Review capacity assessments when decisions, health, risk, or communication change, and set planned checks for fluctuating or progressive conditions.
Capacity is decision specific and time bound. A person may manage one choice now yet need help with another tomorrow. For that reason, review is not a box tick; it is a safety net that keeps decisions fair, lawful, and person led.
What The Law And Guidance Say
Under the Mental Capacity Act, capacity relates to a specific decision at the time it must be made, and it can change. National guidance also asks teams to record when a past assessment will be reviewed. See the Mental Capacity Act Code of Practice and the NICE guideline on decision-making and mental capacity for the exact wording and practical expectations.
Quick Reference: Triggers And Review Windows
The table below lists common prompts to revisit a capacity assessment and a sensible window for that review. Use this as a starting point and tailor to the person, the decision, and the risk.
| Trigger | What To Check | Typical Review Window |
|---|---|---|
| New decision is proposed | Is the decision the same scope as before? | Assess now for that decision |
| Acute illness or delirium | Has attention, memory, or insight changed? | Daily until stable |
| Medication started or stopped | Effect of sedatives, pain meds, or antipsychotics | 48–72 hours after change |
| Fluctuating presentation | Best time of day or place to assess | At peak times; set review in 1–2 weeks |
| Communication aid introduced | Whether a tool improves understanding or expression | Within 7 days of trial |
| New safeguarding risk | Ability to weigh risk and alternatives | Immediately |
| Rehab or recovery milestones | Gains in cognition or function | At each milestone or monthly |
| Planned major treatment | Capacity for consent to the specific procedure | Close to decision point |
How Often Should Capacity Assessments Be Reviewed In Practice?
There is no single fixed interval. The right answer depends on the decision, the person’s condition, and the level of risk if you get it wrong. Still, patterns help. Use the scenarios below to set a sensible cadence, then write that plan into the record so every team member knows when the next check is due.
Acute Illness Or Delirium
Expect fast change. Assess daily while the person is confused, agitated, or drowsy. Once the cause settles, repeat at the bedside when the person is rested and hydrated. If a big decision cannot wait, weigh best interests with those who know the person well, and record the plan to review capacity again when the acute phase resolves.
Dementia Or Progressive Conditions
Memory and reasoning can ebb over months, not hours. Tie reviews to real decisions: consent to a new treatment, property matters, or a change of living setting. Many teams add a standing check each quarter, then bring the date forward if family or staff notice a step change.
Brain Injury Or Stroke Recovery
Early weeks bring gains. Set weekly checks for high-impact choices, then move to monthly as progress levels. Pick times of day when fatigue is lowest. Use short, concrete questions and visual aids so the person can show what they know and decide.
Learning Disability With Mental Health Needs
Capacity can vary with mood, distress, or place. Build review points around therapy steps, medicine adjustments, or life events. Keep the decision small and specific, then scale up only if the person shows they can understand, retain, weigh, and communicate across the wider choice.
Consent To Treatment In Clinic Or Theatre
Assess near the time of the procedure. For planned surgery, do a check at consent clinic, then confirm again on the day if there has been any change. For ongoing treatments, repeat if doses, side effects, or goals of care shift.
Financial And Property Decisions
Tie the review to the act itself: signing a tenancy, setting up a direct debit, selling an item of value. If an attorney or deputy is in place, agree how fresh capacity will be checked for each discrete decision, and record who will lead that step.
Cues That Tell You A Review Is Due
Small signals often arrive before a formal trigger. Watch for any of the signs below and bring the date forward if they appear.
- Change in alertness, sleep-wake pattern, or attention span.
- New pain, infection, or poor intake of food and fluids.
- New distress, anxiety, or strong beliefs that were not present before.
- New communication barriers: hearing aid lost, glasses broken, voice too faint.
- Different views from family or staff on what the person understands.
- New risks in the home or ward, or a near-miss incident.
Method That Holds Up Under Scrutiny
Write a clear plan that names the decision, the assessor, the aids to be used, the best time or place for the person, and the next review date. Keep the language simple, specific, and concrete. If doubt remains, seek a second view and log why.
Plan The Next Review Date
After each assessment that finds a lack of capacity, set a review timescale. Choose a date that fits the clinical picture: sooner for delirium, later for slow change. If the person might regain capacity, name the conditions you expect to improve and the sign you will watch for.
Choose The Right Assessor
The decision maker leads the check, with input from staff who know the person. Bring in specialists when the decision is complex or when tests, therapy, or communication aids are central to the choice.
Record What You Did And Why
Use plain notes that show the four-stage test, the steps taken to help the person decide, the outcome, and the agreed review date. Save copies of any prompts, pictures, or tools used. Share the plan with the person and, with consent, their family or advocate.
Who Does What In A Review
| Role | Main Contribution | What To Record |
|---|---|---|
| Decision maker | Defines the decision and runs the assessment | Outcome and review date |
| Named nurse or key worker | Prepares the person and gathers views | Best time or place; aids used |
| Doctor or therapist | Explains risks, benefits, and options | Clinical factors and changes |
| Family or advocate | Shares wishes, values, and preferences | What matters to the person |
| Specialist (e.g., SALT, neuropsychology) | Advises on communication or cognition | Tools tried and effect |
| Legal or safeguarding lead | Checks law, risk, and best interests process | Escalation route and decisions |
Tools That Make Decisions Clear
Good tools raise a person’s chance to decide for themselves. Use pictures, plain-language leaflets, teach-back (“tell me in your words”), calendars, pill boxes, and pain scales. For speech limits, try yes/no cards, writing pads, or a simple touch screen. For language barriers, book an accredited interpreter and build in extra time.
Special Settings And Review Rhythm
Emergency Department
Work is fast and noisy. If a life-saving act cannot wait, act in best interests, then book a review once the person is stable, awake, and able to take in information. Re-check before any follow-up procedure that is not urgent.
Inpatient Wards
Add a daily prompt to ward rounds: “Is a capacity review due?” Tie checks to drug charts, therapy goals, and discharge plans. When a person moves to rehab, pass the next review date forward in the transfer note.
Care Homes
Link reviews to care plan dates and real choices: going out, spending money, or changing routines. Keep a simple log at the front of the file with the next review date and the trigger that would bring it forward.
Outpatient Clinics
Many choices are scheduled. Assess at clinic, then confirm on the day of the act if anything has changed. If treatment plans shift, repeat the check and document the new review date.
Putting It Into A Service Rhythm
Build review points into care plans and handovers. Add a prompt that asks, “Is a capacity review due?” Use whiteboards or digital flags so dates are visible. When a person moves setting, carry the plan forward and confirm who owns the next check.
Documentation Tips That Save Time Later
Write the decision in the first line. Add the test you used, the information given, who was present, and the person’s answers. If you judged a lack of capacity, explain why it was not simply an unwise choice. Finish with the review date and the trigger that would bring it forward.
Audit Checklist You Can Reuse
- Decision named in the first line and scoped clearly.
- Steps taken to help the person decide are listed.
- Four parts of the test are shown with brief quotes or paraphrase.
- Outcome is clear and linked to the decision named.
- Review date and bring-forward triggers are recorded.
- Plan is shared with the person and, with consent, those close to them.
Common Mistakes To Avoid
- Recycling an old assessment for a new decision.
- Skipping review dates in delirium or early recovery.
- Writing page-long notes that hide the outcome and plan.
- Forgetting to test with hearing or visual aids in place.
- Assuming lack of capacity equals lack of rights.
Clear Takeaway For Teams
Review capacity when the decision changes, the person changes, or the risk changes. For fluctuating or progressive conditions, add a standing cycle and write the next review date into the notes. Clear plans protect rights, keep care person led, and save time when the next call arrives.