The Best Interests case conference (also known as the Best Interests meeting) is a formal meeting (or series of meetings) that involves;
The purpose of the Best Interests case conference is to;
On the first occasion that a decision about routine care or treatment needs to be made it may be useful to arrange a Best Interests case conference, although there is no requirement to do so under the Act.
A Best Interests case conference may be particularly useful if;
Acts can then be carried out routinely to implement the original decision each time that the care or treatment is required, so long as the manner in which acts should be carried out is;
There is no requirement under the Mental Capacity Act to arrange a Best Interests case conference during any Best Interests decision making process. As Decision Maker it is your responsibility to decide whether to arrange a Best Interests case conference or not.
Whether or not you arrange a Best Interests case conference will depend on a range of factors including;
Arranging a Best Interests case conference can be particularly helpful when;
Some of the factors that you should consider include;
As Decision Maker it is your responsibility to decide who should attend any Best Interests case conference that you arrange.
It is not paramount that every person consulted attends the meeting, and you should consider carefully the benefit of different people being there or not.
Some of the things you should consider are whether a particular person;
Where they exist the following people should always be invited to attend the meeting, and where possible steps should be taken to arrange the meeting, and where possible steps should be taken to arrange the meeting at a convenient time to facilitate their involvement;
When deciding the nature of a person’s attendance you need to decide whether they should;
If you anticipate the meeting to be challenging it is also appropriate to discuss whether it would be beneficial for a manager, or a legal representative to attend. For example;
You should also consider the need for a minute taker to be present for the purpose of recording what is said, considered and agreed at the meeting. This may be particularly useful when;
The purpose of involving the person is to understand, as far as is reasonably ascertainable;
The nature of the person’s involvement will depend on their ability to;
As Decision Maker it is your responsibility to decide how to involve the person in the Best Interests case conference. When doing so you must have regard for the Code of Practice, which states that you must do whatever is possible to;
You must not make a decision about involving the person in the meeting based solely on;
Some of the steps that you should consider taking to facilitate the person’s involvement are;
In any record of the meeting you should document the steps that you have taken to involve the person in the Best Interests case conference and, if you decide not to involve them you must;
You should proceed to arrange the Best Interests case conference when;
Some things to consider when arranging the meeting include;
You should consider preparing a formal agenda to;
Wherever possible, any agenda that you prepare should be shared with anyone who will be attending the Best Interests case conference before the day of the meeting.
Click here to access a tri.x agenda tool that can be used to structure a Best Interest Case Conference.
Consulting with people who will not be attending
It is important that you consult before the day of the meeting with;
You need to gather;
You must take steps during consultation to ensure that;
Any information gathered should be shared at the Best Interests case conference and considered in the process of making the Best Interests decision.
Consulting with people who will be attending
To assist you in effectively chairing the Best Interests case conference meeting it may be necessary to consult with those people who will be attending beforehand to obtain initial information about;
Providing information to prepare the person
If the person who lacks capacity is going to attend the Best Interests case conference you should provide them with the following information;
Wherever possible, the information should be provided to the person in a way that;
You should also;
Providing information to prepare others
You should provide the following information to everybody who is going to be present at the Best Interests case conference;
It is always worth completing final checks to make sure that you are as prepared as possible for the meeting in order to prevent the need to delay the decision further.
You should make sure that you;
As Chair it is important that you make sure;
You should consider preparing a formal agenda to support the structure and flow of the meeting.
Click here to access a tri.x agenda tool that can be used to structure and Chair a Best Interest Case Conference.
The following guidance for co-ordination, structure and content of a Best Interests case conference is based around the steps set out in the agenda tool.
|Step||Guidance for Chair|
Introduce yourself and your role.
If the person lacking capacity is present allow them to introduce themselves, either directly or through their representative (which could be you).
Allow everyone in the room to introduce themselves, including their role and their relationship/professional involvement with the person.
Provide information about the role and involvement of those persons not present, and how they are to be represented.
Summarise the purpose of the meeting.
Clarify the nature of the decision that is to be made and the reasons for it (this should be clearly recorded on any Mental Capacity assessment).
Affirm that a Mental Capacity assessment has been completed, when and the outcome. Establish that the outcome is not contested.
Consider whether the person is likely to regain capacity and whether the decision can be delayed.
Affirm your role as Decision Maker and confirm that there is no Deputy, Donee of a Lasting Power of Attorney or other person more suitable to make the decision; or in the case of decisions about life sustaining treatment only there is no Advance Decision to Refuse Treatment.
If the decision can be delayed, if there is a Deputy or Donee that may be authorised to make the decision, or (in the case of life sustaining treatment) there may be an ADRT you should consider delaying the meeting, or seeking advice about continuing to act as Decision Maker.
Explain the need to keep the views, wishes, beliefs, values and rights of the person central to the decision that is made.
If the person who lacks capacity is present invite them to provide relevant information about their situation, what is important to them now and in the future, their views, wishes, beliefs and values (past and present) and their preferred outcome. The person can do this directly or can request a representative speak on their behalf;
If the person is not present provide (or ask their representative to provide) the same information. You (or the representative) should be clear how this information has been gathered.
Provide a summary of each available option, either verbally or in written form.
Invite persons present to provide further options and agree their viability. If they are viable you should include them with other options and consider them equally.
If there are a large number of options you should try to provide these to people before the meeting.
|Risks and Benefits||
Explore the risks and benefits of each available option in turn, setting out;
Click here for guidance about using a balance sheet approach to explore options.
Make sure that you allow everyone present to provide any views and information that they have. In particular you must make sure that you seek the views of the person (if they are present) and any IMCA (if present).
Conversations about risks should be evidence based, and not based on perceived risks associated with general anxiety and assumptions.
|Views of those Consulted||
If the person who lacks capacity is present you should seek their views about the preferred outcome.
If an IMCA is present you must seek their views about which outcome would be in the person’s Best Interests, and the reasons for their view.
You must then seek the views of all other person present about what may be in the person’s Best Interests and the reasons for it.
If you have information from people who were not able to attend the meeting, but who you have consulted beforehand this must also be shared.
Identify any need to consult further or gather any more information before a decision can be made.
If so, you need to consider whether the decision can be delayed in order to gather the required information.
Click here to access guidance about when a decision should be made at a Best Interest case conference.
If the decision can be made follow the guidance about how to make the decision by clicking here.
|Implementing the Decision||
If the decision is made, you should seek the views of person’s present about the best way to implement the decision, which must be done in a way that is least restrictive of the person’s rights.
Click here to access guidance about how to implement Best Interest decisions.
|Reviewing the Decision||
If the decision is made, you should seek the views of the person’s present about the best way to review the impact of the decision on the person.
Click here to access guidance about reviewing Best Interests decisions.
It is not unusual for there to be some disagreement during the Best Interests case conference about what is in the person’s Best Interests.
As Decision Maker and Chair of the meeting, it is your role to manage any disagreement and limit the negative impact of any conflict that occurs, particularly if the person who lacks capacity is present and likely to be affected by it.
A proactive approach
You should be clear about the following from the start of the meeting, and whenever conflict is likely;
If you anticipate conflict before the meeting begins you should seek the support of your line manager and;
A reactive approach
If conflict occurs you should consider whether any of the following strategies may be helpful in managing any tension, seeking the support or your line manager as required;
If the person that lacks capacity is present at the meeting you must remember that you have a requirement to do whatever is possible to;
If the presence or behaviour of anyone else present at the meeting is inhibiting the person’s involvement you must;
You must record (or arrange for a minute taker to record) the following information, all of which should be used to support the decision to be made;
If a decision is made at the Best Interests case conference the following must be clearly recorded;
Click here to access guidance about how to make a Best Interests decision.
If a decision cannot be made at the Best Interests case conference the following should be recorded;
The circumstances when you can make a decision at a Best Interests case conference, and the process of making a decision are the same as the circumstances and process of making a decision through other means.
Click here to access guidance about when and how to make a Best Interests decision.
The process for agreeing how to implement a decision at a Best Interests case conference is the same as the process for agreeing how to implement a decision through other means.
Click here to access guidance for how to implement a Best Interest decision.