Where a client lacks capacity and an important decision regarding their health and welfare needs to be made, and there is no Health and Welfare Lasting Power of Attorney or Advanced Decision which applies, it is likely that a formal best interests meeting will be required.
Best interest meetings require the decision making process to be transparent and clearly recorded. They also ensure that the client is central to the decision making process, as well as being empowered and protected from unscrupulous decision making.
When should a best interests meeting take place?
Firstly, it is important to note that if a client has capacity then he/she is responsible for making the decision in question and should be able to do so even if the decision is considered to be unwise.
Where a client has been deemed to lack capacity, it may be appropriate for a best interests meeting to take place when deciding where the client should live, what care services should be arranged and whether these services are at home or in a residential care setting, who they should have contact with and what medical treatment they should receive. These examples are by no means an exhaustive list and each client’s situation will need to be judged on its own merits.
How should a best interests meeting be conducted?
Firstly, it is important to decide who is going to chair the meeting. This may be the care home manager, the client’s GP, treating consultant, hospital team or social worker. The chair must ensure that the client’s best interests are not overlooked at any time and may need to mediate or negotiate with the attendees.
The chair should then arrange the meeting and invite all those who need to attend including relatives, close friends, health professionals and where appropriate the client themselves. The chair should decide on a suitable location for the meeting and this should provide adequate space which is confidential and free from interruption. It is sensible for the chair to provide those attending with an agenda.
Attendees should ensure that they arrive well prepared. They should understand their role in the meeting and have all of the information which they may require in order to be able to contribute.
The format of the meeting may vary depending on the chair however it is sensible for the following points to be discussed:
- The capacity assessment which has taken place;
- Any background information;
- The decision which needs to be made;
- Whether it is likely that the client will regain capacity in the future enabling him/her to make the decision for him/herself;
- What is known about the client’s past and present wishes and feelings, any written statements which may have been made by the client when they had capacity, their values and beliefs;
- The opinions of those in attendance and those who may be unable to attend but have provided their opinions in advance of the meeting;
- The options available – advantages, disadvantages and any alternatives which should be considered
What happens if an agreement cannot be reached?
In the event that those attending the best interests meeting cannot reach an agreement as to the decision which should be made, an application will need to be made to the Court of Protection. Before considering an application the Court will expect to see evidence of a best interests meeting having taken place and the issues which have been discussed.
It is however important to note that the Court will only make a judgment in relation to a specific decision and it is unlikely that a deputy will be given blanket authority to make health and welfare decisions on behalf of the client.