Closing Date: 1pm on 19 July 2022
Scope
This Health and Social Care Delivery Research (HSDR) Programme call is for high-quality research on how the Mental Capacity Act (2005) has been implemented in practice across health and social care organisations. The programme welcomes applications for cross-UK studies. The main aim is to provide an overview and evaluation of the implementation of Mental Capacity Act assessments, training and assessment tools, and to understand the impacts on people using health and care services.
Research to understand how the Mental Capacity Act has been embedded in practice and its impact on people using services and their carers, was identified as one of the top ten priorities in the 2018 James Lind Alliance (JLA) Priority Setting Partnership on Adult Social Work. NICE guideline NG108 highlights the need for research:
- to evaluate the effectiveness of training on improving mental capacity assessment practice in supporting decision-making, conducting capacity assessments and making best interests decisions
- to evaluate the effectiveness, cost-effectiveness and acceptability of mental capacity assessment tools that are compliant with the Act
- to understand the components of an effective assessment of mental capacity.
Identified research need
The Mental Capacity Act 2005 (MCA) is designed to empower and protect people who may lack the mental capacity to make their own decisions about their support and treatment, ranging from everyday issues to more serious, life-changing decisions. Evidence has highlighted several aspects of the way assessments are being carried out which are not compliant with the MCA. There is also a lack of evidence relating to the validity and acceptability of available assessment tools, the effectiveness of health and social care staff training, and how the MCA is embedded (or not) throughout organisations. Research which evaluates the effectiveness of training and assessment tools and resources, the embeddedness of the MCA in practice, and the impact of the Act on individuals using services across health and social care, is needed to support policy and service decision-makers such as commissioners, health and social care professionals, and people who use services as well as informal carers.
Areas of interest
The HSDR Programme wants to fund high quality research which evaluates training and assessment tools and other available materials and resources, supporting the implementation and delivery of optimal decision-making and MCA-compliant capacity assessments in any settings.
The research funded will be intended to improve outcomes for people who use services and their supporters, health and social care professionals’ practice, the quality and accessibility of services, and the provision of evidence for decision makers. Whilst there is different legislation in place across nations of the UK (The Mental Capacity Act (Northern Ireland) 2016 and the Adults with Incapacity (Scotland) Act 2000), cross-UK exploration would be welcome.
This funding call welcomes applicants from as broad a range of backgrounds and expertise as possible, including (but not limited to) applied health research, mental health, social work, social care, legal and ethics, philosophy and social sciences. Studies will use a variety of methods which must all be clearly explained and justified, most likely based on a mixed methods approach. There should be a focus on lived experience of people using services, their families, their informal support networks and staff. The following areas of interest are examples of the type of research areas in scope for this call:
- Overview and evaluation (including accuracy, reliability, usability and acceptability) of tools currently used by health and social care professionals to support decision-making and assess mental capacity.
- Identification of barriers and facilitators to conducting MCA-compliant assessments of mental capacity, and how these can be overcome.
- Evaluation of training and educational interventions to improve staff knowledge, confidence and consistency in supporting decision making, conducting MCA assessments and best interest decisions. This will include looking at issues identified by staff as development gaps, such as dealing with ‘undue influence’.
- Identification and evaluation of the components of an effective assessment of mental capacity to improve consistency in delivery and outcomes of capacity assessments, and to facilitate collaborative multi-disciplinary working.
- Understanding the risks and impact of cultural bias, as well as identifying barriers and enablers to consideration of cultural, ethnic and religious factors in supporting implementation of decision-making and assessments.
- Evaluation of how the Mental Capacity Act has been embedded (or not) in organisations and practice and the impact on, and experiences of, people using services and their carers.
- Exploration of differences and commonalities in decision-making and assessments carried out by different professionals and in different contexts, from mental health settings to community and home assessments, and how this understanding can be used to improve practice.
- Effectiveness of multi-agency working within application of the MCA and understanding how this operates across different health and social care settings.
Equality, diversity, and inclusion in research
The NIHR is committed to actively and openly supporting and promoting equality, diversity and inclusion (EDI). All NIHR applications need to demonstrate they have met the requirements of the Equality Act (2010) by embedding EDI throughout the research proposal, ensuring there is no discrimination across the following domains:
- age
- disability
- race, including colour, nationality, ethnic or national origin
- religion or belief
- sex
- sexual orientation
- gender reassignment
- being married or in a civil partnership
- being pregnant or on maternity leave.
Applicants are expected to pay attention to populations in locations with greatest need, socioeconomic disadvantage, which have disproportionately less access to health and social care services and are of an under researched area.
General guidance
The NIHR Health and Social Care Delivery Research programme supports applied research with the aim of improving health and social care services across the UK. It is open to any methodology, or combination of methods, appropriate to answer the proposed research question(s), and this must be fully explained and justified.
To enhance the success of a proposal a clear theory of change and pathway to impact with links into the NHS and social care is required. It is useful to consider in your study design how outcomes can be scaled up to maximise impact and value for money across the NHS and social care – the focus is on applied research with tangible impact on systems to improve the quality, accessibility and organisation of health and social care services. This also includes stakeholder engagement and the development of processes, tools, and guidelines to strengthen workforce capacity.
Further general information can be found on the Health and Social Care Delivery Research programme.
Research proposals should be co-produced with national organisations and professional bodies, health and social care service professionals, and individuals with lived experiences. Links with health and social care planners, commissioners and professional bodies is encouraged to facilitate the impact and scaling up of research findings to benefit the wider health and social care system. Applicants should consult the NIHR INVOLVE guidance on co-producing research. The COVID-19 outbreak is having a significant impact across health and social care. As this research might be conducted during the COVID-19 response and recovery stage, the research should consider how the impact of COVID-19 response and recovery could affect how the proposed research will be conducted. Mitigating steps need to be set out to demonstrate deliverability and feasibility of the proposed work.