Importance Of Capacity Assessments In Care Act Needs Assessments – TDB v London Borough Of Haringey

The Court of Appeal recently handed down a significant judgment in TDB v London Borough of Haringey, which provides valuable guidance on the often-overlapping relationship between the Care Act 2014 and the Mental Capacity Act 2005 (“MCA”).

Background

This case is centred around TDB (“T”), a 25-year-old man with developmental impairments, including a diagnosis of autism. T sadly had a traumatic childhood and suffers from severe anxiety and is prone to self-harm. T has a history of offending behaviour and struggles to understand sex and relationships. Given T’s complex background, he is an extremely vulnerable individual.

T received support from the London Borough of Haringey (“LBH”) – the local authority responsible for meeting his needs – throughout his childhood and latterly as an adult. LBH therefore ought to be aware of T’s complex history and vulnerability, given their longstanding input in his care and support.

In December 2024, LBH completed an assessment of T’s needs under the Care Act following repeat requests by T’s solicitor and family to review his needs as a matter of urgency. This assessment identified a range of difficulties and highlighted concerns around T’s understanding of relationships, including sexual relationships, his social media use, personal care and safety. The assessment expressly recorded that T “lacks capacity in understanding relationships/sexual relationships and boundaries of relationships“. This finding was based on “information shared” by the agency managing T’s placement and not a formal capacity assessment conducted during the process of the Care Act assessment. Despite significant vulnerabilities and clear indications that T lacked capacity in several areas impacting his wellbeing and safety, LBH did not carry out a capacity assessment.

Litigation

T’s mother was appointed as his litigation friend and challenged LBH’s assessment by way of judicial review on the following grounds:

• The assessment was unlawfully conducted without the requisite skills, knowledge, and competence.
• The assessment arrived at irrational and/or unreasonable conclusions in relation to learning disability and primary support.
• The local authority was unlawfully fettering its discretion by continuing to apply an inflexible policy and/or criteria.

It was argued that, where there is evidence raising doubts about an individual’s capacity, a local authority could not lawfully complete a care needs assessment in line with its duties under the Care Act without carrying out a mental capacity assessment first. LBH submitted that no capacity assessment was necessary due to Section 1 (2) of the MCA, which requires that a person must be presumed to have capacity unless it is established otherwise. It is also important to note that the presence of a learning disability was disputed due to differing conclusions being reached by assessors.

The matter was heard by HH Judge Bird, who dismissed the claim on all grounds. He later dismissed an application for permission to appeal. Shortly after, a notice of appeal was filed with the Court of Appeal to challenge the dismissal of the judicial review claim. Permission to appeal was granted shortly thereafter.

Appeal

On appeal, the Court quashed the December 2024 assessment on the basis that a capacity assessment should have been undertaken before the Care Act assessment. The Court also found that LBH should have obtained specialist psychological or psychiatric input. The Court rejected HH Judge Bird’s conclusion that specialist input was unnecessary and found the failure to seek such input irrational.

T, supported by the intervening mental health charity Mind, argued that concerns about capacity ought to trigger a formal assessment and that it is impossible to properly assess some care needs without understanding whether the individual can make relevant decisions for themselves.

The key findings in this case are as follows:

• Where there is reason to doubt a person’s mental capacity in an area relevant to their care and support needs, the local authority must carry out a capacity assessment in line with the MCA before completing an assessment for care and support needs.
• That capacity assessment must be carried out by an “appropriately qualified professional”.
• It is essential to understand an individual’s capacity when conducting a care needs assessment.
• The statutory guidance is clear that concerns about capacity will trigger the threshold for an assessment.
• The presumption of capacity principle cannot be used as a reason to avoid assessing capacity where there is a legitimate concern present.

The Court further highlighted that there were numerous indicators which ought to have triggered a capacity assessment in this case, including:

• Previous capacity assessments finding a lack of capacity to make various decisions;
• Concerns raised by care providers about T’s ability to understand relationships and boundaries;
• T’s autism and ADHD diagnoses; and
• T’s history of vulnerability, exploitation and allegations of sexual offending.

The Court held that LBH acted unlawfully by failing to obtain specialist professional input, considering T’s complex presentation. This sets an important precedent to ensure that capacity is considered appropriately at the relevant time, as it is often central to understanding a person’s wellbeing, needs and ability to participate in decision-making.

Importantly, the Court rejected reliance on the statutory presumption of capacity as a reason not to assess capacity. While this presumption remains fundamental, it cannot be used to avoid investigating concerns that already exist. This judgment effectively confirms that capacity is not a separate issue to be considered later: where concerns over capacity are present, capacity must be considered as part of the assessment process itself. Failure to do so may render the care and needs assessment unlawful.

Why this matters

This judgment is likely to have significant practical implications for local authorities and Court of Protection practitioners.

The Court provides clear guidance on the intersection between the Care Act and MCA, particularly where an individual’s presentation is particularly complex. In TDB’s case, the Court concluded that psychological or psychiatric expertise should have been obtained to ensure his needs were properly understood and assessed. This aspect of the judgment will no doubt help to ensure that individuals are assessed in a way that is appropriate for them whilst ensuring their cooperation is maximised by having regard to their individual needs and circumstances.

It also makes it clear that regard must be given to the individual’s particular circumstances to ensure that any assessment is undertaken by an appropriately qualified professional with the relevant skills and knowledge.

This judgment plainly provides that the presumption of capacity cannot be used as justification for avoiding capacity assessments where there are legitimate concerns over capacity. The Court emphasised that capacity is integral to Care Act assessments and therefore, if there is reason to doubt a person’s capacity in matters relevant to their care and support, local authorities must assess capacity before finalising their assessment. It is not appropriate to rely on the presumption of capacity, nor is it acceptable to use as a reason to avoid existing concerns. Equally, where needs are complex, specialist expertise may be essential to ensure the assessment is lawful and accurate.

Conclusion

The Court of Appeal’s judgment strengthens the procedural safeguards available to vulnerable adults. It makes clear that capacity is not a separate issue to be considered later; when relevant, it forms a key part of understanding a person’s needs and how those needs should be met.