1. Introduction
Consent is the principle that a person must give permission before they receive any type of care and support, medical treatment, test or examination. This must be done on the basis of an explanation by a practitioner or clinician.
Consent from the adult, or their representative if the adult lacks mental capacity (see Mental Capacity), is needed regardless of the action or procedure.
The principle of consent is an important part of medical ethics and the international human rights law.
2. Principles
The following are the principles regarding consent in relation to people who use services:
- where they are able, people who use services give consent to the care and support they receive;
- staff should presume that people have capacity to give consent unless there is evidence to show otherwise;
- just because a person has a diagnosis of a learning disability, mental health diagnosis or some other diagnosis condition does not override a person’s ability to consent to their care or treatment;
- where they are unable to consent, procedures are in place for a best interest’s decision to be made;
- service users and those lawfully acting on their behalf, have given consent before any care or treatment is provided;
- service users should understand and know how to change any decision about care and support that has been previously agreed;
- they can be confident that their human rights are respected and taken into account.
Consent is an important aspect of providing care and treatment, but in some cases, acting strictly in accordance with consent may mean other regulations cannot be met, in relation to nutrition and person-centred care, for example. Staff must not provide unsafe or inappropriate care however, just because someone has consented to care or treatment that would be unsafe.
Consent may be implied and include non-verbal communication such as sign language or by someone rolling up their sleeve to have their blood pressure taken or offering their hand when asked if they would like help to move.
Staff who obtain the consent of service users must be familiar with the principles and codes of conduct associated with the Mental Capacity Act 2005 (MCA), and are able to apply those when appropriate, for any of the people they are caring for (see Mental Capacity).
3. Managing Risk through Effective Consent
The service will ensure that:
- when a service user is asked for their consent, information about the proposed care and treatment must be provided in a way that they can understand. This should include information about the risks, complications and any alternatives. A member of staff or other relevant professional, such as a doctor, with the necessary knowledge and understanding of the care and treatment should provide this information so that they can answer any questions about it to help the person consent to it;
- discussions about consent must be held in a way that meets the communication needs of the service user. This may include the use of different formats including pictures or languages and may involve others such as a speech language therapist or an independent advocate;
- consent must be treated as a process that continues throughout the duration of care and treatment, recognising that it may be withheld and / or withdrawn at any time;
- when a service user or a person acting lawfully on their behalf refuses to give consent or withdraws it, everyone providing care and treatment must respect this;
- consent procedures must make sure that people are not pressured into giving consent and, where possible, plans must be made well in advance to allow time to respond to people’s questions and provide adequate information;
- where a person lacks mental capacity to make an informed decision, or give consent, staff must act in accordance with the requirements of the MCA and associated code of practice (see Mental Capacity);
- procedures to get consent and best interests decisions should be followed, monitored and reviewed;
- service users must be given enough time to think about their consent decisions where requested, except in an emergency when this may not always be possible;
- service users have the right to have an advocate to assist them in making an informed decision;
- there must be a regular review of consent decisions taking into account the changing needs of the service user;
- consideration should be given to a person’s changing needs in relation to their health and wellbeing and this should trigger a review of a person’s support plan and any consent decisions should be reviewed.
4. Gaining Consent
The following points should be followed when obtaining consent to share information:
- if you feel that the information should be shared ask the service user’s (or their legal representative) permission to do so;
- when gaining consent be specific regarding the information / action to be shared and to whom;
- explain clearly why it is required and accurately record;
- if there are any concerns in these areas seek advice from your line manager;
- whenever practical or reasonable any records pertaining to an individual service user should be completed in their presence and with their co-operation;
- when sharing information about a service user with others, their permission, wherever possible, should be gained first;
- if a service user requests that certain information is not shared with others, this should be respected unless the staff member receiving the information is obliged to share it by law or if they feel the information needs to be shared to protect the service user or others, in which case they should discuss their concerns with the manager;
- every service user has the right to see any information held on him / her and correct any errors / omissions.
The manager should ensure through induction training, staff meetings and supervision that all staff are aware of their responsibilities around service user confidentiality.
Staff should not discuss information pertaining to a service user outside of the service setting.
