Declarations of interest CQC: Consent

Our consent to examination or treatment policy has recently been revised. This policy sets out the standards and procedures to assist our healthcare professionals in appropriately obtaining valid consent from patients before starting any treatment, physical investigations, or care.

Valid consent to treatment based upon patient understanding is central to all forms of healthcare, from providing personal care to undertaking major surgery. Seeking consent is also a matter of common courtesy between healthcare professionals and patients.

The context of consent can take many different forms, ranging from an active request by a patient for a particular treatment to the passive acceptance of a health professional’s advice. In some cases, the health professional will suggest a particular form of treatment or investigation and after discussion the patient may agree to accept it. In others, there may be a number of ways of treating a condition and the health professional will provide advice on the risks and benefits of each and will be available to assist the patient to decide between them.

Significant revisions to our policy include the inclusion of a quick reference guide at the beginning of the document incorporating the principles of consent, highlighting such important points as respecting patients’ views, checking whether patients understand what is being asked of them, and appropriately recording decisions. Whilst the overall consent process remains the same, the revisions are aimed at making the issue of consent clearer and easier for users to understand, including who should be involved in the consent process, how consent applies in emergencies, and how the condition of the patient can significantly affect any consent required.

The importance of the two stage consent process for non-emergency and elective procedures has also been emphasised. In most cases where written consent is required, treatment options will usually have been discussed well in advance of the procedure/s being carried out. There is now a clearer explanation of the two stage consent process, clearly highlighting the provision of information, discussion of options and initial decision making at stage 1, and then further confirmation of the patient’s continuing consent and understanding at stage 2.

For patients who entirely lack capacity, clearer advice is now given on optimising a patient’s overall understanding of the process. Best interest decisions and best interest meetings are explained in detail, and clearer guidance is given for when a patient is mentally able but physically unable to sign consent. The section relating to children and young people has been expanded and clearer explanations provided of ‘Gillick competence’, parental responsibility, and refusals of treatment.

The policy now contains references to the possibility of obtaining potential e-consent, and clearer guidance for departments who may wish to develop their own procedure specific consent forms, beyond those consent forms already approved for Trust use.

Finally, a section entitled ‘where to go for guidance’ has been added to the policy in the event that further advice is still required to support our health professionals in their roles.

You can access the policy on the policies and guidelines Alex page.