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COMMISSIONING IMCA SERVICES. A brief overview. How many decisions will involve an IMCA?.

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how many decisions will involve an imca
How many decisions will involve an IMCA?
  • It is estimated that there might be 39,000 decisions every year about serious medical treatment and 69,000 decisions about moves into or between long-term care affecting people who lack capacity to make these decisions.
  • Of these around 15% will not have friends or relatives who can be consulted.
  • So there will be around 16,000 decisions involving an IMCA
  • Cost of an IMCA is estimated at £25 per hour. This will include management costs, training and accommodation.
  • Providing an IMCA for 16,000 people at an average of 8 hours per decision = £3.2m
  • Dealing with 4,000 more complex cases at an additional 8 hours per case = £800k
  • Giving Local Authorities discretion as to when to use an IMCA, 12,500 extra cases at 8 hours per case = £2.5m
  • Total £6.5m
guidance from the mental capacity implementation team to local authorities on commissioning
Guidance from the Mental Capacity Implementation Team to Local Authorities on commissioning

The Implementation Team have issued guidance to Local Authorities on how to commission IMCA services. This is not intended to be directive, but merely to help Local Authorities identify some of the issues.

They are set out in a series of steps.

step one identify local advocacy providers
Step One; Identify local advocacy providers
  • LA may already be commissioning advocacy services
  • Or working with services funded from other sources
  • If no local advocacy services available then they might want to consider regional or national advocacy services, or support local voluntary organisations to develop a new advocacy service
step two pre qualifying organisations
Step two: Pre-qualifying organisations
  • If a large number of advocacy services in the area the LA might want to identify those which they think are most suitable through pre-qualifying criteria.
  • Alternatively if there are few or no suitable advocacy service available the LA might wish to pre-qualify a number of voluntary organisations who could develop an advocacy service.
step three develop a specification for an imca service
Step three: Develop a specification for an IMCA service.
  • Existing specifications need to be adapted to fit the requirements of an IMCA service.
  • Small areas of populations might be better served by LAs considering a joint commissioning approach.
  • LA need to consider how to ensure swift responses to referrals, and that there is an IMCA service that can provide that service 52 weeks of the year. Cont.
step three develop a specification for an imca service cont
Step three: Develop a specification for an IMCA service. Cont.
  • Larger LA, due to their larger budget, might be able to commission a more flexible service, but should take into account geographical distances that may have to be covered.
  • LA need to consider that the IMCA service must provide a service for a wide range of client groups. Cont.
step three develop a specification for an imca service cont1
Step three: Develop a specification for an IMCA service. Cont.
  • LA are recommended to develop the specification and the tendering process jointly with the their local health partners.
  • It is suggested that three years contracts would probably be appropriate.
step four advertising interviewing and selecting
Step four: Advertising, interviewing and selecting
  • National advertising of IMCA tenders might be considered, unless there is already well established tender arrangements based on preferred partner status.
  • Service users and carers could be involved in the interviewing and selection process.
  • CSIP regional development will be able to assist commissioners.
early lessons learnt from pilots
Early lessons learnt from pilots
  • The IMCA service cannot operate without widespread awareness raising and publicity within the health and social care sector it serves.
  • The publicity needs to be supported by adequate information
  • It is recommended that engagement protocols are developed cont.
early lessons learnt from pilots cont
Early lessons learnt from pilots, cont.
  • Procedures for assessing capacity need to be made available to all staff who are expected to refer to the IMCA advocates
  • Very clear arrangements need to be made for early referrals from staff involved in discharging patients from hospitals to other forms of long term institutional care


early lessons learnt from pilots cont1
Early lessons learnt from pilots, cont.
  • Very clear arrangements need to be made for referrals where homes are being closed and clients resettled
  • Each health trust or hospital may want to assist doctors with procedures for discussing what is and what is not ‘serious medical treatment’ and for recording this on patients notes
  • Doctors working with patients with acquired brain injury are those least likely to be familiar with the IMCA service
service specification
Service specification
  • Copies available