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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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People’s Decision-Making and Autonomy Policy

1. Purpose

This policy ensures that all individuals supported by {{org_field_name}} are empowered to make decisions about their own lives, care, and treatment to the fullest extent possible. It aligns with legal and regulatory obligations including the Care Act 2014, Mental Capacity Act 2005, and Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – particularly Regulations 9 (Person-Centred Care), 10 (Dignity and Respect), and 11 (Need for Consent). The policy aims to promote autonomy, respect for individual rights, and person-led planning and decision-making.

2. Scope

This policy applies to all staff, volunteers, contractors, and professionals working within or on behalf of {{org_field_name}}, in any setting or capacity. It is relevant to all people we support, including those with reduced mental capacity, and it applies across all care and support services provided by the organisation.

3. Policy Statement

{{org_field_name}} is committed to ensuring that:

• All people we support are presumed to have capacity to make decisions unless proven otherwise, in line with the Mental Capacity Act 2005.
• Every person is supported to make informed choices, understand their options, and participate fully in decisions about their care, treatment, and daily life.
• All staff must actively respect and uphold the autonomy, values, and lifestyle choices of each person, even where these differ from staff’s own views.
• Support will be tailored to each individual’s needs, communication preferences, cultural background, beliefs, and cognitive ability.
• Consent must always be sought before delivering care or treatment, and refusal of care must be respected unless there is a legal exception.
• Best interest decisions will be made in line with statutory guidance when a person lacks capacity, and they will involve the person (as far as possible), their family, advocates, or legal representatives.

4. Implementation Guidelines

4.1 Supporting Decision-Making

At {{org_field_name}}, we recognise that enabling informed decision-making is a continuous and proactive process. Our staff will:

• Provide clear, relevant, and timely information using accessible formats suited to the individual (e.g., Easy Read, large print, audio, or translated materials).
• Allow time for reflection and consultation with others (e.g., family, advocates) before decisions are made.
• Adapt communication methods to each person’s needs—this includes the use of non-verbal communication, pictorial aids, communication technology, or specialist input from speech and language therapists if necessary.
• Create a safe and private environment conducive to open dialogue and choice-making.
• Ensure that information includes potential benefits, risks, and alternatives so the person can fully understand their options.

4.2 Enabling and Respecting Autonomy

All people we support are entitled to lead their own lives. Staff must:

• Respect daily decisions related to clothing, food, routines, friendships, leisure, spiritual practice, and involvement in community life.
• Recognise that a person’s right to make unwise decisions is protected under the Mental Capacity Act 2005. A choice seen as unwise does not in itself indicate lack of capacity.
• Provide consistent and non-judgemental support even when choices differ from what staff may personally prefer or believe is in the person’s best interest.
• Promote and facilitate independence through goal setting, life skills development, and empowering activities.

4.3 Mental Capacity Assessments

Capacity assessments are only conducted when:

• There is a genuine reason to doubt a person’s ability to make a specific decision at a specific time.

When conducting these assessments:

• The assessor must follow the five key principles of the Mental Capacity Act 2005.
• The assessment must be decision-specific (e.g., consenting to medication, finances) and time-specific (i.e., reflecting the person’s capacity at the time of the decision).
• The person must be supported as much as possible to make the decision themselves before any assumption of incapacity is made.
• All findings must be recorded in the individual’s file and reviewed regularly or when circumstances change.

4.4 Best Interests Decision-Making

When an individual is assessed to lack capacity for a decision:

• Staff must act in accordance with the person’s best interests, involving family members, legal representatives, Independent Mental Capacity Advocates (IMCAs), or advocates as required.
• Staff must always consider the person’s past wishes, beliefs, values, and previously expressed preferences.
• A best interests meeting should be convened for complex or high-impact decisions.
• Staff must explore all less restrictive options before settling on a course of action, in line with the least restrictive principle of the Act.

4.5 Advocacy and Legal Representation

To ensure people’s rights are upheld:

• Staff will inform people of their right to advocacy.
• An IMCA must be arranged where required under the Act—especially where there are no family or friends available to consult.
• The organisation maintains a list of local advocacy services and how to access them. Staff must be familiar with these and support individuals in referrals.

4.6 Risk and Choice

Supporting autonomy includes supporting positive risk-taking:

• Staff will work collaboratively with the person to understand the risks involved in their decisions, ensuring the person understands possible consequences.
• Risk assessments will be person-centred, proportionate, and reviewed regularly.
• Where appropriate, involve multi-disciplinary teams to support safe, informed risk-taking while promoting autonomy and dignity.
• Staff must avoid overly paternalistic approaches that unnecessarily limit freedom of choice.

4.7 Record Keeping and Documentation

Transparency and accountability are essential:

• All key decisions, conversations, assessments, consents, and best interests meetings must be recorded thoroughly and promptly.
• Records should reflect the person’s views, who was involved in the decision, and any agreed outcomes or follow-up actions.
• Records must be stored securely in line with the Confidentiality and Data Protection Policy (CH34).

5. Related Policies

• CH07-Person-Centred Care Policy
• CH08-Dignity and Respect Policy
• CH09-Consent to Care Policy
• CH39-Mental Capacity and Deprivation of Liberty Safeguards Policy
• CH42-Communication and Engagement with Service Users and Families Policy
• CH06-Compliance with the Care Act 2014 Policy

6. Policy Review

This policy will be reviewed annually, or earlier if there are changes in legislation, regulatory guidance, or operational requirements. The review will be led by the Registered Manager and Nominated Individual.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.