Ben is 28 years old and has Multiple Sclerosis. Multiple sclerosis (MS) is a condition that can affect the brain and spinal cord, causing a wide range of symptoms, including problems with vision, arm or leg movement, sensation or balance. It's a lifelong condition and is one of the most common causes of disability in younger adults in the UK.

Whilst in hospital, Ben’s doctors came to believe that Ben’s Multiple Sclerosis was impeding his cognitive functioning, including his ability to understand information and make decisions for himself. He was assessed as lacking the capacity to decide where he should live after he was discharged from hospital. By law, Ben was entitled to advocacy support and a referral was made by the NHS Trust to POhWER for support from an Independent Mental Capacity Advocate (IMCA).

Andrea, a POhWER advocate, spoke to the NHS staff member who made the referral, who invited her to attend a Care Programme Approach (CPA) meeting to gather information about the decision being made. At that meeting Andrea identified that as Adult Social Care were to fund Ben’s care placement, they would need to appoint a ‘Decision Maker’ rather than the NHS Trust. Andrea took the time to explain this clearly to the attendees at the CPA meeting, and she then contacted the allocated Social Worker in Adult Social Care to seek instruction.

Andrea also met with Ben. He acknowledged the level of help he needed. He explained he would need someone to cook for him and give him full support during meals because his hands shake. He joked ‘I like to eat my meals, not paint with them’. He also pointed out that his reluctance to use the Rotunda Transfer Aid to transfer from his bed to his wheelchair was not because of a lack of insight into his risk of falling, but due more to his level of determination, and his desire to maintain as much independence as he was able to, for as long as possible.

After meeting with Ben, Andrea felt the capacity assessment undertaken by the NHS Trust staff had been over-zealous and explained to his Social Worker that, whilst Ben's physical health was deteriorating, she believed that he may have the capacity to make a decision about where to live and receive support after his discharge. Andrea recommended that as the appropriate Decision Maker, the Social Worker should revisit the capacity assessment. The Social Worker agreed to do so.

Andrea drafted a report to back up her findings, but did not need to submit this as the Social Worker rapidly concluded, based on her own capacity assessment undertaken with a colleague, that Ben was able to make the decision about where he would wish to live after discharge.

Andrea supported Ben to uphold his right to personal control and increased independence by reminding the Decision Maker of his right to contribute to his discharge planning and enabled his voice to be heard.