Fill - Free fillable UK Gov Department of Health & Social Care - Deprivation of Liberty Form 24 Selection of a Representative PDF form

Mental Capacity Act 2005

DEPRIVATION OF LIBERTY FORM No. 24

SELECTION OF A REPRESENTATIVE

(To be completed by best interests assessor)

The process has two stages:

(1) the selection of a representative by a best interests assessor (Form 24)

(2) the representative’s appointment by the supervisory body (Form 25).

The process of selecting a representative must begin as soon as a best interests assessor is appointed

following a request for a standard authorisation.

Regulations state that an individual can only be selected and appointed if they are eligible to be the person’s

representative. An individual is eligible if they are:

(a) aged 18 or over

(b) able to keep in contact with the relevant person

(d) not ﬁ nancially interested (see notes at end of form) in the relevant person’s managing authority

(e) not a relative (see notes at end of form) of a person who is ﬁ nancially interested in the managing

authority

(f) not employed by, or providing services to, the relevant person’s managing authority (where the relevant

person’s managing authority is a care home)

(g) not employed to work in the relevant person’s managing authority in a role that is, or could be, related to

the relevant person’s case (where the relevant person’s managing authority is a hospital); and

(h) not employed to work in the supervisory body that is appointing the representative in a role that is, or

could be, related to the relevant person’s case.

Any person selected must inform the supervisory body in writing that they are willing to accept the

appointment. Part H of this form allows for a potential representative to indicate their willingness to be

selected as the representative should they be offered the appointment. Completion of this part of the form

will remove the need for the supervisory body to check separately that the person concerned is willing to act

as the representative.

A representative’s appointment expires when the standard authorisation comes to an end. Therefore, the

selection and appointment process must be done afresh if a further standard authorisation is required.

PART A — WHY THIS FORM IS BEING COMPLETED

Place a cross in box A1 or A2 Ø

A1 This form is being completed in relation to a new standard authorisation (which

includes one that is to come into force on the expiry of a previous standard authorisation).

A2 This form is being completed because a representative’s appointment has been

terminated before it was due to expire and it is necessary to appoint a replacement.

CASE

NUMBER

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PART B — BASIC INFORMATION

Name and address of the best interests

assessor

Full name of the person being assessed

Their date of birth (or estimated age if

unknown)

Name of the relevant hospital or care home

Name of the supervisory body

Address of the relevant person

(Place a cross in the relevant box and,

where applicable, state the address)

Address of the relevant hospital or care

home

(Place a cross in the relevant box and,

where applicable, state the address)

PART C — PERSONS WHOSE ELIGIBILITY COULD NOT BE CONFIRMED

Note: this part of the form should be used to record the details of any individuals who were selected by

someone to be the person’s representative but who were not recommended by the assessor because their

eligibility could not be conﬁ rmed.

I was unable to conﬁ rm the eligibility of the following individual(s) selected by the person themselves, or by

a donee of a lasting power of attorney or deputy appointed by the Court of Protection:

Name

Address

Name

DOB

Est. age

Name

As stated on the request for a standard

authorisation

As stated immediately below

Address

As stated on the request for a standard

authorisation

As stated immediately below

Address

ddm

yyyy

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Name of the individual Who selected them Reason why their eligibility could not

selected (e.g. person, donee) be conﬁ rmed (e.g. not willing to act)

PART D — CAPACITY OF THE PERSON TO SELECT THEIR OWN REPRESENTATIVE

I have determined whether the person has capacity to select a representative. I have determined that:

Place a cross in one box only (D1, D2, D3 or D4) Ø

D1 The person has capacity to select a representative. They have selected the family

member, friend or carer named in Part G of this form. This individual is eligible to

be appointed. I therefore recommend their appointment as the person’s representative.

If you placed a cross in Box D1, please now:

• enter the representative’s details in Part G of this form

• invite the representative to sign Part H of this form

• enter, in Part C of this form, the details of any individuals selected by the

person who you did not recommend because you could not conﬁ rm their eligibility

• sign and date the form (no other part of this form needs to be completed).

D2 The person has capacity to select a representative. Although they selected one or

more family members, friends or carers to be their representative, I was unable to

conﬁ rm the eligibility of any of the individuals selected.

I advised the person of this and of my reasons, and invited them to make a further

selection. They did not make a further selection.

If you placed a cross in box D2, please now:

• enter, in Part C of this form, the details of any individuals selected by the

person who you did not recommend because you could not conﬁ rm their

eligibility; and then

• proceed to Part F of this form (do not complete Part E).

D3 The person has capacity to select a representative but does not wish to select a

family member, friend or carer to be their representative.

If you placed a cross in box D3, please proceed to Part F of this form

(do not complete Part E).

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D4 The person lacks capacity to select a representative.

If you placed a cross in box D4, please now:

• proceed to Part E of the form if a donee or deputy has been appointed for

the person; or

• proceed to Part F of the form if they do not have a donee or deputy.

PART E — PERSON LACKING CAPACITY HAS A DONEE OR DEPUTY

Place a cross in one box only (E1, E2 or E3) Ø

E1 The person has a donee or deputy whose authority permits them to select a

family member, friend or carer of the person to be their representative.

The donee or deputy has selected the family member, friend or carer named in

Part G of this form. This individual is eligible to be appointed. I therefore recommend

their appointment as the person’s representative.

If you placed a cross in box E1, please now:

• enter the representative’s details in Part G of this form

• invite the representative to sign Part H of this form

• enter, in Part C of this form, the details of any individual selected by the donee or

deputy who you did not recommend because you could not conﬁ rm their eligibility

• sign and date the form (no other part of this form needs to be completed).

E2 The person has a donee or deputy whose authority permits them to select a family

member, friend or carer of the person to be their representative.

Although that donee or deputy selected one or more family members, friends or

carers to be the person’s representative, I was unable to conﬁ rm the eligibility of

any of the individuals selected.

I advised the donee or deputy of this and of my reasons, and invited them to make

a further selection. They did not make a further selection.

If you placed a cross in box E2, please now:

• enter, in Part C of this form, the details of any individuals selected by the donee or

deputy who you did not recommend because you could not conﬁ rm their eligibility

• proceed to Part F of this form.

E3 The person has a donee or deputy whose authority permits them to select a family

member, friend or carer to be the person’s representative.

However, the donee or deputy does not wish to select a family member, friend

or carer to be the person’s representative.

If you placed a cross in box E3, please now proceed to Part F of the form.

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PART F — SELECTION OF A REPRESENTATIVE BY BEST INTERESTS ASSESSOR

Place a cross in one box only (F1 or F2) Ø

F1 I have selected a family member, friend or carer of the person who is eligible to

be a representative.

The person does not object to the individual selected by me and nor does any donee or

deputy appointed for them.

I therefore recommend the person selected by me for appointment as a representative

to the supervisory body.

If you placed a cross in box F1, please now:

• enter the representative’s details in Part G of this form

• invite the representative to sign Part H of this form

• enter, in Part C of this form, the details of any individual you did not recommend

because you could not conﬁ rm their eligibility

• sign and date the form.

F2 I have not been able to select an eligible person to be a representative.

If you placed a cross in box F2, please now:

• enter, in Part C of this form, the details of any individual you did not

recommend because you could not conﬁ rm their eligibility

• sign and date the form.

PART G — DETAILS OF THE INDIVIDUAL SELECTED TO BE THE REPRESENTATIVE

The following individual has been selected to be the person’s representative:

G1 Full name of the person selected

G2 Their address

G3 Their contact details

G4 Their relationship with the relevant

person

Name

Address

Telephone

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PART H — CONSENT OF THE PERSON SELECTED TO BEING APPOINTED

Note: this is an optional Part of the form. Its completion will save the supervisory body having to write

separately to the person to obtain their consent before offering them the appointment.

I am willing to be appointed as this person’s representative under the deprivation of liberty safeguards

provisions of the Mental Capacity Act 2005, and I am aware that I am expected to:

(a) maintain contact with the person

(b) represent the person in matters relating to, or connected with, their deprivation of liberty under the

standard authorisation

Signed (person named in Part G above)

Dated

As soon as it is completed and signed, this form should be passed to the supervisory body, so that

a representative can be appointed.

Signed (best interests assessor)

Dated

NOTES

The arrangements for the selection and appointment of representatives are contained in the Mental

Capacity (Deprivation of Liberty: Appointment of Relevant Person’s Representative) Regulations

2008 accessible via: http://www.dh.gov.uk/en/SocialCare/Deliveringadultsocialcare/MentalCapacity/

MentalCapacityActDeprivationofLibertySafeguards/DH_084948

Deﬁ nition of a relative

Regulation 3(2) deﬁ nes a ‘relative’ as

(a) a spouse, ex-spouse, civil partner or ex-civil partner

(b) a person living with the relevant person as if they were a spouse or civil partner

(d) a brother or sister

(e) a child of a person falling within sub-paragraphs (a), (b) or (d)

(f) a grandparent or grandchild

(g) a grandparent-in-law or a grandchild-in-law

(h) an uncle or aunt

(i) a brother-in-law or sister-in-law

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(j) a son-in-law or daughter-in-law

(k) a ﬁ rst cousin; or

(l) a half-brother or half-sister.

Deﬁ nition of ‘ﬁ nancial interest’ in a managing authority

Regulation 3(3)(c) states that a person has a ﬁ nancial interest in a managing authority where:

(i) that person is a partner, director, other ofﬁ ce-holder or major shareholder of the managing authority that

has made the application for a standard authorisation, and

(ii) the managing authority is a care home or independent hospital.

Regulation (3)(3)(d) states that a major shareholder means:

(i) any person holding one tenth or more of the issued shares in the managing authority, where the

managing authority is a company limited by shares, and

(ii) in all other cases, any of the owners of the managing authority.

Donees and deputies

The appointment of a representative is in addition to any appointment of a donee or deputy. The functions

of a representative do not affect the authority of any donee, the powers of any deputy, or any powers of the

court.

Section 39A IMCAs

If the person has a section 39A IMCA, the effect of the appointment of a representative for the person is

generally that the duties imposed on, and the powers exercisable by, the IMCA no longer apply. The IMCA

may, however, still make an application to the Court of Protection concerning the standard authorisation, but

must take account of the views of the representative in doing so.

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