CH09-Consent to Care Policy
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Consent to Care Policy
1. Purpose
The purpose of this policy is to ensure that every individual receiving care from our organisation does so with full informed consent, in accordance with Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are committed to respecting each person’s right to autonomy and decision-making, ensuring that care and treatment are only provided when consent has been given or when a lawful process, such as the Mental Capacity Act 2005, is followed in the case of individuals who lack capacity.
Consent is not just a formality; it is a fundamental principle of dignity, respect, and ethical care. Every individual has the right to be involved in decisions about their care, and we ensure that they have access to all the necessary information, support, and opportunities to make informed choices. This policy outlines how we obtain, manage, and document consent while ensuring compliance with legal frameworks.
This policy is implemented in the context of the Health and Social Care Act 2008 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (as amended), including Regulation 9 (Person-centred care), Regulation 10 (Dignity and respect), Regulation 11 (Need for consent), Regulation 13 (Safeguarding service users from abuse and improper treatment), Regulation 17 (Good governance) and Regulation 18 (Staffing). It must also be read alongside the Mental Capacity Act 2005 and its Code of Practice, the Care Act 2014 and all relevant CQC guidance on these regulations. Care Quality Commission
2. Scope
This policy applies to all individuals who receive care in our organisation, as well as to the staff responsible for delivering that care. It includes:
- People we support, ensuring that their rights, choices, and preferences are respected.
- Staff members, including care workers, nurses, management, and external professionals providing care.
- Families, carers, and advocates, who may assist individuals in decision-making.
- CQC inspectors and regulatory bodies, to demonstrate compliance with legal and ethical standards.
This policy applies to all aspects of care and treatment, from day-to-day personal care (such as assistance with dressing and hygiene) to medical interventions and long-term care planning.
3. Related Policies
This policy is closely aligned with other policies that support best practices in consent and ethical decision-making. These include:
- Person-Centred Care Policy, ensuring that care is tailored to individual needs and preferences.
- Dignity and Respect Policy, emphasising the importance of treating individuals with respect and sensitivity.
- Mental Capacity and Deprivation of Liberty Safeguards Policy, outlining legal protections for individuals who may lack capacity.
- Safeguarding Adults from Abuse and Improper Treatment Policy, ensuring that consent processes prevent abuse or coercion.
- Communication and Engagement with Service Users and Families Policy, which promotes accessible and clear communication to support informed decision-making.
4. Policy Statement
Our organisation upholds the principle that care and treatment must only be provided with valid consent. We are committed to ensuring that individuals:
- Understand the care or treatment they are consenting to, including the benefits, risks, and alternatives.
- Are given the time and support they need to make an informed decision.
- Have their consent sought in a way that is accessible and appropriate for their needs.
- Can change or withdraw their consent at any time.
- Are protected when they lack capacity, ensuring that decisions are made in their best interests and in line with legal frameworks.
Consent is an ongoing process, not a one-time event. This means that individuals must be regularly consulted and their wishes respected as their circumstances or preferences change.
For the avoidance of doubt, consent to care and treatment under this policy is separate from consent as a lawful basis for processing personal data under data protection legislation. We will normally rely on legal duties and other appropriate lawful bases (such as provision of health or social care) when processing personal data, and will only rely on “consent” for data processing where this is appropriate, freely given and can be withdrawn without detriment to the person’s access to necessary care.
5. Implementation – How We Manage Consent to Care Efficiently
5.1 Understanding Valid Consent
For consent to be legally and ethically valid, three essential criteria must be met:
- Capacity – The individual must have the mental ability to understand and make a decision about their care.
- Voluntariness – The decision must be made freely, without coercion or undue influence.
- Informed Decision-Making – The individual must be provided with all relevant information, including the nature of the care, potential risks, benefits, and available alternatives.
To ensure these criteria are met, staff must assess each person’s ability to make decisions and provide the necessary information in an accessible and understandable way.
5.2 Obtaining Consent
Consent can be obtained in different ways depending on the nature of the care or treatment:
- Verbal consent is sufficient for everyday care activities, such as assisting with meals or dressing.
- Written consent is required for significant interventions, such as medical procedures, changes in care plans, or participation in research.
- Implied consent may be observed in routine care, such as when a person extends their arm for a blood pressure check. However, staff must always confirm that the individual is comfortable with the action being taken.
When obtaining consent, staff must ensure that individuals fully understand what they are agreeing to. This includes explaining the purpose of the intervention, possible risks and side effects, alternative options, and the right to refuse.
5.3 Supporting Informed Decision-Making
Our organisation recognises that some individuals may require additional support to understand their choices. To facilitate informed decision-making:
- Staff provide information in clear and straightforward language, avoiding jargon.
- Where needed, we arrange for translators, sign language interpreters, or communication aids.
- Individuals are given adequate time to ask questions and reflect on their options.
- Family members, advocates, or legal representatives may be involved, where appropriate, to support decision-making.
If an individual chooses to refuse treatment or care, their wishes must be respected unless there is an immediate risk of harm, in which case legal guidance must be followed.
5.4 Managing Consent When Capacity is in Question
All staff must apply the five statutory principles of the Mental Capacity Act 2005 when there are concerns about a person’s capacity to consent:
- A person must be assumed to have capacity unless it is established that they lack capacity.
- A person is not to be treated as unable to make a decision unless all practicable steps to help them do so have been taken without success.
- A person is not to be treated as unable to make a decision merely because they make an unwise decision.
- Any act done, or decision made, under the Act for or on behalf of a person who lacks capacity must be done, or made, in their best interests.
- Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be achieved as effectively in a way that is less restrictive of the person’s rights and freedom of action.
Capacity assessments must follow the MCA two-stage test, considering whether the person has an impairment of, or disturbance in, the functioning of the mind or brain and, if so, whether this means they cannot understand, retain, use or weigh the relevant information, or communicate a decision, in relation to the specific matter at the time it needs to be made.
If there are concerns about an individual’s ability to make an informed decision, we follow the Mental Capacity Act 2005. This includes:
- Conducting a formal capacity assessment to determine whether the person can understand, retain, and weigh the information necessary to make a decision.
- Making a decision in the person’s best interests if they are found to lack capacity, involving family members, advocates, and healthcare professionals.
- Following Deprivation of Liberty Safeguards (DoLS) when care arrangements significantly restrict a person’s freedoms.
- Respecting Advance Decisions and Lasting Power of Attorney (LPA) arrangements, ensuring that legally appointed representatives are consulted.
5.5 Documenting and Reviewing Consent
Consent must be properly recorded and reviewed on an ongoing basis. Our procedures include:
- Documenting all consent discussions in the individual’s care plan.
- Reviewing consent regularly to ensure that it remains valid and appropriate.
- Ensuring that individuals are aware of their right to withdraw consent at any time.
Staff are trained to immediately act upon any withdrawal of consent, adapting care plans accordingly.
5.6 Training and Responsibilities of Staff
To ensure compliance and high standards in consent management, all staff receive mandatory training on:
- The principles of informed consent and capacity.
- How to communicate effectively with individuals about their choices.
- Legal and ethical responsibilities, including the Mental Capacity Act 2005.
- How to recognise and respond to situations where consent is refused or withdrawn.
- Mandatory training on learning disability and autism, at a level appropriate to each person’s role and responsibilities, in line with section 20(5ZA) of the Health and Social Care Act 2008 (as amended by the Health and Care Act 2022) and the national standards and code of practice for learning disability and autism training.
The Registered Manager will ensure that this training is completed, refreshed and recorded for all staff, and that staff are able to demonstrate in practice how they use their learning disability and autism training to communicate effectively, support decision-making and obtain valid consent.
Managers are responsible for ensuring that staff are confident in applying best practices and complying with legal requirements.
5.7 Deprivation of Liberty Safeguards (DoLS) and Liberty Protection Safeguards (LPS)
At the time of this policy review, the Deprivation of Liberty Safeguards (DoLS) under the Mental Capacity Act 2005 remain the legal framework for authorising deprivations of liberty in care homes and hospitals for people who lack capacity. Staff must follow our Mental Capacity and DoLS Policy to ensure that any restrictions on a person’s freedom are lawful, necessary and proportionate, and that appropriate authorisations are obtained.
Although the Liberty Protection Safeguards (LPS) have been legislated for, they have not yet been implemented nationally. When the government brings LPS into force and issues updated statutory guidance and Codes of Practice, this policy and the related Mental Capacity and Deprivation of Liberty policy will be reviewed and updated accordingly. GOV.UK
6. Compliance with CQC Standards
This policy ensures full compliance with Regulation 11 – Need for Consent, which requires care providers to demonstrate that they:
- Seek and obtain valid consent before providing care.
- Provide individuals with adequate information to make informed choices.
- Recognise and uphold the rights of those who lack capacity, ensuring decisions are made lawfully.
- Maintain clear and accurate records of consent.
In meeting Regulation 11, we follow the Care Quality Commission’s current guidance on “Need for consent”, ensuring that staff who obtain consent are familiar with, and able to apply, the principles and Code of Practice of the Mental Capacity Act 2005 and that consent is obtained lawfully, voluntarily and on the basis of sufficient, understandable information. Care Quality Commission
In addition, our consent processes align with:
- The Care Act 2014, which emphasises individual choice and well-being.
- The Mental Capacity Act 2005, which provides a legal framework for decision-making for those who lack capacity.
- Regulation 10 – Dignity and Respect, ensuring that individuals’ rights and preferences are central to care delivery.
- Regulation 13 – Safeguarding from Abuse and Improper Treatment, preventing coercion or unauthorised care interventions.
7. Monitoring and Review
This policy will be reviewed annually or sooner if:
- Legislation or CQC requirements change.
- Internal audits identify areas for improvement.
- Service users, families, or staff raise concerns about consent practices.
The Registered Manager is responsible for ensuring that all staff adhere to this policy and that consent processes remain legal, ethical, and person-centred.
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