Module 5: Putting the person first: choice and mental capacity

Module 5: Putting the person first: choice and mental capacity. Video transcript

Full narration with what is on screen, for learners who prefer to read or cannot hear the video.

[00:00] Module 5: Putting the person first

On screen: Choice and mental capacity; Coming Home Carer Skills; About 7 minutes. Picture: By Abena's open wardrobe, Moses holds up two bright patterned dresses, one in each hand. Abena, smiling, points firmly at the one she wants.

Welcome to Module 5 of Coming Home Carer Skills: Putting the person first, choice and mental capacity. On screen are Moses and his mum, Abena. Abena is 82 and lives with dementia. She still loves choosing her own clothes. Moses holds up 2 dresses, and Abena points to the one she wants.

[00:23] Before we start

On screen: Our own free course for family carers.; Topics follow the 16 Care Certificate standards (2025).; Not the Care Certificate. Not a qualification.; Not endorsed by Skills for Care, NHS England or Skills for Health..

First, a short note. Coming Home Carer Skills is our own free course for family carers. Its topics follow the 16 Care Certificate standards (2025) from Skills for Care, NHS England and Skills for Health. It is not the Care Certificate, it is not a qualification, and those organisations have not endorsed it.

[00:48] In this module

On screen: Knowing the person; Asking first, and helping someone decide; Mental capacity and best interests; Planning ahead in your nation; General information, not legal advice.

By the end, you should know how to support the person's choices, the main ideas of mental capacity law, and how to plan ahead in each part of the UK. This is general information, not legal advice.

[01:02] Knowing the person

On screen: What matters to them?; Likes, dislikes and routines; Write a one-page profile, and share it.. Picture: Moses and Abena sit side by side at the kitchen table, sticking small photos onto a single sheet of paper (no readable writing). Abena laughs at one of the photos.

Putting the person first starts with knowing them. What do they enjoy? What upsets them? What does a good day look like? Moses and Abena made a one-page profile together. It says she loves bright colours, gospel music on the radio, and tea with milk and 2 sugars. With Abena's agreement, Moses shares it with her paid carers, so everyone knows what matters to her.

[01:30] Asking first

On screen: Ask before you help.; Explain what you are doing.; If they say no, stop. Try again later.. Picture: Joy, the paid care worker, crouches to Abena's eye level and gently asks whether she would like help with her shoes. Abena, seated, nods and holds out a foot.

Always ask before you help. This is called consent. It means the person agrees to what you do. Explain what you would like to do, in simple words. Look for a yes or a no in their face and body, as well as their words. If they say no, stop, and try again later, or in a different way.

[01:53] Helping someone decide

On screen: Pick their best time of day.; Offer 2 simple choices.; Show the real things, or pictures.; Give them time.. Picture: Moses holds out two plates, one with rice and stew, one with toast and eggs. Abena considers them and reaches for the rice and stew, pleased.

Many people can make their own choices with the right support. Abena thinks most clearly in the morning, so Moses saves bigger questions for then. He offers 2 choices, not 10, and shows her the real things, like 2 plates of food. Give the person time to answer. Do not rush them, and do not answer for them.

[02:17] Mental capacity in plain words

On screen: Being able to make a particular decision; One decision, at one time; Assume the person can decide.; An unwise choice is still their choice.. Picture: At the table, Abena happily ties a bright headwrap she has chosen, while pushing a plain unopened envelope towards Moses with a puzzled smile. Moses smiles back.

Mental capacity means being able to make a particular decision for yourself, at the time it needs to be made. It is about one decision at one time. Abena can choose her clothes and her meals. But a letter from the bank about her savings is much harder for her. In England and Wales, the law about this is the Mental Capacity Act 2005. It says you must assume a person can make their own decisions, unless it is shown that they cannot. You must help them to decide first. And a person is not unable to decide just because their choice seems unwise to you.

[02:57] The law in each nation

On screen: England and Wales: Mental Capacity Act 2005; Scotland: Adults with Incapacity (Scotland) Act 2000; Northern Ireland: Mental Capacity Act (Northern Ireland) 2016, only partly in force. Picture: Four panels, one household in each nation, each making an everyday choice together: (1) Moses and Abena choosing a headwrap (England); (2) Rhys and Carys choosing a film (Wales); (3) Morag and Alasdair choosing a walk route on a paper map with no text (Scotland); (4) Ciara and Declan choosing a card game (Northern Ireland).

The law is different in each nation. In Wales, it is the same as in England. In Scotland, the law is the Adults with Incapacity (Scotland) Act 2000. Anything done for the person must benefit them, limit their freedom as little as possible, take account of their wishes, and encourage them to use their own skills. In Northern Ireland, the Mental Capacity Act (Northern Ireland) 2016 is only partly in force. Ask your Health and Social Care Trust, or a solicitor, how it applies.

[03:33] Your role, and health worries

On screen: Big decisions: ask the GP or a social worker about capacity.; Memory getting worse slowly? Talk to their GP.; If you need advice quickly, call NHS 111. In Northern Ireland, contact your GP out of hours service.; Sudden confusion, or an emergency: call 999..

A note about your role. For big decisions, such as where to live, ask the GP or a social worker to assess whether the person can decide. If memory or confusion is getting worse slowly, talk to their GP. If you need advice quickly, call NHS 111. In Northern Ireland, contact your GP out of hours service. If someone suddenly becomes confused, get help straight away. Call 999.

[04:05] Best interests

On screen: If someone cannot decide, the decision must be in their best interests.; Their wishes, feelings and beliefs count.; Talk to family and carers.; Choose the option that limits their freedom least.. Picture: Hamza, the social worker, sits with Abena and Moses at the kitchen table. Hamza faces Abena and listens as she talks, smiling; Moses has an arm round the back of her chair.

Sometimes a person cannot make a particular decision, even with help. In England and Wales, any decision made for them must then be in their best interests. Best interests means thinking about what the person would want. Their past and present wishes, their feelings and their beliefs all count. They should still take part as much as they can. The person making the decision should talk to family and carers, and choose the option that limits the person's freedom the least. Hamza, a social worker, met Moses and Abena about more help at home. Abena has always loved company, so they agreed to try a lunch club twice a week.

[04:48] Planning ahead: England and Wales

On screen: Lasting power of attorney; 2 types: health and welfare, and property and money; Make it while you can still decide.; Register it with the Office of the Public Guardian.. Picture: A memory scene from two years ago: Abena sits at the table signing a document with a firm hand, Moses beside her. Both look calm and pleased. Papers have no readable text.

A power of attorney is a legal document. It lets you choose someone you trust to make decisions for you, if one day you cannot. In England and Wales, it is called a lasting power of attorney. There are 2 types: one for health and welfare, and one for property and money. You must make it while you can still decide. It must then be registered with the Office of the Public Guardian. After that, it can be used. Abena made both types 2 years ago, with Moses as her attorney. An attorney is the person chosen to decide. If there is no power of attorney and someone can no longer decide, a relative may need to apply to the Court of Protection to become their deputy.

[05:36] Scotland and Northern Ireland

On screen: Scotland: continuing and welfare powers of attorney; Northern Ireland: enduring power of attorney, for money and property only; Each nation has its own office to register them.. Picture: Two panels: (1) Morag and Alasdair sit across a desk from a solicitor (unnamed extra) in a small office, Alasdair signing; (2) Ciara and Declan at their kitchen table reading a plain leaflet together, Declan pointing at it.

In Scotland, there are 2 kinds. A continuing power of attorney covers money and property. A welfare power of attorney covers care and personal decisions, and is only used once the person cannot decide. Both must be registered with the Office of the Public Guardian in Scotland. Morag and Alasdair made theirs with a solicitor. In Northern Ireland, you can make an enduring power of attorney. It covers money, property and financial affairs, but not health and welfare decisions. It must be registered with the Office of Care and Protection if the person is becoming unable to manage their affairs.

[06:18] Get help

On screen: England and Wales: Office of the Public Guardian; Scotland: Office of the Public Guardian (Scotland); Northern Ireland: Office of Care and Protection; Carers UK helpline: 0808 808 7777 (free); A solicitor, and your council or Trust.

For help with powers of attorney, contact the Office of the Public Guardian in England and Wales, the Office of the Public Guardian in Scotland, or the Office of Care and Protection in Northern Ireland. For advice about caring, Carers UK runs a free helpline on 0808 808 7777. A solicitor can give legal advice. Your council, or your Trust in Northern Ireland, can help with care decisions.

[06:48] To sum up

On screen: Know the person, and ask first.; Help them decide, one decision at a time.; Best interests: their wishes count.; Plan ahead while you can.; Next: read the pages, then try the quiz.. Picture: Abena, in the dress she chose and a matching headwrap, walks arm in arm with Moses along a tree-lined street towards a community hall, both laughing.

To sum up. Get to know what matters to the person, and ask before you help. Support them to make their own choices, one decision at a time. If they cannot decide, any decision must put them first, and take account of their wishes. And plan ahead, while everyone can still have a say. Now read the pages below, then try the quiz. You can take it as many times as you like.