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- Every adult is presumed to have capacity to make their own decisions. Staff must take all practical steps to support a person before anyone questions that.
- Capacity is judged for one decision at one time, not for a person in general.
- The Act has been in force since 26 April 2023. It ended wardship and set up the Decision Support Service.
What the Act is
The Assisted Decision-Making (Capacity) Act 2015 is about supporting people to make decisions about their health, welfare and finances. The HSE describes it as a law for any adult who may need support to make decisions, now or in the future.
The Act replaced the old wards of court system with a system of supported decision-making. The Government announced on 26 April 2023 that the Act, and the 2022 amending Act, had been commenced on that day, and that wardship was abolished.
What it means day to day
Presume capacity. The Decision Support Service (DSS) code of practice for healthcare professionals says that when you interact with a person who needs to make a decision, you must presume they have capacity at the time the decision needs to be made.
Support first. The same code says a person must not be considered unable to make a decision until all practical steps have been taken to help them. Support can include giving access to clear information, thinking about the environment, and communicating in the way that suits the person.
Capacity is decision-specific and time-specific. The DSS says capacity is assessed only for the decision in question, at the time it has to be made. The DSS's code on supporting decision-making and assessing capacity says a pre-existing clinical diagnosis must not be used to determine capacity.
The four abilities. When capacity has to be assessed, the person assessing looks at whether the person can understand the relevant information, keep it long enough to make a choice, weigh it up, and communicate the decision by any means.
Decision support arrangements
The Act sets out five formal arrangements. Two are for advance planning: the advance healthcare directive and the enduring power of attorney. Three depend on the level of support needed for a decision: a decision-making assistance agreement, a co-decision-making agreement and a decision-making representation order.
Staff need to know that these exist, to check what a decision supporter is allowed to decide, and to know when to contact the DSS. The DSS keeps the registers and supervises decision supporters.
Where to read more
- The DSS website, its codes of practice, its code of practice for healthcare professionals, and its other codes of practice.
- The HSE staff page for the Act, which describes a three-module programme on HSeLanD (the HSE's learning site) for healthcare workers.
- The HSE National Consent Policy page, in effect from 22 January 2024, which covers support arrangements under the Act.
We have not tried to cover decisions about finances, enduring powers of attorney in detail, or the courts. The DSS covers those.
What this means for training
Care providers can ask whether every member of staff who supports people with decisions knows the points above, and whether the team knows who to ask. Samson's Capacity Act 2015 course covers the principles, the arrangements and the workplace use of the Act. There is also a course on functional capacity assessment.
The Act matters in every setting. See the pages for home care, nursing homes, disability services, hospitals and core skills.
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