NICE Guideline on Decision-making and Mental Capacity

NICE guideline

NICE guideline for health and social care professionals.

Its aim is to help professionals to support people to make their own decisions where they have the capacity to do so. It also has recommendations about how best to keep people who lack mental capacity at the centre of the decision-making process.

The National Institute for Health and Care Excellence sets quality standards and offers guidance and advice to improve health and social care.

The NICE guideline published in October 2018 is chiefly aimed at professionals who work in health and social care roles. It is also useful guidance for anyone who has to be involved in making decisions for a mentally incapacitated person.

The NICE guideline sets out recommendations on several aspects of decision-making. These include:

  • supporting individuals to make decisions
  • advance care planning
  • assessing mental capacity to make specific decisions at a particular time
  • best interests decision-making

Here are some of the recommendations in the NICE guideline for health and social care professionals when they are discussing advance care planning with people who have deteriorating conditions:

  • be sensitive, recognising that some people may prefer not to talk about this, or prefer not to have an advance care plan
  • be prepared to postpone discussions until a later date, if the person wishes
  • recognise that people have different needs for knowledge, autonomy and control
  • talk about the purpose, advantages and challenges of this type of planning

This may all sound pretty obvious but many of our clients tell us about their experiences of advance care planning meetings and they are not always good experiences. So there is clearly a need for the NICE guideline and for some health and social care organisations to overhaul their policies and procedures.

The guideline also places an emphasis on the importance of training and access to expert advice. This is just as important for non-professional carers such as relatives as it is for professionals. How can you know you’re approaching your care-role in the best way if you have had no training?

NICE has published some training tools and a practical steps guide.