Your Consent

1.0 Introduction

The Wellness Clinic Wokingham recognise that it is a general, legal and ethical principle that valid consent must be obtained before providing care and treatment to any individual who uses our service.

This principle reflects the right of the individual to determine what happens to their own bodies and is a fundamental part of good practice.

The Care Quality Commission (CQC) include consent as part of their ongoing monitoring process as part of the “fundamental” standards”. Regulation 11 sections 11(1) to 11(5). As a provider The Wellness Clinic Wokingham must make sure that consent is obtained lawfully and that the person who obtains the consent has the necessary knowledge and understanding of the care and treatment that they are asking consent for. 

2.0 Purpose

The purpose of this policy is to set out the standards and procedures to enable staff to be informed and compliant with the requirements and guidance on consent. 

3.0 Scope 

The policy applies to all employees and workers working on behalf of The Wellness Clinic Wokingham. 

4.0 Responsibilities:

4.1 The Board of Directors

The company is required to have a policy on consent to care and treatment. It is the responsibility of the Board to approve this policy and ensure that the contents are available to all employees. 

4.2 Registered Manager

· The Registered Manager must make all employees aware of the Consent policy and their obligations to adherence to it. 

· The Registered Manager must ensure that each employee has completed mandatory training to help them understand the principles of consent and care to treatment and offer ongoing supervision and support as required. 

· The Registered Manager is responsible for reviewing and updating the policy every three years, or sooner if any changes to legislation are made

4.3 Employees

· All employees must adhere to this policy and inform the registered manager of any concerns. Seeking consent from clients is a matter of course between employees and the people that use our service.

· Training (including refresher training) must be completed as allocated in the advised timeframe to support employees in ensuring that appropriate consent is obtained in all circumstances where it is required. 

5.0 What is consent?

“Consent” is a person’s agreement to someone providing the care or treatment to them. However, for the consent to be deemed as valid the person must:

· be competent to take the particular decision

· have received sufficient information to take it

· not be acting under duress.

Consent is often wrongly equated with a person’s signature on a consent form. A signature on a form is evidence that the person has given consent but is not proof of valid consent.

Consent may be given in writing or verbally. 

5.1 Valid Consent

To be valid, consent should be freely and voluntarily given. There should be no pressure or undue influence exerted on the individual by relatives, partners, or health care professionals. If the employee believes this is a risk, they should arrange to speak to the client on their own to establish that the decision is truly theirs.

The client must have the capacity to understand and retain information and weigh up the risks and benefits involved.

5.2 Types of Consent - Verbal (explicit) and non-verbal (implied or implicit) consent

Sometimes verbal consent may be referred to as explicit consent and non-verbal referred to as implied or implicit consent. 

An example of verbal or explicit consent would be where a doctor carries out an internal investigation and tells the person what they are going to do and asks them if they agree to the examination. If they agree this is explicit consent (verbal). 

An example of non-verbal or implied consent would be where a person, after receiving appropriate information holds their arm out to have their blood pressure taken or opens their mouth to have their teeth examined. However, the person must have understood what examination or treatment is intended and why, for such consent to be deemed as valid.

In all cases, staff should be aware of the different types of consent and the importance of making sure the person understands what is going to happen to them and what is involved. 

It will not usually be necessary to document the consent of a person we support for routine and low risk procedures, such as providing personal care. However, if you have any reason to believe that the consent may be disputed later or if the procedure is of particular concern to the person (for example if they have declined, or become very distressed about, similar care in the past), it is advisable to do so, as well as discussing the relevant team member.

5.3 Refusal of Consent 

If the process of seeking consent is to be a meaningful one, refusal must be an option. Any refusal to give consent, or difficulty in obtaining it because of suspected mental incapacity, should be recorded in the client’s daily record, together with an account of the actions taken to address the consequences of the decision or difficulty. Any valid decision by a service user to refuse or withdraw consent should always be fully respected.

An adult is entitled to refuse care or treatment except in circumstances governed by the Mental Health Act 1983. Adults with mental illnesses can refuse to consent to treatment for any procedure unconnected with their mental illness. The Mental Health Act (1983) sets out various legal rights that apply to people with severe mental health problems. The act also contains the powers which, in extreme cases, enable some people with mental health problems to be compulsorily detained in hospital. 

Employees should be aware of and understand what to do if a person refuses care or treatment or when consent is no longer valid. These details should be included in the person’s support plan and agreed with them and their representatives if necessary, for example if they have been assessed as lacking capacity. 

Where a person we support lacks the mental capacity (either temporarily or permanently) to give or withhold consent for themselves, no one else can give consent on their behalf. However, treatment may be given if it is in their best interests, as long as it has not been refused in advance in a valid and applicable advance directive.

If the person does not have the capacity to give or withhold the consent this fact should be documented in their care plan along with the assessment of the person’s capacity and a best interests meeting held. This should be attended by other professional’s and people closest to the person and agreements made and recorded.

The person carrying out the care or treatment is ultimately responsible for ensuring that the person is genuinely consenting to what is being done: it is they who will be held responsible in law if this is challenged later. 

5.4 Children and Young People

Children who understand fully what is being proposed can consent to treatment but may not be able to refuse treatment. In some cases, persons with parental responsibility, or a court, may be able to override the child's refusal. In such cases, it is important that the health professional seek legal advice as the issue may need to be determined by the courts.

5.5 Gillick Competence

In 1983 a criteria for establishing whether a child under 16 has the capacity to provide consent to treatment was developed. It was determined that children under 16 can consent if they have sufficient understanding and intelligence to fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options.

For a young person under the age of 16 to be ‘Gillick’ competent, s/he should have:

· the ability to understand that there is a choice and that choices have consequences

· the ability to weigh the information and arrive at a decision 

· a willingness to make a choice (including the choice that someone else should make the decision)

· an understanding of the nature and purpose of the proposed intervention 

· an understanding of the proposed intervention’s risks and side effects 

· an understanding of the alternatives to the proposed intervention, and the risks attached to them 

· freedom from undue pressure.

It is important to give children under 16 appropriate information depending on the age and communication skills.

5.6 Absence of consent

Although consent is generally required, it may not be needed in the following circumstances:

• Emergency situations where treatment is necessary to preserve health or life. The treatment must be in the best interests of the person we support until they recover, when longer term measures can be considered. This applies to children and adults. Please note: you must not provide treatment if an advance decision has been made, and you know the client would object to the treatment.

• Mental health: The Mental Capacity Act (2005) is designed to protect people who cannot make decisions for themselves. It explains when a person is considered to be lacking capacity, and how decisions should be made in their best interests.

• Children and young people under 16 years: A child client should be treated if they are in danger of death or serious disability where there is no one with parental responsibility prepared to consent and no time to make an application to court.

5.7 Points to consider before commencing treatment without consent

It is essential that:

• The decision is made carefully in consultation with the multi-disciplinary team and with relatives where appropriate 

• All decisions are made in line with local guidelines and protocols and based on professional and evidence-based practice 

• Any decisions are carefully documented. This includes clear reasons for the decision to treat without consent, how the decision was reached including details of assessment and outcome.

Should care and treatment be required in the above circumstances, an incident form must be completed and submitted