Another extract, which seems to demonstrate that GIDS only began to take capacity to consent seriously after the courts agreed to hear the judicial review (paperwork filed October 2019, Keira joins Jan 2020, confirmation that the court would hear the case March 2020).
‘Staff had received training in the Mental Capacity Act 2005. This training included details of the five statutory principles of the Act. The service had provided training on the Mental Capacity Act to over 50 staff at a team meeting in July 2020. A further training session for staff on assessing competency in children under the age of 16 was held at the team meeting in October 2020.
The provider had a policy on the Mental Capacity Act. Staff were aware of the policy and had access to it.
Staff knew where to get advice from within the provider regarding the Mental Capacity Act. When staff had any concerns about a patient’s competency or capacity, they could discuss the matter with senior colleagues at the complex cases panel. If the staff required further advice, they could contact an independent legal service.
For young people who might have impaired mental capacity, staff had not always assessed and recorded competency or, capacity to consent appropriately, although the service had recently made some improvements. We reviewed 16 records of young people the service had referred to endocrinology services for hormone blockers. On six of these records where the patient had been referred for treatment before January 2020, there was no evidence of an assessment of the patient’s capacity or competency.
Some records showed that staff had discussed the effects of hormone treatment with the young people and recorded that the patient demonstrated an understanding of the potential benefits and side- effects, although these records still lacked a comprehensive, structured approach to the assessment of the patient’s mental capacity. Since the introduction of a standard operating procedure for consent, capacity and competency, in January 2020 there had been improvements. This procedure had introduced a form for staff, young people and parents to sign confirming their consent to treatment.
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However, the absence of structured assessments prior to staff implementing the standard operating procedure in January 2020 meant that the service has not fully assessed the competency and capacity of some young people who were still receiving hormone blockers. At the time of the inspection we asked the trust to review this.’