Pictured are the guest speakers at the Roadshow: Lorraine Dolan, Regional Coordinator Sage Advocacy Midwest; Mary O'Dwyer, Chairperson of Mid West CHO ADM Steering Group; Jacqueline Grogan, HSE National Office for Human Rights and Equality Policy; Aine Flynn, Director of the Decision Support Service; Professor Shaun O’Keeffe, Consultant Geriatrician, University Hospital Galway; and Maria Bridgeman, Chief Officer, HSE Mid West Community Health.
HSE Mid West Community Healthcare hosted a very informative and important Roadshow on Assisted Decision Making at the Castletroy Park Hotel this week which proved extremely useful and worthwhile for all participants.
With almost 150 in attendance, the event organised by the local ADM Steering Committee under Chairperson Mary O’Dwyer, Head of Quality, Safety & Service Improvement, HSE Mid West Community Healthcare, featured expert contributors in the field of ADM including:
- Aine Flynn, Director of the Decision Support Service who delivered the keynote address;
- Professor Shaun O’Keeffe, Consultant Geriatrician, University Hospital Galway who discussed what will the Assisted Decision Making (Capacity) Act 2015 mean for practice;
- Jacqueline Grogan, HSE National Office for Human Rights and Equality Policy who outlined the national resources and supports available for managers and staff;
- Lorraine Dolan, Regional Coordinator Sage Advocacy (Midwest) who joined the discussion panel and brought her personal experience at the coalface to the fore.
On the 26th April this year, the Assisted Decision-Making (Capacity) Act 2015 (the Act) was commenced. The Act gives each person the right to be assisted to make decisions with legally recognised supports regardless of disability or any condition which may affect a persons’ decision-making capacity. The Act ensures each person’s right to make autonomous and independent decisions for as long as possible.
A core principle of the Act is that all persons should be presumed to have decision-making capacity and should be supported to make their own decisions as far as is possible. The Act emphasises minimal restriction of a person’s rights and freedoms and the importance of respect for the person’s past and present will and preferences.
Key reforms include the abolition of the wards of court system for adults under the Lunacy Regulation (Ireland) Act of 1871 and the discharge of adults from wardship within three years of the commencement of the Act.
A public body called the Decision Support Service has been established to register the new decision support arrangements and supervise the individuals who are providing a range of supports to people who may have difficulties in exercising their decision-making capacity.
The role of the Decision Support Service is to promote public awareness of the Act and to provide information about their services. This includes providing information and guidance to people who may use this service and to their families.
Chief Officer’s Opening Address: The Roadshow was opened by Chief Officer, Maria Bridgeman who said that the Assisted Decision Making Act 2015 “reminds us that we must be aware of people who do not have that ability to make their own decisions. It really does touch in every interaction with every adult service user in Mid West Community Healthcare. Some of this is a big change for the health service and for Irish Society.”
She continued: “In Mid West Community Healthcare, our goal is to deliver high quality care to all - every service user. Human rights principles of fairness, respect, equality, dignity and autonomy are fundamental to high quality care. To fully implement the Act, we must build on the work already in place regarding person centred care, informed consent, risk management, open disclosure.
“So how can I support you and your teams and how do we ensure we apply the Act across HSE Mid West Community Healthcare? There is a very clear direction I am taking on this Act and with that in mind I have assigned responsibility for leading implementation of ADM to Mary O’ Dwyer, Head of Quality Safety & Service Improvement.
“A Steering Group has been established and I know that a number of people from the Mid West, both HSE and HSE funded services, will be undertaking the ADM mentorship programme in the autumn which will build our service level knowledge base.
As a priority, I am seeking resources for an ADM team to provide the subject expertise to support development of new ways of working. I am fully committed to supporting this team to support all persons to make their own decisions as far as possible. I acknowledge the scale of reform cannot be overstated I am very focused on enhancing our ability to provide our service users with the best opportunity to exercise their rights.
“Finally on today’s Roadshow, I want to thank and congratulate Mary and the Steering Group on putting together a very impressive line-up of speakers who are experts in their field. Listen to them; ask questions; learn from them; and we will all leave here today far better informed about ADM than when we walked in here this morning,” she said.
Panel discussion
The main goal of the Roadshow was to prepare staff and services, for the changes related to the Assisted Decision-Making (Capacity) 2015 Act, by providing relevant details, resources, and training through: building on an increasing awareness of the Act and implications with HSE staff and wider HSE funded services; assisting staff to access, information on the Act, and support, to implement over coming months; and highlighting ongoing training opportunities and upcoming webinars.
Attendees, who submitted many questions to the panel and participated in the debate, heard that the Act will provide a new tiered framework of formal supports for those who need them, with supervision by the Decision Support Service. The three levels of supports for people who may require support with making decisions are decision-making assistants, co-decision-makers and decision-making representatives. These decision supporters will likely be someone that the person knows and trusts, such as a family member or a close friend.
As anyone could face challenges with decision-making in their future lives, the Act provides new tools for any adult who wishes to plan ahead by way of an advance healthcare directive or an enduring power of attorney.
Codes of Practice
The Decision Support Service have published 13 Codes of Practice on the Act, including a Code for Healthcare Professionals. This Code has been developed to guide healthcare professionals in carrying out their functions and duties when interacting with a person who uses their services who may need support to exercise their decision-making rights. You can view all of the Codes of Practice on www.decisionsupportservice.ie.
Supporting guidance
The Decision Support Service has also developed a range of accompanying materials, including a plain English guide to the codes; plain English leaflets; informational videos on each code; accessible guidance documents for people who want to make a decision support arrangement; an easy-read guide to the Act and the functions of the Decision Support Service; and materials setting out 60 different scenarios to help to explain how each code could apply in real-life.
What does the Act mean for healthcare professionals?
The guiding principles of the Act require healthcare workers to:
- Presume every person has the capacity to make decisions about their life
- Support each person as much as possible to make their own decisions
- Not assume a person lacks capacity just because they are making, have made or are likely to make an ‘unwise’ decision
- Take action only where it is really necessary
- Take the least restrictive action on a person’s rights and freedoms
- Consider how urgent the action is
- Give effect to the person’s will and preferences
- Consider the views of other people
- Use information appropriately.
It is important to remember that this Act supports and builds on existing clinical practice and guidelines on person centred care.
Resources to support staff to implement the Act
The HSE National Office for Human Rights and Equality Policy have developed a range of resources to support your day-to-day work. These include e-learning programmes, frequently asked questions, and webinar recordings. The development of resources and guidance will be ongoing as new issues arise over the coming months and years.
You can find more information about the Act and the resources that have been developed on www.assisteddecisionmaking.ie.