Mca Code Of Practice Best Interests Checklist

[Kylee Mccandrew]

Thiscollection of training, improvement support, consultancy and resources is designed to help local authorities, health and care providers, safeguarding boards, churches and faith groups to safeguard those at risk.

The video looks at the five key principles of the Mental Capacity Act (MCA), and how these can be applied to the care planning process. It shows, through interviews with self-advocates, and health, legal and social care professionals, how the proper application of the MCA is needed to ensure that care planning is person-centred and empowering. The film stresses the importance of planning for the least restrictive option in any situation, and always acting in the best interests of people who lack capacity, and not in organisational interests. It talks about how advance decisions about future treatment can be really helpful.

Again, it is vital that you record your best interests decision. Not only is this good professional practice, but given the evidence-based approach required by the MCA, you will have an objective record should your decision or decision-making processes later be challenged.

Assessment of capacity, and of best interests, is set out in the Mental Capacity Act (MCA) 2005 and its accompanying Code of Practice. These provide a framework for caring for or treating people 16-years old or over in England and Wales who lack the ability to make decisions for themselves.

The individualised approach is well summarised in the judgement of Aintree University Hospitals NHS Foundation Trust v James [2013]. Recognising the difficulty in making these individual decisions the Supreme Court explained:

"The most that can be said, therefore, is that in considering the best interests of this particular patient at this particular time, decision-makers must look at his welfare in the widest sense, not just medical but social and psychological; they must consider the nature of the medical treatment in question, what it involves and its prospects of success; they must consider what the outcome of that treatment for the patient is likely to be; they must try and put themselves in the place of the individual patient and ask what his attitude to the treatment is or would be likely to be; and they must consult others who are looking after him or interested in his welfare, in particular for their view of what his attitude would be."

The decision therefore must be the one which the healthcare professional reasonably believes is right for the individual patient in question. It is not about what might be thought generally to be the best medical approach.

Chapter 5 of the MCA Code of Practice provides a checklist of factors to consider when working out best interests. However, before working through the checklist below, it's important to define the decision to be made along with the various options and choices available.

In emergencies, it will almost always be in the person's best interests to give urgent treatment without delay. With a key exception to this being that a valid, applicable advance decision to refuse such treatment is in place (see below).

If there is nobody who fits into these categories, involve an IMCA (independent mental capacity advocate) for decisions about major medical treatment. It may be useful to have a best interests meeting, involving those caring for the patient, family members, and those interested in patient's welfare (or an IMCA).

Advance decisions to refuse life-sustaining treatment are not always valid and applicable, and must be considered carefully. Seek support if you are faced with such a situation and call us for advice.

Careful documentation will ensure there is a clear picture of the patient's care and it can also aid you if you are called on to justify your decision. It may well be valuable to set out a list of the pros and cons, with the risks and benefits, and what has been done to reduce any risks, together with the conclusion as to what option is in the patient's best interests and why.

While the principles and process may seem daunting, the Mental Capacity Act includes protections for those who can demonstrate having made a decision in the reasonable belief it was in the best interests of the person who lacks capacity, applying the checklist described above.

Good code reviews look at the change itself and how it fits into the codebase. They will look through the clarity of the title and description and "why" of the change. They cover the correctness of the code, test coverage, functionality changes, and confirm that they follow the coding guides and best practices. They will point out obvious improvements, such as hard to understand code, unclear names, commented out code, untested code, or unhandled edge cases. They will also note when too many changes are crammed into one review, and suggest keeping code changes single-purposed or breaking the change into more focused parts.Better code reviews look at the change in the context of the larger system, as well as check that changes are easy to maintain. They might ask questions about the necessity of the change or how it impacts other parts of the system. They look at abstractions introduced and how these fit into the existing software architecture. They note maintainability observations, such as complex logic that could be simplified, improving test structure, removing duplications, and other possible improvements. Engineer Joel Kemp describes great code reviews as a contextual pass following an initial, light pass.

The tone of code reviews can greatly influence morale within teams. Reviews with a harsh tone contribute to a feeling of a hostile environment with their microaggressions. Opinionated language can turn people defensive, sparking heated discussions. At the same time, a professional and positive tone can contribute to a more inclusive environment. People in these environments are open to constructive feedback and code reviews can instead trigger healthy and lively discussions.Good code reviews ask open-ended questions instead of making strong or opinionated statements. They offer alternatives and possible workarounds that might work better for the situation without insisting those solutions are the best or only way to proceed. These reviews assume the reviewer might be missing something and ask for clarification instead of correction.Better code reviews are also empathetic. They know that the person writing the code spent a lot of time and effort on this change. These code reviews are kind and unassuming. They applaud nice solutions and are all-round positive.

Starting at a new company is overwhelming for most people. The codebase is new, the style of programming is different than before, and people review your code very differently. So should code reviews be gentler for new starters, to get them used to the new environment, or should they keep the bar just as high, as it is for everyone else?Good code reviews use the same quality bar and approach for everyone, regardless of their job title, level or when they joined the company. Following the above, code reviews have a kind tone, request changes where needed, and will reach out to talk to reviewers when they have many comments.Better code reviews pay additional attention to making the first few reviews for new joiners a great experience. Reviewers are empathetic to the fact that the recent joiner might not be aware of all the coding guidelines and might be unfamiliar with parts of the code. These reviews put additional effort into explaining alternative approaches and pointing to guides. They are also very positive in tone, celebrating the first few changes to the codebase that the author is suggesting.

Code reviews get more difficult when reviewers are not in the same location. They are especially challenging when reviewers are sitting in very different time zones. I have had my fair share of these reviews over the years, modifying code owned by teams in the US and Asia, while being based in Europe.Good code reviews account for the time zone difference when they can. Reviewers aim to review the code in the overlapping working hours between offices. For reviews with many comments, reviewers will offer to chat directly or do a video call to talk through changes.Better code reviews notice when code reviews repeatedly run into timezone issues and look for a systemic solution, outside the code review framework. Let's say a team from Europe is frequently changing a service that triggers code reviews from the US-based owner of this service. The system-level question is why these changes are happening so frequently. Are the changes done in the right codebase or should another system be changed? Will the frequency of changes be the same or go down over time? Assuming the changes are done in the right codebase and the frequency will not go down, can the cross-office dependency be broken in some way? Solutions to these kinds of problems are often not simple and could involve refactoring, creating of new services/interfaces or tooling improvements. But solving dependencies like this will make the life of both teams easier and their progress more efficient for the long term, meaning the return on investment is often quite impressive.

The best practice should be "limit the length of a line so that you, all your colleagues, and all the tools that you are using are happy with it", plus some common sense. 80 characters seems to be very low and tends to reduce readability. I have once been totally tricked by a line like this:

I set my editor to display a 100 column margin, plus rewrapping the code on display, so everything is always visible while editing, and overly long lines tend to be manually split into two or sometimes more lines. Pray that your editor formats split statements nicely if it does auto formatting. Use a coding style that doesn't lead to deeply nested statements. (Some people create a nest of twenty if-statements followed by a tail of twenty else's which leads to 200 character deep indentation, and nobody can figure out which else belongs to which if).

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