol yw’r penderfyniad, y mwyaf ffurfiol yw’r asesiad galluedd sydd ei angen. Bydd y dull o gofnodi asesiadau o’r fath, a’r angen i’w cofnodi ai peidio, yn amrywio yn ôl difrifoldeb y penderfyniad a wnaed.

Dylech gadw mewn cof bob amser nad yw’r ffaith nad oes gan berson y galluedd i wneud penderfyniad ar un achlysur yn golygu na fydd ganddo’r galluedd i wneud penderfyniad yn y dyfodol, nac am fater gwahanol.

Enghraifft:

Mae gan Ridwaan ddementia, ac mae’n byw mewn cartref gofal preswyl.

Fel llawer o bobl sydd â dementia, mae ei alluedd meddyliol yn mynd a dod.

Ar y rhan fwyaf o ddiwrnodau, mae’n gallu gwneud yr holl benderfyniadau sylfaenol am fywyd bob dydd, fel ymolchi, bwyta ac yfed ac ati.

Ond, weithiau nid oes ganddo’r galluedd i wneud y penderfyniadau mwyaf sylfaenol, fel beth i’w fwyta.

Ar yr adegau hyn, byddai cofnod yn y cofnodion gofal yn gallu edrych fel hyn: “Yn ystod amser cinio heddiw, doedd gan Ridwaan ddim y galluedd i benderfynu beth i’w fwyta, felly cafodd penderfyniad am hynny ei wneud gyda lles pennaf Ridwaan mewn golwg. Bob amser bwyd, byddwn yn asesu ei alluedd i benderfynu beth mae eisiau ei fwyta. Os oes gan Ridwaan y galluedd i wneud y penderfyniad hwn ar unrhyw adeg, Ridwaan fydd yn penderfynu beth i’w fwyta”.

Pryd ddylid asesu galluedd?

Mae’r Ddeddf Galluedd Meddyliol yn dweud yn glir bod rhaid i unrhyw asesiad o alluedd person fod yn benodol i benderfyniad, sy’n golygu:

• bod rhaid i’r asesiad o alluedd ymwneud â’r penderfyniad penodol y mae’n rhaid ei wneud ar adeg benodol, ac nad yw’n ymwneud ag ystod o benderfyniadau;
• os na all rhywun wneud penderfyniadau cymhleth, nid yw hyn yn golygu nad yw’n gallu gwneud penderfyniadau syml. Er enghraifft, mae’n bosibl y gallai person ag anableddau dysgu wneud penderfyniadau ynghylch beth i’w wisgo neu ei fwyta, ond nid ynghylch a yw angen byw mewn cartref gofal ai peidio; ac
• ni allwch benderfynu bod gan rywun ddiffyg galluedd ar sail ei oedran, ei ymddangosiad, ei gyflwr neu ei ymddygiad yn unig.

Y prawf i asesu galluedd

Fel arfer, fyddwch chi ddim yn asesu galluedd heb gynnwys teulu, ffrindiau a/neu ofalwyr neu Eiriolwr Galluedd Meddyliol Annibynnol os oes un wedi cael ei benodi (edrychwch ar ran 8). Bydd hyn yn dibynnu ar y sefyllfa a’r penderfyniad y mae angen ei wneud.

Ddylech chi byth fynegi barn, heb gynnal asesiad priodol yn gyntaf o alluedd y person i wneud penderfyniad.

Y prawf galluedd gweithredol

Er mwyn penderfynu a oes gan berson y galluedd meddyliol i wneud penderfyniad penodol, rhaid i chi benderfynu yn gyntaf a oes nam neu rywbeth yn tarfu ar y ffordd y mae meddwl neu ymennydd y person yn gweithio (does dim ots a yw hynny’n barhaol neu dros dro).

Os felly, yr ail gwestiwn y mae’n rhaid i chi ei ateb yw a yw hynny’n golygu nad yw’r person yn gallu gwneud y penderfyniad penodol?

Fydd y person ddim yn gallu gwneud y penderfyniad penodol os nad yw’n gallu gwneud y pethau canlynol ar ôl cael yr holl help a chefnogaeth briodol (egwyddor 2).

1. Deall yr wybodaeth sy’n berthnasol i’r penderfyniad hwnnw, gan gynnwys deall canlyniadau tebygol gwneud, neu beidio â gwneud, y penderfyniad.
2. Dal gafael ar yr wybodaeth honno.
3. Defnyddio neu bwyso a mesur yr wybodaeth honno fel rhan o’r broses o wneud y penderfyniad.
4. Cyfleu ei benderfyniad (boed hynny drwy siarad, defnyddio iaith arwyddion neu unrhyw ddull arall).

Dylid gwneud pob ymdrech i ddod o hyd i ffyrdd o gyfathrebu â pherson cyn penderfynu nad oes gan y person y galluedd i wneud penderfyniad dim ond ar sail ei anallu i gyfathrebu. Ychydig iawn o bobl fydd â diffyg galluedd ar sail hyn yn unig. Gallai’r achosion hynny gynnwys pobl sy’n anymwybodol neu mewn coma, neu sy’n dioddef o gyflwr niwrolegol prin iawn sy’n cael ei alw’n ‘syndrom cloi-i-mewn’. Mewn llawer o achosion eraill, gall camau syml fel blincio neu wasgu llaw fod yn ddigon i gyfleu penderfyniad. Mae’n debygol y bydd angen mewnbwn gweithwyr proffesiynol sydd â sgiliau arbenigol mewn cyfathrebu geiriol a dieiriau wrth wneud penderfyniadau yn y maes hwn.

Rhaid gwneud asesiad yn ôl yr hyn sy’n debygol – a yw’n fwy tebygol na pheidio fod gan y person ddiffyg galluedd? Dylech allu dangos yn eich cofnodion pam eich bod wedi dod i’r casgliad nad oes gan y person y galluedd i wneud y penderfyniad penodol.

Herio canlyniad asesiad galluedd

Weithiau bydd yr asesiad rydych chi neu gydweithiwr wedi’i wneud yn cael ei herio.

Efallai mai’r person sydd wedi cael ei asesu fydd yn ei herio, neu rywun sy’n gweithredu ar ei ran, er enghraifft perthynas neu eiriolwr.

Pan fydd asesiad yn cael ei herio, gallai’r person geisio datrys y mater yn y ffyrdd canlynol.

• Y cam cyntaf bob amser fydd codi’r mater gyda’r person a wnaeth yr asesiad. Bydd cofnodion yr asesydd yn rhan bwysig o’r broses hon.
• Gall ail farn fod yn ddefnyddiol mewn rhai achosion.
• Cynnwys eiriolwr (nid Eiriolwr Galluedd Meddyliol Annibynnol) sy’n annibynnol ar bob parti sy’n ymwneud â’r achos.
• Gweithdrefnau cwyno lleol.
• Cyfryngu.
• Cynhadledd Achos.
• Os nad yw’n bosibl datrys y mater, gall wneud cais i’r Llys Gwarchod (edrychwch ar ran 12) i geisio cael dyfarniad.

I gael arweiniad manylach ar ffyrdd o ddatrys anghytundeb, dylech gyfeirio at y Cod Ymarfer.

Adran 7. Lles pennaf

Os aseswyd bod gan berson ddiffyg galluedd, rhaid i unrhyw gamau sy’n cael eu cymryd, neu unrhyw benderfyniad sy’n cael ei wneud ar ei gyfer neu ar ei ran, gael eu gwneud er lles pennaf y person dan sylw (egwyddor 4).

Mae’r person sy’n gorfod gwneud y penderfyniad yn cael ei alw’n ‘benderfynwr’. Fel arfer, y gofalwr sy’n gyfrifol am y gofal o ddydd i ddydd yw’r penderfynwr, neu weithiwr proffesiynol fel meddyg, nyrs neu weithiwr cymdeithasol pan fydd rhaid gwneud penderfyniadau ynghylch triniaeth, trefniadau gofal neu lety.

Beth yw ‘lles pennaf’?

Mae’r ddeddf yn rhoi rhestr wirio o ffactorau allweddol y mae’n rhaid i chi eu hystyried wrth benderfynu beth sydd er lles pennaf y person sydd â diffyg galluedd. Dydy’r rhestr hon ddim yn gyflawn, a dylech gyfeirio at y Cod Ymarfer i gael rhagor o fanylion.

• Mae’n bwysig peidio â gwneud rhagdybiaethau am les pennaf person dim ond ar sail ei oedran, ymddangosiad, cyflwr neu unrhyw elfen o’i ymddygiad.
• Rhaid i’r penderfynwr ystyried yr holl amgylchiadau perthnasol sy’n ymwneud â’r penderfyniad dan sylw.
• Rhaid i’r penderfynwr ystyried a yw’r person yn debygol o adennill galluedd (er enghraifft, ar ôl derbyn triniaeth feddygol). Os felly, a yw’r penderfyniad neu’r weithred yn gallu aros tan hynny?
• Rhaid i’r penderfynwr fynd ati i gynnwys y person cymaint â phosibl yn y penderfyniad sy’n cael ei wneud ar ei ran
• Os yw’r penderfyniad yn ymwneud â darparu neu dynnu triniaeth cynnal bywyd yn ôl, ni chaiff dyhead i achosi marwolaeth y person fod yn gymhelliant i’r penderfynwr.

Yn benodol, rhaid i’r penderfynwr ystyried:

• dymuniadau a theimladau blaenorol a phresennol y person (yn enwedig os ydyn nhw wedi cael eu nodi ar bapur); ac
• unrhyw gredoau a gwerthoedd (er enghraifft rhai crefyddol, diwylliannol neu foesol) a fyddai’n debygol o ddylanwadu ar y penderfyniad dan sylw ac unrhyw ffactorau perthnasol eraill.

Hyd ag y bo modd, rhaid i’r penderfynwr ymgynghori â phobl eraill os yw’n briodol gwneud hynny ac ystyried eu barn ynghylch beth fyddai o les pennaf i’r person sydd â diffyg galluedd, yn enwedig::

• unrhyw un y mae’r person sydd â diffyg galluedd wedi ei enwi o’r blaen fel rhywun y dylid ymgynghori ag ef/hi;
• gofalwyr, perthnasau agos neu ffrindiau agos, neu unrhyw un arall sydd â diddordeb yn llesiant y person;
• unrhyw Atwrnai sydd wedi cael ei benodi o dan Atwrneiaeth Arhosol; ac
• unrhyw Ddirprwy sydd wedi cael ei benodi gan y Llys Gwarchod i wneud penderfyniadau ar ran y person.

Os ydych chi’n gwneud y penderfyniad o dan y Ddeddf Galluedd Meddyliol, rhaid i chi gymryd y camau uchod, ymysg eraill, a phwyso a mesur y ffactorau uchod er mwyn penderfynu beth sydd o les pennaf i’r person. I gael rhagor o wybodaeth, dylech gyfeirio at y Cod Ymarfer.

Yn achos penderfyniadau ynghylch triniaeth feddygol ddifrifol neu newidiadau penodol i lety a lle nad oes neb sy’n perthyn i unrhyw un o’r categorïau uchod, dylech ystyried a oes angen i chi gynnwys Eiriolwr Galluedd Meddyliol Annibynnol (edrychwch ar ran 8).

Beth ddylwn i ei wneud os oes anghydfod ynghylch lles pennaf?

Ni fydd teulu a ffrindiau bob amser yn cytuno ar yr hyn sydd o les pennaf i’r unigolyn.

Os mai chi yw’r penderfynwr, bydd angen i chi ddangos yn glir yn eich cofnodion eich bod wedi gwneud penderfyniad ar sail yr holl dystiolaeth a oedd ar gael, ac wedi ystyried yr holl safbwyntiau gwahanol.

Os oes anghydfod, gallai’r pethau canlynol eich helpu i benderfynu beth sydd o les pennaf i’r person.

• Cynnwys eiriolwr sy’n annibynnol ar bob parti sy’n ymwneud â’r achos.
• Cael ail farn.
• Cynnal cynhadledd achos ffurfiol neu anffurfiol.
• Defnyddio gwasanaeth cyfryngu.
• Byddai modd gwneud cais i’r Llys Gwarchod am ddyfarniad.

Adran 8. Gwasanaeth Eiriolwr Galluedd Meddyliol Annibynnol

Yn y rhan fwyaf o sefyllfaoedd, bydd gan bobl sydd â diffyg galluedd rwydwaith o gefnogaeth gan aelodau o’r teulu neu ffrindiau sy’n cymryd diddordeb yn eu llesiant, neu gan Ddirprwy (edrychwch ar ran 12) neu Atwrnai sydd wedi cael ei benodi o dan Atwrneiaeth Arhosol (edrychwch ar ran 10). Ond, mae’n bosibl na fydd gan rai pobl sydd â diffyg galluedd neb i’w helpu (ar wahân i staff cyflogedig) gyda phenderfyniadau mawr a allai newid eu bywyd, felly mae’r Ddeddf Galluedd Meddyliol wedi creu Eiriolwr Galluedd Meddyliol Annibynnol (EGMA) a fydd yn eu cynrychioli a’u helpu.

Mae EGMA yn fath penodol o eiriolwr y mae’n rhaid ei gynnwys os nad oes neb priodol y gellir ymgynghori â nhw. Nid EGMA yw’r penderfynwr, ond mae gan y penderfynwr ddyletswydd i ystyried yr wybodaeth y mae’r EGMA wedi’i darparu.

Mae’r gwasanaeth EGMA yn cael ei ddarparu ym mhob ardal bwrdd iechyd lleol yng Nghymru, ac ym mhob ardal awdurdod lleol yn Lloegr.

Bydd EGMA yn cymryd rhan yn y broses dim ond os yw’r canlynol yn berthnasol:

• mae’r penderfyniad yn ymwneud â thriniaeth feddygol ddifrifol sy’n cael ei darparu gan y GIG;
• mae bwriad i symud y person i ofal tymor hir o fwy na 28 diwrnod mewn ysbyty neu 8 wythnos mewn cartref gofal; neu
• mae symud y person i lety gwahanol am gyfnod hir (8 wythnos neu fwy) yn cael ei ystyried, er enghraifft, i ysbyty neu gartref gofal gwahanol;

Yng Nghymru mae awdurdodau lleol a byrddau iechyd lleol, ac awdurdodau lleol a’r GIG yn Lloegr, wedi cael pwerau i ymestyn y gwasanaeth EGMA i sefyllfaoedd penodol os ydyn nhw’n fodlon y byddai EGMA yn darparu budd penodol, sef:

• adolygiadau gofal am lety neu newidiadau i lety; ac
• achosion amddiffyn oedolion (hyd yn oed os oes gan y person sydd â diffyg galluedd deulu a/neu ffrindiau).

Ond, does dim rhaid cynnwys EGMA os bydd y driniaeth yn cael ei rhoi o dan Ddeddf Iechyd Meddwl 1983, neu os yw’n ofynnol o dan y Ddeddf Iechyd Meddwl i’r person dan sylw fynd i’r ysbyty neu’r cartref dan sylw

Dyletswyddau EGMA yw:

• helpu’r person sydd â diffyg galluedd, a chynrychioli ei farn a’i fuddiannau i’r penderfynwr;
• derbyn a gwerthuso gwybodaeth – gall EGMA siarad â’r claf yn breifat ac archwilio, a phan fydd yn briodol, cymryd copïau o gofnodion iechyd a gofal cymdeithasol fel cofnodion clinigol, cynlluniau gofal neu ddogfennau asesu gofal cymdeithasol;
• hyd y bo modd, mynd ati i gael gwybod beth yw dymuniadau, teimladau, credoau a gwerthoedd y person;
• sicrhau ffyrdd eraill o weithredu;
• cael barn feddygol bellach, os oes angen; a
• pharatoi adroddiad ar gyfer y person a roddodd y cyfarwyddyd i’r EGMA.

Os bydd EGMA yn anghytuno â’r penderfyniad a wnaed, gall EGMA hefyd herio’r penderfynwr.

Os mai chi yw’r penderfynwr yn y bwrdd iechyd lleol (yng Nghymru) neu’r GIG neu’r awdurdod lleol (yn Lloegr), eich dyletswydd chi yw cyfarwyddo’r EGMA cyn gwneud y penderfyniad (ac eithrio mewn sefyllfaoedd brys). Bydd comisiynwyr a darparwyr gwasanaethau EGMA lleol yn sicrhau bod y manylion cyswllt angenrheidiol yn cael eu dosbarthu’n eang er mwyn i’r penderfynwyr allu cysylltu’n gyflym â darparwr neu ddarparwyr gwasanaethau EGMA pan fydd angen.

Enghraifft:

Mae Jamil yn oedolyn sydd ag anableddau dysgu difrifol, ac mae ei ddau riant wedi marw’n ddiweddar.

Mae angen llawdriniaeth ddargyfeiriol ar y galon ar Jamil. Dyma’r tro cyntaf ers i’w rieni farw y mae angen gwneud penderfyniad mewn perthynas â Jamil, ac nid oes ganddo berthnasau eraill na ffrindiau na neb arall i’w gynrychioli neu ei helpu.

Er ei fod yn gallu gwneud penderfyniadau am ei fywyd o ddydd i ddydd, nid oes ganddo’r galluedd i gydsynio i’r llawdriniaeth.

Felly, bydd EGMA yn cael cyfarwyddyd i fynd ati i gael gwybod beth yw barn Jamil i’r graddau y bo modd, ac i gyfleu ei farn i’r meddyg a fydd wedyn yn penderfynu a yw bwrw ymlaen â’r llawdriniaeth o les pennaf i Jamil ai peidio.

Os oes angen i chi roi cyfarwyddyd i EGMA, gallwch gael arweiniad a gwybodaeth fanylach am y gwasanaeth EGMA:

• Yn y Cod Ymarfer
• Ar dudalennau gwe EGMA yr Adran Iechyd, gan gynnwys gwybodaeth am gynlluniau peilot EGMA, Canllawiau Comisiynu EGMA, gwybodaeth am ddeunyddiau hyfforddi EGMA a chanllawiau hefyd ar ddehongli’r rheoliadau sy’n ymestyn y gwasanaeth EGMA i adolygiadau llety ac achosion amddiffyn oedolion: www.gov.uk/government/organisations/department-of-health-and-social-care
• Rheoliadau EGMA ar gyfer Lloegr sy’n rhoi manylion am rôl a swyddogaethau’r EGMA:
  www.opsi.gov.uk/si/si2006/20061832.htm
  www.opsi.gov.uk/si/si2006/20062883.htm
  
• Rheoliadau EGMA drafft ar gyfer Cymru sy’n rhoi manylion am rôl a swyddogaethau’r EGMA: e-bost sarah.austin@wales.gov.uk

Adran 9. Darparu gofal neu driniaeth i bobl sydd â diffyg galluedd

Sut mae’r Ddeddf Galluedd Meddyliol yn eich amddiffyn os ydych chi’n gweithio ym maes iechyd a gofal cymdeithasol?

Mae’r Ddeddf Galluedd Meddyliol yn darparu gwarchodaeth gyfreithiol rhag atebolrwydd am gyflawni gweithredoedd penodol mewn cysylltiad â’r gofal a’r driniaeth a roddir i bobl sydd â diffyg galluedd i gydsynio, ar yr amod:

• eich bod wedi dilyn egwyddorion y Ddeddf Galluedd Meddyliol;
• eich bod wedi cynnal asesiad o alluedd, a’ch bod yn credu’n rhesymol bod gan y person ddiffyg galluedd mewn perthynas â’r mater dan sylw (rhan 6); ac
• eich bod yn credu’n rhesymol bod y camau rydych chi wedi’u cymryd o les pennaf i’r person (rhan 7).

Gallai rhai penderfyniadau rydych chi’n eu gwneud arwain at newidiadau mawr mewn bywyd neu at ganlyniadau sylweddol i’r person dan sylw, ac mae angen ystyried y rhain yn ofalus iawn. Er enghraifft, newid preswylfan, efallai i gartref gofal neu gartref nyrsio; neu benderfyniadau mawr am ofal iechyd a thriniaeth feddygol.

Gwybodaeth i bobl sy’n gweithio ym maes gofal cymdeithasol

Ar yr amod eich bod wedi cydymffurfio â’r Ddeddf Galluedd Meddyliol wrth asesu galluedd person a’ch bod wedi gweithredu er lles pennaf y person, gallwch gyflawni sawl agwedd ar ofal personol person heb ei ganiatâd a chael eich gwarchod rhag atebolrwydd wrth wneud hynny

Gall gweithredoedd sy’n ymwneud â gofal person a allai fod â gwarchodaeth rhag atebolrwydd gynnwys y canlynol:

• helpu i ymolchi, gwisgo neu ddelio â hylendid personol;
• helpu i fwyta ac yfed;
• helpu pobl i gerdded a helpu gyda chludiant;
• helpu i drefnu gwasanaethau i’r cartref fel cyflenwadau pŵer, gwaith tŷ, atgyweirio neu gynnal a chadw;
• gweithredoedd mewn perthynas â gofal cartref neu wasanaethau eraill;
• gweithredoedd mewn perthynas â gwasanaethau eraill ar gyfer gofal yn y gymuned. (fel gofal dydd, llety preswyl neu ofal nyrsio);
• gweithredoedd sy’n gysylltiedig â newid preswylfan;
• gweithredoedd sy’n gysylltiedig â diogelwch y person; a
• gweithredoedd sy’n gysylltiedig â gweithdrefnau amddiffyn oedolion.

Gan fod gweithredoedd o’r fath yn gallu achosi anghydfod, byddai o fudd i chi gadw cofnod o’r camau a gymerwyd a’r ffactorau a ystyriwyd wrth wneud hynny. Gall manyldeb y cofnodion amrywio yn ôl difrifoldeb y weithred.

Mewn argyfwng, bydd yn aml o les pennaf i’r unigolyn i chi ddarparu gofal brys heb oedi.

Gwybodaeth i bobl sy’n gweithio ym maes gofal iechyd

Ar yr amod eich bod wedi cydymffurfio â’r Ddeddf Galluedd Meddyliol wrth asesu galluedd person, a’ch bod wedi gweithredu er lles pennaf y person, byddwch chi’n gallu gwneud diagnosis a thrin cleifion nad oes ganddyn nhw y galluedd i gydsynio. Er enghraifft

• profion ac archwiliadau diagnostig;
• asesiadau;
• triniaeth feddygol a deintyddol;
• gweithdrefnau llawfeddygol;
• derbyn i’r ysbyty i gael asesiad neu driniaeth (ac eithrio pobl sy’n agored i gael eu cadw (detained) o dan Ddeddf Iechyd Meddwl 1983). Edrychwch ar ran 14 i gael gwybodaeth am y berthynas rhwng y Ddeddf Galluedd Meddyliol a Deddf Iechyd Meddwl 1983);
• gofal nyrsio; a
• gweithdrefnau brys (fel adfywio cardio-pwlmonaidd).

Mae’n bwysig cadw cofnod llawn o’r hyn sydd wedi digwydd. Ni fydd y warchodaeth rhag atebolrwydd ond ar gael os gallwch ddangos eich bod wedi asesu galluedd (edrychwch ar ran 6), os ydych yn credu’n rhesymol ei fod yn ddiffygiol, ac wedi gweithredu mewn ffordd rydych chi’n credu’n rhesymol sydd o les pennaf i’r person (edrychwch ar ran 7).

Mewn argyfwng, bydd yn aml o les pennaf i’r person i chi ddarparu triniaeth frys heb oedi.

Mae rhai penderfyniadau am driniaeth feddygol mor ddifrifol fel y dylai pob achos fynd i’r Llys Gwarchod. I gael gwybodaeth fanylach, dylech gyfeirio at y Cod Ymarfer.

Mae ffurflenni cydsynio enghreifftiol a chanllawiau cydsynio yr Adran Iechyd ar gael yn: www.dh.gov.uk/consent

The use of restraint

Issues relating to restraint may be of particular concern to you.

Restraint covers a wide range of actions, including the use, or threat, of force to do something that the person concerned resists, for example by using cot sides or confining people’s movements or a restriction of his or her liberty of movement (falling short of a restriction that would deprive them of their liberty).

The MCA identifies two additional conditions that must be satisfied in order for protection from liability for restraint to be available.

• You must reasonably believe that it is necessary restrain the person who lacks capacity in order to prevent them coming to harm.
• Any restraint must be reasonable and in proportion to the potential harm.

Using excessive restraint could leave you liable to a range of civil and criminal penalties. For instance, it may be necessary to accompany someone when going out because they cannot cross roads safely, but it may be unreasonable for you to stop them from going outdoors all together.

Deprivation of Liberty Safeguards

These safeguards are designed to protect people lacking capacity who need to be deprived of their liberty for their own safety and who are not capable of making decisions themselves about arrangements that should be made for their care and treatment. They were introduced into the Mental Capacity Act 2005 by the Mental Health Act 2007 (which received Royal Assent on 19 July 2007) and apply to people in care homes or hospitals.

What are the Mental Capacity Act 2005 Deprivation of Liberty Safeguards?

The Mental Capacity Act 2005 Deprivation of Liberty Safeguards (MCA DOLS), which come into force in England on 1 April 2009, provide a legal framework to prevent unlawful deprivation of liberty occurring. They protect vulnerable people in hospitals or care homes who lack the capacity to consent to the arrangements made for their care and/or treatment but who need to be deprived of their liberty in their own best interests to protect them from harm. Primary care trusts (PCTs), local authorities, hospitals and care homes have a statutory responsibility for administering and delivering the MCA DOLS at a local level.

If you want to find out more about what MCA DOLS means for you or your organisation, the MCA DOLS Code of Practice, which explains in detail how MCA DOLS’ processes and procedures work, can be downloaded at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085476

Or you can visit the website at: www.dh.gov.uk/en/SocialCare/Deliveringadultsocialcare/MentalCapacity/MentalCapacityActDeprivationofLibertySafeguards/index.htm

The Welsh Assembly Government has published three guidance booklets to assist managing authorities and supervisory bodies identify the key processes in the safe and effective use of the safeguards:

1. Guidance for Managing Authorities working within the Mental Capacity Act Deprivation of Liberty Safeguards.
2. Guidance for Supervisory Bodies working within the Mental Capacity Act Deprivation of Liberty Safeguards.
3. Standard Forms and Letters for the Mental Capacity Act Deprivation of Liberty Safeguards.

The Welsh Assembly Government has also published a range of information leaflets which managing authorities and supervisory bodies may use to assist in providing information to the relevant person. These can be found at www.mentalcapacityact.wales.nhs.uk

Protecting people who lack capacity from ill-treatment or wilful neglect

The MCA introduces a new criminal offence of ill treatment or wilful neglect of a person who lacks capacity. This is intended to deter people from abusing, ill-treating or neglecting people who lack capacity. If convicted, people can be imprisoned or fined.

The offence covers restraining someone unreasonably against their will, failure to provide adequate care, and also the more commonly understood types of abuse such as financial, sexual, physical and psychological abuse.

This offence applies to a person who: * has the care of a person who lacks capacity; * is an Attorney appointed under a LPA or EPA; or * is a Deputy appointed for the person by the Court of Protection.

You need to have full knowledge of this as you carry out your duties. In keeping with good practice in health and social care, you should keep records showing that you have followed the Code of Practice.

While the majority of people who are involved in the care of vulnerable people are entirely trustworthy, everyone should be alert to signs of abuse and take swift action to prevent or stop it. If you think someone is being abused or ill-treated you should contact the police or your Social Services Department’s adult services who will deal with it under local adult protection procedures.

Section 10. Providing care or treatment for people who have planned ahead

The MCA has far reaching effects for people who work in health and social care because it extends the ways in which people using services can plan ahead for the time when they may lack capacity. These are Lasting Powers of Attorney (LPAs), advance decisions to refuse treatment, and written statements of wishes and feelings.

If you are providing care or treatment for someone who lacks capacity these may be very helpful in deciding what to do. If you are working with people who have capacity, or who have fluctuating capacity (such as people with mental health problems) it may be helpful for you to explain to them these ways of planning ahead for a time when they may lack capacity. Providing care or treatment for people who have planned ahead is a very complex area and it is advisable to refer to the Code of Practice for more detailed guidance.

Lasting Powers of Attorney

The MCA introduces a new form of Power of Attorney which allows people over the age of 18 to formally appoint one or more people to look after their health, welfare and/or financial decisions, if at some time in the future they lack the capacity to make these decisions for themselves. The person making an LPA is called the Donor. The power that is given to someone else is called a Lasting Power of Attorney (LPA) and the person(s) appointed are known as an attorney(s). The LPA gives the Attorney authority to make decisions on behalf of the Donor and the Attorney has a duty to act or make decisions in the best interests (principle 4) of the person who has made the LPA.

There are two different types of LPA:

1. A Personal Welfare LPA is for decisions about both health and personal welfare; and
2. A Property and Affairs LPA is for decision about financial matters.

Important facts about LPAs

• The introduction of LPAs for property and affairs means that no more Enduring Powers of Attorney (EPA) can be made, but the MCA makes transitional provisions for existing EPAs to continue whether they are registered or not. This means that pre-existing EPAs can continue to be used (whether registered or not) and can continue to be registered.
• When a person makes an LPA they must have the capacity to understand the importance of the document and the power they are giving to another person.
• Before an LPA can be used it must be registered with the Office of the Public Guardian (sesction 12). This is vital, without registration an LPA cannot be used at all.
• An LPA for property and affairs can be used when the Donor still has capacity unless the Donor specifies otherwise.
• A Personal Welfare Attorney has no power to consent to, or refuse treatment, at any time or about any matter when the person has the capacity to make the decision for himself or herself.
• If the person in your care lacks capacity and has created a Personal Welfare LPA, the Attorney is the decision-maker on all matters relating to the person’s care and treatment. Unless the LPA specifies limits to the Attorney’s authority the Attorney has the authority to make personal welfare decisions and consent to or refuse treatment (except life-sustaining treatment) on the Donor’s behalf. The Attorney must make these decisions in the best interests of the person lacking capacity (principle 4) and if there is a dispute that cannot be resolved, for example, between the attorney and a doctor, it may have to be referred to the Court of Protection.
• If the decision is about life-sustaining treatment, the Attorney only has the authority to make the decision if the LPA specifies this.
• If you are directly involved in the care or treatment of a person who lacks capacity, you should not agree to act as their Attorney other than in exceptional circumstances, for instance, if you are the only close relative of the person.
• It is important to read the LPA if it is available to understand the extent of the Attorney’s power.

Example:
Martin has recently been diagnosed as being in the very early stages of Alzheimer’s disease.
He wants to make sure that if he lacks capacity in the future his personal values and preferences are taken into account when a decision is made on his behalf. He decides to appoint his daughter as a Personal Welfare Attorney to make any personal welfare decisions that he loses capacity to make herself.
He talks through things that are important to him such as wanting to stay near his friends, and to be able to go into a care home that allows pets. His daughter then registers the LPA.
If in the future Martin lacks capacity to decide where he should live, his daughter will have the authority to make this decision as his Personal Welfare Attorney. She will be able to take account of the things that her father has stated when considering what would be in his best interests.

Advance decisions to refuse treatment

Sometimes people have clear views about what types of treatment they don’t want to have and would not consent to. An advance decision allows them to express these views clearly, before they lose capacity. Advance decisions, also called advance directives or ‘living wills’ can currently be made under common law and the Mental Capacity Act puts them on a statutory footing. It also explains what is required in law for an advance decision to be valid and applicable and introduces new safeguards.

An advance decision is where a person aged 18 or over may set out what particular types of treatment they would not want to have and in what circumstances, should they lack the capacity to refuse consent to this treatment for themselves in the future. It can be about any treatment even if it may result in the person’s death and if it is valid and applicable it must be followed as it is legally binding and has the same force as when a person with capacity refuses treatment (see below for the requirements for advance decisions). An advance decision does not need to be in writing, except for decisions relating to life-sustaining treatment (see below) but it is helpful if it is.

What are the requirements for advance decisions?

The MCA introduces a number of rules people must follow when making an advance decision. If you are making a decision about treatment for someone who is unable to consent to it, you must be satisfied that the advance decision exists and is valid and applicable to the particular treatment in question.

The following list gives a very brief summary of some of the main requirements for advance decisions (if you are involved in such a decision you should consult the Code of Practice).

• It must be valid. The person must not have withdrawn it, or overridden it by making an LPA that relates to the treatment in the advance decision (see part 10), or acted in a way that is clearly inconsistent with the advance decision.
• It must be applicable to the treatment in question. It should clearly refer to the treatment in question (detailed medical terms do not have to be used) and it should explain which circumstances the refusal refers to. If there have been changes in circumstances which there are reasonable grounds for believing would have affected a person’s advance decision when they made it, then it may not be applicable. You should also note the following.
• Where people are detained under the Mental Health Act 1983 and can therefore be treated for mental disorder without their consent, they can also be given such treatment despite having an advance decision to refuse the treatment.
• People cannot make an advance decision to ask for medical treatment - they can only say what types of treatment they would refuse.
• People cannot make an advance decision to ask for their life to be ended. If you are satisfied that the decision is both valid and applicable then you will have to abide by that decision.

Advance decisions to refuse life-sustaining treatment

The MCA sets out additional formalities for advance decisions that refuse life-sustaining treatment. An advance decision to refuse life-sustaining treatment must fulfil the following additional requirements:

• It must be in writing, which includes being written on the person’s behalf or recorded in their medical notes.
• It must be signed by the maker in the presence of a witness who must also sign the document. It can also be signed on the maker’s behalf at their direction if they are unable to sign it for themselves.
• It must be verified by a specific statement made by the maker, either included in the document or a separate statement, that says that the advance decision is to apply to the specified treatment even if life is at risk. If there is a separate statement this must also be signed and witnessed.

Example:
Ike has witnessed a friend die of cancer. He decides that he would not wish to receive chemotherapy or radiotherapy if he became seriously ill and was close to dying. Ike is concerned that if he is unable to make a decision, the doctors may make it for him.
So he makes an advance decision stating that in the future if he becomes ill he does not want to receive chemotherapy or radiotherapy. His advance decision includes a written statement confirming that he does not want chemotherapy or radiotherapy even if his life is at risk. Ike signs the advance decision and his close friend witnesses the signature.
The advance decision must be followed if and when it becomes relevant and the doctor is satisfied that it is valid and applicable.

Providing care or treatment for people who have made advance decisions is a complex area and it is advisable to refer to the Code of Practice for more detailed guidance.

Conscientious objection

You will not have to act on an advance decision if you object to it on religious or moral grounds.

You must make this known as soon as possible and arrangements must be made for the management of the patient’s care to be transferred to another health professional.

Liability of people who work in health and social care

You will not incur liability for providing treatment in a patient’s best interests if, having taken reasonable steps, you do not know or are not satisfied that a valid and applicable advance decision exists. If you are satisfied that an advance decision exists which is valid and applicable, then not to abide by it could lead to a legal claim for damages or a criminal prosecution for assault.

If you reasonably believe that there is a valid and applicable advance decision then you will not be held liable for the consequences of abiding by it and not providing treatment. You should clearly record how you came to your conclusions.

Disputes and disagreements about advance decisions

You will have to form a view about whether or not an advance decision is valid and applicable and you should refer to the Code of Practice for more detailed guidance particularly if there is a disagreement.

If there is a dispute or difficulty, then you should consider mediation or the matter could be referred to the Court of Protection by you or a relative, carer or a close friend of the patient.

Dealing with advance decisions that were made before October 2007

If any of the people you provide care or treatment for had an advance decision (sometimes known as a ‘living will’) before the MCA came into force then it may still be valid. However, you should check that it meets the new rules, particularly if it deals with life-sustaining treatment. More detailed guidance on this is available at www.dh.gov.uk/consent

Statements of wishes, feelings, beliefs and values

Sometimes people will want be able to write down or tell people about their wishes and preferences about future treatment and care and explain their feelings or values that govern how they make decisions.

These statements can be about anything, including personal preferences such as having a shower rather than a bath, or wanting to sleep with the light on. Such statements can request certain types of treatment, which you must consider carefully, in particular if they have been written down.

Example:
Khalid is vegetarian and has a degenerative condition. He wants to make sure that if he lacks mental capacity and needs people to help him with daily tasks they take into account his personal beliefs. He therefore writes down a statement explaining that he only wishes to receive vegetarian food.
Khalid asks for the statement to be filed with his health records so that in the future, if he can no longer make and communicate his own decisions, he receives food in line with his wishes.

When you are assessing what treatment or care is in a person’s best interests you will have to take these statements into account. However, your final decision must always be based on your assessment of what is in the person’s best interests and your professional judgement of what is clinically necessary or appropriate. If this is different to what they have said in their statement of wishes and feelings you should keep a record of this and be prepare to justify your decision if challenged.

Section 11. Confidentiality and record-keeping

Confidentiality

You are required to maintain confidentiality with regard to information about the people in your care. Personal information should not be disclosed unless:

• the person agrees;
• there is a legal obligation to do so; or
• there is an overriding public interest.

Where a person lacks capacity the Mental Capacity Act test of ‘best interests’ may also justify disclosure (see section 7). An assessment of capacity may require the sharing of information among health and social care workers. If a person lacks capacity to consent to disclosure then you must work out whether it would in their best interests (see section 7) to disclose the information. Only as much information as necessary should be divulged.

Where an Attorney under a Personal Welfare LPA has been appointed they will determine whether information can be disclosed and you must normally consult with them before sharing any information. Where it is not possible to consult, for example, because urgent treatment is necessary, you must act in the patient’s best interests and advise the Attorney of any action taken as soon as practicable.

Disclosure of, and access to, information can be complex. The Information Commissioner has issued guidance on the Data Protection Act 1998, and the Mental Capacity Act does not change or substitute this. Also, professionals and organisations have their own codes of conduct, policies and procedures about confidentiality. These are supported by experts such as Information/Data Protection Officers in Social Services and Caldicott Guardians in NHS organisations.

For more detailed guidance and sources of information on confidentiality, you should go to:

• Guidance on the Data Protection Act 1998 https://ico.org.uk/
• NHS Code of Practice on confidentiality and information on Caldicott Guardians www.dh.gov.uk (search under ‘patient confidentiality’)
• You should also refer to any codes of conduct or procedures on confidentiality that your workplace has.

Record-keeping

As a person who works in health or social care you will need to record accurately the decisions you make about the assessment of mental capacity, and the determination of best interests.

The decisions may be recorded in the:

• care plan;
• nursing records;
• medical records;
• social work records;
• other health and social care records; and/or
• other notes and records such as those kept by social workers, therapists or care assistants.

You should remember that the records you keep might in the future be referred to if there is a dispute or as part of legal proceedings.

Section 12. New public bodies and services created by the Mental Capacity Act

The MCA created a new court and a new public official to protect people who lack capacity and to supervise and support those making decisions on their behalf.

Court of Protection and Deputies

The previous Court of Protection was replaced by a new Court of Protection which is a specialist court that deals with all issues related to the MCA. It deals with decisions concerning both the property and affairs and the health and welfare of people who lack capacity. It is particularly important in resolving complex or disputed cases, for example, about whether someone lacks capacity or what is in their best interests.

In specific situations the Court of Protection is able to consider cases relating to children who are under 16, for example, when longer-term decisions need to be made about their financial affairs.

The Court of Protection has the power to:

• make declarations about whether or not a person has capacity to make a particular decision;
• make decisions on serious issues about healthcare and treatment;
• make decisions about the property and financial affairs of a person who lacks capacity;
• appoint Deputies to have ongoing authority to make decisions; and
• make decisions in relation to Lasting Powers of Attorney (LPAs) and Enduring Powers of Attorney (EPAs).

The Court is able to appoint a Deputy if necessary, for example, because a person has an ongoing lack of capacity. The Court tailors the powers given to a Deputy based on the circumstances of the case.

Deputies replace the previous system of Court-appointed Receivers to deal with property and affairs of someone who lacks capacity, Under the Mental Capacity Act, however, Deputies can also be appointed to deal with personal welfare decisions.

Deputies have to pay attention to the Code of Practice (see section 3) and have to act in the best interests of the person who lacks capacity (see section 7).

People who work in health and social care and are directly involved in the care or treatment of a person who lacks capacity, will not usually be appointed as Deputies because of the possible conflict of interests.

The Public Guardian

The role of the Public Guardian is to protect people who lack capacity from abuse. The Public Guardian is supported by the Office of the Public Guardian (OPG).

Some of the tasks of the Public Guardian include:

• maintaining a register of LPAs and EPAs;
• maintaining a register of orders appointing Deputies;
• supervising Deputies appointed by the Court;
• directing Court of Protection Visitors to visit people lacking capacity;
• receiving reports from Attorneys acting under LPAs and from Deputies;
• providing reports to the Court as requested;
• dealing with representations (including complaints) about the way in which Attorneys or Deputies exercise their powers; and
• providing general information about the MCA.

Section 13. Research involving people who may lack capacity

The MCA sets out a clear legal framework for many types of research involving people who lack capacity to consent to taking part in such research. As someone who provides care or treatment for a person who lacks capacity you may be asked to be involved if the person is taking part in such research.

It is important that research is able to involve people who lack capacity, to provide knowledge about the causes of incapacity and about the diagnosis, treatment, care and needs of people who lack capacity. The MCA covers a wide range of research including clinical, health and social care research but not clinical trials, which are covered by separate legislation.

Research covered by the MCA includes:

• developing new and more effective ways of treating a condition;
• improving the quality of health and social care services;
• discovering the cause of a debilitating illness or learning disability;
• preventing harm, exclusion or disadvantage on the part of people who lack capacity; and
• checking to see what type of intervention works best in a particular situation. The MCA introduces a number of safeguards to protect people taking part in such research, which include the following.
• A family member or unpaid carers must be consulted about any proposal and agree that the person can be part of the research. If such a person cannot be identified, then the researcher must identify a person who is independent of the research project to provide advice on the participation of the person who lacks capacity in the research.
• If the person without capacity shows any sign that they are not happy to be involved in the research then the research is not allowed to continue.
• All plans for research are to be checked by a recognised independent research ethics committee.
• The committee needs to agree that the research is necessary, safe and appropriate and cannot be done as effectively using people who have mental capacity.
• The committee also has to approve plans to deal with people who consented to join a long-term research project but lost capacity before the end of the project.

The person’s past or present wishes and feelings and values are most important in deciding whether they should take part in research or not. Someone involved in a research project may ask you if you know what the person’s feelings are. Part of a research project may be carried out when you are providing care or treatment for a person and you may be asked to let the researchers know if the person seems upset about any aspect of it.

Anyone setting up or carrying out such research will need to make sure the research complies with the provisions set out in the MCA and will need to follow the guidance given in the Code of Practice.

Further sources of information and guidance

• For more detailed guidance on research involving people who lack capacity you should read the Code of Practice.
• For more information on issues relating to the consent to the use of tissue or organs for research you should refer to the Human Tissue Authority

Section 14. Interface with other legislation, policy and procedures

The Mental Capacity Act applies in conjunction with other laws relevant to or affecting the property and affairs, care or treatment of people who may lack capacity in relation to specific matters. People who work in health and social care should also be aware of their obligations under other laws, including (but not limited to) the following:

• Care Standards Act 2000
• Data Protection Act 1998
• Disability Discrimination Act 1995
• Human Rights Act 1998
• Mental Health Act 1983
• National Health Service and Community Care Act 1990
• Human Tissues Act 2004.

The MCA and the Mental Health Act 1983

• The MCA may be used to treat people for mental disorder when they cannot consent to the treatment because they lack capacity and where the treatment is in their best interests (see part 7).
• But the MCA cannot be used to detain anyone. If you think a person might need to be detained for treatment for mental disorder, you will need to consider taking steps to have them assessed with a view to detention under the Mental Health Act 1983 (MHA).
• If a person is detained under the MHA, the MCA does not apply to treatment for the person’s mental disorder which can be given without consent under the MHA itself. This is because even people who have capacity to consent cannot refuse such treatment. It also means that Attorneys (and Deputies) cannot consent or refuse such treatment on the patient’s behalf. For the same reason, an advance decision to refuse treatment for mental disorder can be over-ridden where necessary.
• For most other purposes, the MCA applies to a patient detained under the MHA. This means, for example, that an advance decision to refuse treatment for any illness or condition other than mental disorder is not affected, nor is any power an Attorney has to consent to such treatment. It also means that where a detained patient lacks capacity to consent to treatment other than treatment for mental disorder, the decision-maker will need to act in accordance with the MCA.

For more detail on the interface between the MCA and the Mental Health Act 1983 you should read the Code of Practice.

The MCA and assessment processes across health and social care

There are currently a range of national assessment processes in place across health and social care, including the following:

• The Single Assessment Process (SAP) in England, called the Unified Assessment Process (UAP) in Wales, which is the way care and treatment is planned and provided for older people.
• The Care Programme Approach (CPA) which is the way care and treatment is planned and provided to adults who receive statutory mental health services.
• Person-Centred Planning which is the way care and treatment is planned and provided to adults with a learning disability.

These assessment processes may also involve people who work in voluntary and independent sector care services.

If you work as part of any of these processes, such as a CPA care co-ordinator for someone, you should consider how the MCA will apply, and how it will help you and the person you are caring for.

The MCA helps emphasise the importance of ensuring the individual is at the centre of these processes including decision-making and processes about the care and treatment the person receives. The MCA also emphasises that the person should be supported as much as possible to make their own decisions, even where you may consider these decisions to be unwise (see section 5).

If you are involved in the assessment of someone’s needs, providing care and treatment as part of a person’s care plan, or reviewing their care plan you have to take into account the provisions of the MCA. For example:

• you may have to assess the person’s capacity to make certain decisions about their care or treatment (see section 6);
• when you make a decision for a person who lacks capacity you have to consider what is in their best interests (see section 7);
• if the person has planned ahead and has made an advance decision to refuse treatment that is valid and applies to the treatment you are proposing, you have to abide by it (see section 10);
• if the person has made a written statement of wishes and feelings you need to take this into account (see section 10);
• if the person has made an LPA (particularly one for health and welfare) and now lacks capacity, you need to involve the Attorney in the planning and provision of care or treatment (see section 10). If the LPA gives the Attorney the power to consent to or refuse treatment or care on behalf of the person you need to ensure that the decision made by the Attorney is treated in the same way as a decision made by the person (see section 10); and
• the person may request your help in making a written statement or advance decision to refuse treatment (see section 10).

The MCA and Social Security appointees

Some people who receive benefits or pensions will lack capacity to act for themselves. In those circumstances an appointee is appointed by the Department of Work and Pensions to claim, spend and manage the benefit or pension on the person’s behalf.

If you are an appointee for someone who lacks capacity to make financial decisions, or you work with someone who has an appointee, the appointeeship should be carried out in accordance with the MCA. For example, decisions on how the person’s money should be spent should be done according to the best interest principle (see section 7) and the principle about doing things that are least restrictive of a person’s rights and freedoms (see section 4).

If there is evidence that the appointee is not following these principles the appointment can be revoked.

The MCA and the Human Tissue Act 2004

The Human Tissue Act 2004 deals with, amongst other things, issues relating to the consent to the use of tissue or organs for purposes such as transplantation, research or gaining information that may be relevant to another person. Before considering the storage or use of tissues or organs for any of these purposes from people who lack the capacity to consent, healthcare professionals must take into account the Human Tissue Act 2004. Further guidance is available from the Human Tissue Authority

The MCA and children and young people

1. Where the MCA applies to young people aged 16 to 17

• There is an overlap between the MCA and the Children Act for 16 and 17 year olds. Most of the provisions of the MCA apply to young people, and the Code of Practice for the MCA gives guidance on how to proceed.
• Any decisions relating to the treatment of young people of 16 or 17 years old must be made in their best interests and in accordance with the principles of the MCA. As with all such decisions, the decision-maker must, where practicable and appropriate, consult the person’s family and friends, especially those with parental responsibilities, as part of the best interests decision-making process (see section 7).

2 Where the MCA does not apply to young people aged 16-17

There are certain parts of the MCA that do not apply to young people aged 16-17 years old, as the MCA requires a person to be 18 or over. These are:

• making a Lasting Power of Attorney (see section 10);
• making an advance decision to refuse treatment (see section 10); and
• making a will. The law generally does not allow people under 18 to make a will and the MCA confirms that the Court of Protection has no power to make a will on behalf of anyone under 18.

3 Where the MCA applies to children under the age of 16

In most situations the care and welfare of children under 16 will continue to be dealt with under the Children Act 1989.

There are two parts of the MCA that apply to children under 16.

• The Court of Protection’s powers to make decisions concerning the property and affairs of a child under the age of 16. The Court can make these decisions where the Court considers it likely that the child will lack capacity to make decisions about their property and affairs even when they are 16 (see section 12).
• The criminal offence of ill treatment or wilful neglect also applies to children under 16 who lack capacity as no lower age limit is specified for the victim (see section 9). The Code of Practice explains in more detail about legal proceedings for young people and the relationship with other relevant laws such as the Children Act 1989.

Section 15. What if I want to know more about the MCA?

If you would like to know more about the Mental Capacity Act you can call 0845 330 2900 or email customerservices@publicguardian.gov.uk

Other sources of useful information and guidance include:

The Mental Capacity Act 2005
You can view this for free by going to: https://www.gov.uk/government/organisations/office-of-the-public-guardian
Or you can order a hard copy from TSO by calling 0870 600 5522 or emailing customerservices@tso.co.uk

The Code of Practice for the Mental Capacity Act
You can download the Code for free by going to: https://www.gov.uk/government/organisations/office-of-the-public-guardian
You can order a hard copy from TSO by calling 0870 600 5522 or emailing customerservices@tso.co.uk

Best practice tool to assist with testing your organisation’s readiness for the implementation of the MCA
https://www.gov.uk/government/organisations/department-of-health-and-social-care and then go to Chief Execs Bulletin Issue 329, 28 - July 3 August 2006)

Information on the IMCA service, IMCA Pilots and training materials for IMCAs
https://www.gov.uk/government/organisations/department-of-health-and-social-care

Section 16. Some useful contacts

The following government departments work together to implement the Mental Capacity Act

Office of the Public Guardian (OPG)
The Office of the Public Guardian supports and promotes decision-making for those who lack capacity or would like to plan for their future, within the framework of the Mental Capacity Act 2005
www.publicguardian.gov.uk
T 0845 330 2900 E customerservices@publicguardian.gov.uk

Department of Health (DH)
Responsibilities include setting health and social care policy in England. The Department’s work sets standards and drives modernisation across all areas of the NHS, social care and public health
Wellington House, 133-155, Waterloo Road, London, SE1 3UG https://www.gov.uk/government/organisations/department-of-health-and-social-care
T 020 7210 4850

Welsh Assembly Government
Develops policy and approves legislation that reflects the needs of the people of Wales
Cathays Park, Cardiff, CF10 3NQ https://gov.wales/
T 029 2082 5111

The following organisations were involved in writing and advising on this guidance

Making Decisions Alliance
It includes: Action on Elder Abuse, Age Concern England, Alzheimer’s Concern Ealing, Alzheimer’s Society, Beth Johnson Foundation, Carers UK, Centre for Policy on Ageing, Cloverleaf Advocacy, Consumer Forum, Different Strokes, Down’s Syndrome Association, Foundation for People with Learning Disabilities, Headway, Help the Aged, Horsham Gateway Club, Independent Advocacy Service, Kent Autistic Trust, Leonard Cheshire, Mencap, Mental Health Foundation, Mind, Motor Neurone Disease Association, National Autistic Society, North Staffordshire Users Group, The Oaklea Trust, Patient Concern, Powerhouse, Relatives and Residents Association, Respond, Rethink, Rett Syndrome Association, St Clements Patient Council, Scope, Sense, Skills for People, Stroke Association, Turning Point, United Response, WITNESS
https://www.makingdecisions.org.uk

Action for Advocacy
A resource and support agency for the advocacy sector, information, training and advice PO Box 31856, Lorrimore Square, London, SE17 3XR
www.actionforadvocacy.org

Age Concern England
The UK’s largest organisation working to promote the wellbeing of all older people. It provides vital services, information and support to thousands of older people - of all ages and backgrounds
Astral House, 1268 London Road, London, SW16 4ER
http://www.ageconcern.org.uk
https://www.ageuk.org.uk › cymru
Information line 0800 00 99 66

Alzheimer’s Society
The UK’s leading care and research charity for people with dementia, their families and carers
Gordon House, 10 Greencoat Place, London, SW1P 1PH
https://www.alzheimers.org.uk
Helpline 0845 300 0336

Association of Black Social Workers and Allied Professions
The Association aims to improve the quality of health and social care for Black users and staff
65 Woodrow, Woolwich, London, SW18 5DH
T 020 8 854 7402

Association of Directors of Social Services (ADSS)
Represents all the Directors of Adults Social Services (DASS) and Directors of Children’s Services (DCS) in England, Wales and Northern Ireland
ADDSS Administrator, ADDSS Business Unit, Local Government House, Smith Square, London, SW1P 3HZ
https://www.adass.org.uk/
T 020 7072 7433<br< F 020 7863 9133

British Association of Social Workers (BASW)
The largest association representing social work and social workers in the UK. 16 Kent Street, Birmingham, B5 6RD
https://www.basw.co.uk
T (0121) 622 3911
F (0121) 622 4860

British Medical Association (BMA)
BMA represents doctors from all branches of medicine all over the UK
MA House, Tavistock Square, London, WC1H 9JP
https://www.bma.org.uk
T 020 7387 4499
F 020 7383 6400

Carers UK
Looks after family, partners or friends in need of help because they are ill, frail or have a disability
20/25 Glasshouse Yard, London, EC1A 4JT
https://www.carersuk.org<br< T 020 7566 7637
F 0207490 8824

Down’s Syndrome Association
Provides information and support for people with Down’s syndrome, their families and carers, as well as being a resource for interested professionals
Langdon Down Centre, 2a Langdon Park, Teddington, Middlesex, TW11 9PS
https://www.downs-syndrome.org.uk
T 0845 230 0372
F 0845 230 0373

English Community Care Association
The largest representative body for community care in England
4th Floor, 145 Cannon Street, London
www.ecca.org.uk
T 020 7220 9595
F 020 7220 9596

Foundation for People with Learning Disabilities
Works with people with learning disabilities, their families and those who support them to improve the quality of their lives and promotes the rights, quality of life and opportunities of people with learning disabilities and their families
Sea Containers House, 20 Upper Ground, London, SE1 9QB
https://www.learningdisabilities.org.uk/
T 020 7803 1100

General Medical Council (GMC)
GMC registers doctors to practise medicine in the UK
Regents Place, 350 Euston Road London, NW1 3JN
T 0845 357 3456
F 0845 357 8001

Headway – the brain injury association
Promotes understanding of all aspects of brain injury; and to provide information, support and services to people with a brain injury, their family and carers
4 King Edward Court Service , King Edward Street, Nottingham, NG1 1EW
https://www.headway.org.uk/
T 0115 9240800
Helpline 0808 800 2244

Local Government Association (LGA)
Promotes the interests of English and Welsh local authorities – a total of just under 500 authorities
Local Government House, Smith Square, London, SW1P 3HZ
http://www.local.gov.uk/
T 020 7664 3131
F 020 7664 3030

Mental Health Foundation
A leading UK charity that provides information, Carries out research, campaigns and works to improve services for anyone affected by Mental health problems, whatever their age and wherever they live
Sea Containers House, 20 Upper Ground, London, SE1 9QB
https://www.mentalhealth.org.uk/
T 020 7803 1100

MIND
A leading mental health charity, working to create a better life for everyone with experience of mental distress. Provides information and support mental health charity in England and Wales
15-19 Broadway, Stratford, London, E15 4BQ
https://www.mind.org.uk/
T 0208 519 2122

National Autistic Society (NAS)
Champions the rights and interests of all people with autism and to ensure that they and their families receive quality services appropriate to their needs
393 City Road, London, EC1V 1NG
https://www.autism.org.uk/
Autism helpline 0845 070 4004

National Care Association (NCA)
Represents the interests and provides services to support small and medium sized providers of social care in England and Wales
45-49 Leather Lane, London, EC1N 7JT
[https://nationalcareassociation.org.uk[(https://nationalcareassociation.org.uk)
T 020 7831 7090

National Care Forum
Established to represent the interests of not-for- profit health and social care providers in the United Kingdom
National Care Forum, 3 The Quadrant, Coventry, CV1 2DY.
https://nationalcareassociation.org.uk/
T 024 7624 3619

The National Family Carer Network
Provides a focal point for issues affecting families that include an adult with a learning disability
Merchants House, Wapping Road, Bristol, BS1 4RW
https://www.familycarers.org.uk/
T 0117 930 2600

The National Family Carer Support Service
Provides support and information for family carers
Merchants House, Wapping Road, Bristol, BS1 4RW
https://www.hft.org.uk/
T 0117 930 2608

Patient Concern
An organisation committed to promoting choice and empowerment for all health service users
PO Box 23732, London, SW5 9FY
www.patientconcern.org.uk
E patientconcern@hotmail.com

The Relatives and Residents Association
An organisation for older people needing, or living in, residential care and the families and friends left behind
24 The Ivories, 6-18 Northampton Street, London, N1 2HY
https://www.relres.org
T 020 7359 8148

RESCARE
The national society for children and adults with learning disabilities and their families
Steven Jackson House, 31 Buxton Road, Heaviley, Stockport, SK2 6LS
https://www.rescare.org.uk
T 0161 474 7323

RESPOND
Provides a range of services for both victims and perpetrators of sexual abuse who have learning disabilities and those who have been affected by other trauma. Their services extend to support and training for families, carers and professionals.
3rd Floor, 24-32 Stephenson Way, London, NW1 2HD
T 020 7383 0700
F 020 7387 1222
https://www.respond.org.uk
Helpline 0808 808 0700

Royal College of Nursing (RCN)
Represents nurses and nursing
20 Cavendish Square, London, W1G 0RN
https://www.rcn.org.uk
T 020 7409 3333

Royal College of Psychiatrists
The professional and educational body for psychiatrists in the United Kingdom and the Republic of Ireland
17 Belgrave Square, London, SW1X 8PG
https://www.rcpsych.ac.uk
T 020 7235 2351

Social Care Association
A vibrant, inclusive and informed Association which visibly promotes positive practice within all social care services throughout the UK
Thornton House, Hook Road, Surbiton, Surrey, KT6 5AN
https://www.socialcareassociation.co.uk
T 020 8 397 1411

Scope
Disability organisation in England and Wales, whose focus is people with cerebral palsy
6 Market Road, London, N7 9PW
https://www.scope.org.uk
T 020 7619 7100

Sense
Charity providing specialist information, advice and services to deaf blind people, their families, carers and the professionals who work with them. Funded to develop training materials which address the advocacy issues for deaf blind people
11-13 Clifton Terrace, Finsbury Park, London, N4 3SR
https://www.sense.org.uk
T 0845 127 0060
F 0845 127 0061
Text 0845 127 0062

Turning Point
The UK’s leading social care organisation, providing services for people with complex needs, including those affected by drug and alcohol misuse, mental health problems and those with a learning disability
Standon House, 21 Mansell Street, London, E1 8AA
https://www.turning-point.co.uk
T 020 7481 7600