Recurring concern

Unreliable IMCA arrangements for people lacking capacity

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First reported 6 Nov 2019•Latest report 17 Dec 2019

Definition

What this concern includes

Includes failures in arrangements for identifying when IMCA involvement is required, making the necessary referral, correctly distinguishing an IMCA from other advocacy roles, appointing or providing the IMCA, and ensuring relevant care agencies understand the IMCA's role during treatment or other qualifying decisions for people who may lack capacity.

Not included

Excludes generic advocacy, patient-support or communication deficiencies where IMCA involvement is not the identified concern.
Excludes Mental Capacity Act assessment, best-interests decision-making and Deprivation of Liberty Safeguards failures unless they directly concern the IMCA process or required IMCA involvement.
Excludes failures involving Care Act Advocates, independent mental health advocates or other advocates where the assertion does not concern whether an IMCA was required or correctly identified.
Excludes failures in care after an IMCA has been reliably appointed and involved, unless the IMCA arrangement itself remains deficient.

Reports: 2
Individual concerns: 5
Date range: 2019–2019
Stated actions: 0

Reports over time

Reports about this concern issued each year.

* 2026 is projected from reports observed to 7 Sep 2026.

Most frequent recipients

Reports about this concern sent to each recipient.

Advocacy Together Hub Rochdale1

Department of Health and Social Care1

Heywood Health1

Pennine Care NHS Foundation Trust1

Rochdale Adult Care1

Stockport Borough Council1

Concerns and responses across reports

Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.

17 Dec2019
Manchester South
Concerns raised2
1. Failure to provide an IMCA during hospital treatment
2. Failure to discuss End of Life Care with an IMCA
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Respondent positions 3
1. Position
  Medical treatment decisions fall outside the Council’s responsibility, so it cannot comment on the individual’s hospital treatment.
  Stated by Stockport Borough CouncilOutside remit
1. Position
  The NHS Trust was responsible for arranging an IMCA and formal best-interests meeting concerning medical treatment.
  Stated by Stockport Borough CouncilRedirects responsibility
2. Position
  The local NHS is expected to reflect on the LeDeR findings and address identified local failings in care.
  Stated by Helen Whatley MPRedirects responsibility
AI-generated summary

Lewis Victor Mendelson · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Lewis Victor Mendelson, who had profound learning and physical disabilities, became unwell after vomiting on 8 May 2019, was taken to hospital, later received end-of-life care, and died at home on 16 May 2019. The concerns included the absence of a DoLS authorisation, statutory care review and allocated social worker, as well as hospital treatment and end-of-life decisions without a formal best interests meeting or IMCA involvement.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to provide an IMCA during hospital treatment
Wider context from the report
“2. He was treated in hospital with no IMCA in place or formal best interests meeting taking place. As a result it was unclear if the treating physicians understood the complexity of his learning disability and communication issues that flowed from his disability. The inquest heard that repeated attempts were made to insert a nasogastric tube causing him great distress and where there was limited evidence that it would be beneficial; ”
Source location
Lewis Victor Mendelson · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to discuss End of Life Care with an IMCA
Wider context from the report
“3. He was placed on End of Life Care with no best interests meeting taking place or discussion with an IMCA or assessment of what should happen if he rallied – as he did. ”
Source location
Lewis Victor Mendelson · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Medical treatment decisions fall outside the Council’s responsibility, so it cannot comment on the individual’s hospital treatment.

Verbatim wording from the response
“This response solely addresses the concerns under paragraph 1, “The MATTER OF CONCERN”. Stockport Metropolitan Borough Council are unable to comment in respect of paragraph 2 which refers to the individual’s hospital treatment as, in accordance with the Mental Capacity Act 2005, the decision maker for best interest decisions in relation to medical treatment had been the NHS Trust. The arrangement of an IMCA and formal best interests meeting had been the responsibility of the Trust as this had concerned medical decisions. In this instance the NHS Trust would have been under a duty to consult with Stockport Council as stated in the Mental Capacity Act “...anyone engaged in caring for the person or interested in his welfare...”. Ultimately, if the matter had gone to the Court of Protection, the NHS Trust would have been the applicant.”

Source location
2019-0434-Response-from-Stockport-Council_Redacted
Page 1 · response
Published 31 December 2019
Open published response
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
The NHS Trust was responsible for arranging an IMCA and formal best-interests meeting concerning medical treatment.

Verbatim wording from the response
“This response solely addresses the concerns under paragraph 1, “The MATTER OF CONCERN”. Stockport Metropolitan Borough Council are unable to comment in respect of paragraph 2 which refers to the individual’s hospital treatment as, in accordance with the Mental Capacity Act 2005, the decision maker for best interest decisions in relation to medical treatment had been the NHS Trust. The arrangement of an IMCA and formal best interests meeting had been the responsibility of the Trust as this had concerned medical decisions. In this instance the NHS Trust would have been under a duty to consult with Stockport Council as stated in the Mental Capacity Act “...anyone engaged in caring for the person or interested in his welfare...”. Ultimately, if the matter had gone to the Court of Protection, the NHS Trust would have been the applicant.”

Source location
2019-0434-Response-from-Stockport-Council_Redacted
Page 1 · response
Published 31 December 2019
Open published response
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
The local NHS is expected to reflect on the LeDeR findings and address identified local failings in care.

Verbatim wording from the response
“The Programme systematically reviews the deaths of all people with a learning disability, aged four years and above, that are notified to it. The Programme enables a detailed picture to be built of key improvements that are needed both locally and at a national level, to reduce the inequality in life expectancy between people with a learning disability, and those without.”

Source location
2019-0434-Response-from-the-Department-of-Health-and-Pensions-1
Page 4 · response
Published 31 December 2019
Open published response
6 Nov2019
Manchester North
Concerns raised3
1. Failure to correctly identify the statutory advocate’s role
2. Lack of clarity about the referral requirements for IMCA involvement
3. Failure to formally instruct an Independent Mental Capacity Advocate when required
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.

No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
AI-generated summary

Hazel Maureen Lewis · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Hazel Maureen Lewis died in hospital on 28 November 2018 after an unwitnessed fall caused a hip fracture; the medical cause of death was metastatic breast cancer, with the fracture contributing. Concerns were raised about the best-interest decision-making process, including inadequate consultation, failure to formally instruct an IMCA, insufficient exploration of support to help her engage with investigations, and uncertainty about the advocate’s role.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to correctly identify the statutory advocate’s role
Wider context from the report
“The statutory advocate involved in the Deceased’s care was acting as a Care Act Advocate rather than an IMCA. I heard evidence that in order for the advocate to act as an IMCA, a separate referral to Advocacy Together would be required. Both the GP and social worker had understood that the advocate involved in the Deceased’s case was acting as an IMCA. There is a need for greater clarity as to which role an advocate is acting so that all agencies involved in the care of individuals lacking capacity can ensure that the requirements of the MCA are complied with. ”
Source location
Hazel Maureen Lewis · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Lack of clarity about the referral requirements for IMCA involvement
Wider context from the report
“The statutory advocate involved in the Deceased’s care was acting as a Care Act Advocate rather than an IMCA. I heard evidence that in order for the advocate to act as an IMCA, a separate referral to Advocacy Together would be required. Both the GP and social worker had understood that the advocate involved in the Deceased’s case was acting as an IMCA. There is a need for greater clarity as to which role an advocate is acting so that all agencies involved in the care of individuals lacking capacity can ensure that the requirements of the MCA are complied with. ”
Source location
Hazel Maureen Lewis · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to formally instruct an Independent Mental Capacity Advocate when required
Wider context from the report
“Whilst evidence was given that all witnesses had undergone mandatory Mental Capacity Act 2005 (MCA) training, the Court was left with some concerns about the adequacy of that training as it relates to decisions concerning life-sustaining treatment. It would appear that those involved in the Deceased’s care did not fully understand the order in which steps are to be taken under the MCA, the nature of consultation and the role of consultees, when an IMCA is to be instructed and the need to explore all available options before a best interest decision is reached. The best interest decision not to proceed with investigations in this case was taken prior to consultation with those involved in the Deceased’s care. Neither the social worker or community learning disability nurse appreciated that they were being consulted when spoken to by the GP. The carers who provided daily care to the Deceased and who had been able to foster her engagement with social care were not consulted. An IMCA was not formally instructed. There was no exploration of or advice given in relation to the options available to support the Deceased in engaging with medical investigations or medical care such as desensitisation or 1:1 care. The community learning disability nurse’s understanding was that the Deceased had the capacity to decline investigations. A best interest meeting was not convened and whilst this was not mandatory under these circumstances, it would have afforded an opportunity to ensure that agencies applied their minds to the possibility that the Deceased may engage with investigations if additional support was offered. It would also have facilitated more effective communication between the agencies and on-going management of the consequences of the best interest decision. ”
Source location
Hazel Maureen Lewis · Prevention of Future Deaths report
Page 2 · concerns
Open source report

Data last updated 7 September 2026

What this concern includes

Not included

Reports over time

Concerns raised2

Failure to provide an IMCA during hospital treatment

Failure to discuss End of Life Care with an IMCA

Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3

Concerns raised3

Failure to correctly identify the statutory advocate’s role

Lack of clarity about the referral requirements for IMCA involvement

Failure to formally instruct an Independent Mental Capacity Advocate when required

Respondent positions 3