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Consent to Care and Treatment Policy & Procedures – Children and Young People (0–18 years)
1. Purpose
At {{org_field_name}}, we are committed to ensuring that all children and young people receiving our domiciliary care services – whether at home or in the community – are cared for in ways that respect their rights, dignity, and individual needs. This policy outlines our commitment to obtaining valid consent before providing care or treatment to any child or young person, and to making decisions in the child’s best interests in accordance with legal and regulatory requirements. By adapting our adult consent policy to the 0–18 age group, we ensure that both children’s voices and the role of parents or legal guardians are central to our care planning and delivery.
1.1 Upholding Children and Young People’s Rights in Decision-Making
Every child and young person has the right to be involved in decisions about their care to the extent that their age and maturity allow. We recognise that while parents or legal guardians will provide consent for those who are not yet able, children’s views and preferences must still be heard and taken seriously. This policy ensures that:
- Information is child-friendly and clear: Children, young people, and their parents/guardians are provided with accessible, age-appropriate information about care options, including benefits, risks, and alternatives. For example, staff may use simple language, pictures, or play-based explanations with younger children, and more detailed discussions with teenagers.
- Consent is given voluntarily: Decisions about care are made without coercion, undue pressure, or manipulation. Parents/guardians must be free to consent or decline services without pressure, and children and young people should not be forced to accept care they clearly do not want (except in extraordinary circumstances where it is necessary to prevent serious harm).
- Consent is specific and time-limited: Consent applies only to the particular care, support, or treatment agreed upon at that time. If new treatments, activities, or changes in the care plan arise, fresh consent is obtained from the appropriate decision-maker (and the child or young person is consulted according to their understanding).
- Right to refuse or withdraw: Individuals with the authority to consent (and, where applicable, competent young people themselves) have the right to refuse a proposed care intervention or to withdraw consent at any point. This policy emphasizes that even if a parent/guardian has consented, if a child is distressed by or consistently refuses a care activity, staff will pause and seek a solution in the child’s best interests rather than proceed against the child’s will.
- Communication needs and preferences are accommodated: We use appropriate communication aids and methods to ensure understanding. This can include easy-read materials, large-print or Braille (for visually impaired young people or parents), interpreters or sign language for those with language or hearing needs, and advocates or cultural mediators if needed. We are sensitive to cultural and religious values of families when discussing care options, so that consent is truly informed and respectful.
By upholding these principles, {{org_field_name}} ensures that children and young people feel safe and respected, and that parents and guardians are confident in how we involve them in decision-making.
1.2 Compliance with Legal and Regulatory Requirements
This policy aligns with all relevant legislation, regulations, and best practice guidelines governing consent for minors in health and social care in England. Key frameworks include:
- Children Act 1989 & 2004: These Acts establish the paramount importance of the child’s welfare in all decisions. They define parental responsibility and require that the child’s wishes and feelings be considered (in light of their age and understanding). Our consent procedures reflect these principles, ensuring the child’s best interests are at the forefront and that those with parental responsibility are appropriately involved in giving consent.
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Regulation 11 (Need for Consent): Care and treatment for a person of any age must only be provided with appropriate consent. For children under 18, this means consent from a person with parental responsibility or (where legally appropriate) from the child themselves. We comply fully with this regulation by always obtaining the necessary consent or authorization before delivering care.
- Mental Capacity Act 2005 (for 16–17-year-olds) and its Code of Practice: Young people aged 16 or 17 are presumed to have capacity to make decisions about their care unless assessed otherwise. If a 16–17-year-old is unable to make a particular decision due to an impairment of the mind or brain, we follow the Mental Capacity Act framework for assessing capacity and making best interests decisions. (Note: The Mental Capacity Act does not apply to those under 16, so decisions for younger children are made via parental consent or, if applicable, court decisions – always with the child’s welfare in mind.)
- Human Rights Act 1998 – Article 8 (Right to Private and Family Life): Children and their families have the right to respect for private and family life. Our consent policy supports this by involving families in decisions, respecting family roles and cultural values, and ensuring that any intervention in family life (such as providing care in the home or taking a child out into the community) is done lawfully and with consent.
- Fraser Guidelines (1985) and Gillick Competence (Gillick v West Norfolk, 1985): These important legal principles guide us when providing certain types of care or advice directly to an under-16 without parental consent. In the rare instances where a young person under 16 seeks or requires confidential care or treatment (for example, related to sexual health or other sensitive matters) without involving parents, staff will carefully assess the young person’s Gillick competence – i.e., their maturity and understanding of the proposed intervention. The Fraser guidelines (originally set out for contraceptive advice but now broadly informing practice) will be followed, meaning staff must be satisfied that: the young person understands the advice, cannot be persuaded to involve a parent, is likely to face harm without the treatment or advice, and it is in their best interests to proceed without parental consent. While our service primarily involves parental engagement, awareness of these guidelines ensures we uphold young people’s rights and safety in exceptional cases.
- Equality Act 2010: We do not discriminate in the consent process or service delivery on the basis of disability, language, culture, religion, or any protected characteristic. All children and families are treated fairly. Reasonable adjustments (such as communication aids or translated materials) are provided so that everyone can understand and consent to care.
- Data Protection Act 2018 and UK GDPR: We obtain consent for processing a child’s personal and health data in line with data protection laws. Typically, a parent or guardian will consent to the use and sharing of a young child’s information. For an older competent teenager, we also seek their own consent and respect their confidentiality rights (see Section 7). All personal information is handled lawfully and securely (see Section 7 for details).
- Health and Social Care Act 2008 (Regulated Activities) – Safeguarding Regulations: (Including references to the need for consent and protection from abuse.) If consent is withheld or if there are concerns about a parent’s decisions putting a child at risk, we follow safeguarding protocols. For example, if a parent refuses critical care for a child and the child’s health may suffer, or if we suspect a child is being coerced or abused, we will involve the appropriate authorities in line with safeguarding law and guidance (Working Together to Safeguard Children 2018).
- Deprivation of Liberty Safeguards (DoLS) and Court of Protection (for under-18s): By law, DoLS authorisations under the Mental Capacity Act 2005 formally apply only to adults (18+). However, 16–17-year-olds who lack capacity and are subject to very restrictive care arrangements may require legal authorisation through the Court of Protection. We adhere to case law which indicates that a parent cannot consent on a 16–17 year old’s behalf to a deprivation of liberty that meets the “acid test” (continuous supervision and not free to leave); instead, a court order is sought. For children under 16, any care plan that might severely restrict a child’s liberty (beyond normal parental control) would be handled with involvement of the local authority and courts as needed. In all cases, we act lawfully to ensure no child is deprived of their liberty unlawfully (see Section 5.7 for our procedure on this).
By adhering to these legal frameworks and guidelines, {{org_field_name}} ensures that our consent practices for children and young people are not only ethical and child-centred but also fully compliant with current laws, Care Quality Commission (CQC) regulations, and best practices in children’s social care.
1.3 Commitment to Child-Centred Care and Best Interests
At the core of our approach is a commitment to child-centred care. This means each child or young person is seen as an individual with unique needs, views, and potential. We recognise that children are not miniature adults – their care and consent needs require special consideration. To uphold this commitment:
- Active involvement: We encourage children and young people to participate in decisions about their care, proportionate to their age, maturity, and communication abilities. Even a very young child can often express likes/dislikes through behavior, and older children can articulate their wishes. We listen and adapt our care plans accordingly. Parents and guardians are engaged as key decision-makers, but we also create opportunities (such as informal conversations, using toys or communication aids) for the child to have a voice.
- Collaborative care planning: Care plans are developed in partnership with the child (as appropriate to their understanding), their parents or legal guardians, and any relevant professionals. Where a child is “looked-after” by a local authority (such as in foster care or under a care order), we also involve the child’s social worker or corporate parent in care planning and consent decisions. We ensure clarity on who holds parental responsibility in such cases so that the correct people consent to the plan.
- Respect for family and culture: We respect that parents and families know their children best. Staff will work collaboratively with families, respecting cultural, religious, or personal values that affect care preferences (for example, preferences about carers of a particular gender for personal care, or dietary practices). We provide guidance and information, but we do not override a fit parent’s decisions lightly. If we ever feel a parent’s decision may not align with the child’s welfare, we will discuss our concerns openly and, if necessary, follow safeguarding procedures – always aiming to keep families involved and informed.
- Empowerment and support: Our staff are trained to support children and families in making informed decisions. This includes using child-appropriate communication techniques (as detailed above) and giving families ample opportunity to ask questions. We take time to ensure that consent is not rushed – especially with potentially anxious children or parents – so that everyone is comfortable with the agreed care. If a child has disabilities or communication difficulties (for example, non-verbal autism), staff will utilise tools like visual schedules, social stories, or technology-assisted communication to help the child understand and participate as much as possible. Specialists or advocates may be involved if needed.
- Continuous review: Consent and care needs are regularly reviewed. Children grow and change quickly – what a parent consented to for a toddler may need revisiting as that child becomes an older child or teenager with their own views. Likewise, if a child’s health changes or they develop greater understanding, our approach to involving them in consent will evolve. We treat consent not as a one-time formality, but as an ongoing dialogue throughout the care relationship.
By placing the child or young person at the centre of all decision-making, while also supporting parents and guardians in their caring role, we ensure our service is responsive, respectful, and aligned with the child’s best interests at all times.
2. Scope
This policy applies to all employees, agency staff, and representatives of {{org_field_name}} who are involved in providing personal care or support services to children and young people (0–18 years) in any setting. This includes care delivered in the child’s own home as well as support in community settings such as parks, libraries, leisure centres, places of worship, schools or clinics (during appointments), youth groups, or during travel to and from such activities. Every member of staff must understand their role in obtaining, verifying, and documenting consent before providing care or treatment to a minor, and in respecting the decisions made by the child (when competent) or their parent/guardian.
The principles and procedures in this policy also guide how we work with external partners and the families of children in our care. While parents and legal guardians are not employees, our staff must collaborate with them and recognize their primary role in decision-making for their children.
Roles covered by this policy include:
2.1 Care Workers and Support Staff
Care workers, support workers, and personal assistants who provide direct care to children and young people are responsible for upholding consent requirements on a day-to-day basis. Their responsibilities include:
- Obtaining consent before each care intervention: Before delivering any personal care, support, or treatment, care staff must ensure that valid consent has been given. For a young child, this means confirming that the parent/guardian has consented to the specific care task (for example, consent for assistance with bathing or feeding as agreed in the care plan). For an older child or teenager who is assessed as capable of making that decision, this means also asking the young person’s permission and respecting their response. Care workers should never simply assume consent – they should actively seek a nod, verbal “okay”, or other indication from the child when about to assist, even if a parent’s general consent is on file.
- Providing information in an accessible way: Care workers must explain to the child (in a way the child can understand) what they are going to do, and provide explanations to the parent or guardian as needed. This might involve getting down to the child’s eye level and using simple terms (“I’m going to help you wash your hands now, is that alright?”) or using visual cues. For older youths, it means being honest and clear about what a procedure or activity entails. If the child or parent has questions, staff should answer patiently.
- Recognizing limits of a child’s capacity or willingness: Care staff should be attentive to signs that a child does not understand or is not comfortable. If a child appears unable to comprehend what is happening, staff must rely on parental guidance and possibly pause to explain differently or later. If a child resists or says “no” to a care activity, staff should stop and not force the issue. In such cases, they should calmly attempt to find out the child’s concerns, involve the parent for support, or try an alternative approach (for example, taking a short break and then attempting the task in a more playful or less threatening manner).
- Following the Mental Capacity Act framework for 16–17-year-olds: If a young person is 16 or 17 and there is doubt about their mental capacity to consent (perhaps due to a learning disability or illness), care staff must initiate a capacity assessment (see Section 5.3). They should involve their manager and document the findings. If the 16–17-year-old is found to lack capacity for the decision, staff must then ensure that any care provided is in the young person’s best interests and that a parent/guardian or relevant decision-maker is consulted.
- Respecting refusals and raising concerns: If a child (who is competent to do so) or a parent/guardian refuses a particular care or treatment, the care worker must respect this decision. The worker should document the refusal and inform their manager or supervisor, especially if the refusal could lead to health or safety risks. Staff should never ignore a refusal simply because consent was given previously or because they disagree; instead, they follow procedures for managing refusals (see Section 5.6) and seek guidance for next steps.
- Documenting consent and changes: Care workers need to document in the care records whenever consent is obtained (such as noting that a parent gave verbal consent for an outing to the park on a particular day, or that a teenager agreed to the care worker administering their medication). Any withdrawal of consent or change (for example, a parent changing their mind about a specific activity) must also be recorded promptly. This ensures the entire team is aware of the current consent status. Additionally, care staff should note the use of any communication aids or special techniques used to gain the child’s cooperation, as evidence of our efforts to secure truly informed agreement.
Through these actions, front-line care staff play a critical role in making consent a living, ongoing process and in protecting the rights and welfare of the children in our care.
2.2 Managers and Senior Staff
The Registered Manager, Care Coordinators, and other senior staff have a crucial role in implementing this policy and supporting care staff in complex situations. Their responsibilities include:
- Training and guidance: Ensuring that all team members receive training on consent procedures specific to working with children and young people. This includes understanding parental responsibility, how to assess Gillick competence, how to apply the Mental Capacity Act for 16–17-year-olds, and how to communicate effectively with children. Managers should also provide on-the-job guidance, for example, coaching a new care worker on how to ask a shy child for permission in a comforting way.
- Policy compliance monitoring: Managers must regularly monitor that consent is being properly sought and recorded. This can be done through spot-checks (e.g., observing an interaction to see if staff ask the child and inform them appropriately), audits of care records (ensuring consent forms and signatures from parents are in place, and that any capacity assessments or best-interest decisions are documented), and supervision meetings where consent scenarios are discussed.
- Best interests decision-making oversight: When a child or young person is unable to give consent themselves (due to age or lack of capacity), managers oversee the decision-making process to ensure it aligns with the child’s best interests. For instance, if a parent is unavailable in an urgent situation, or if there is disagreement between a parent and a capable teenager, the manager will lead efforts to resolve the issue—potentially convening a best interests meeting with input from health professionals or social workers. Managers use the framework of the Children Act (welfare of the child paramount) and, where applicable, the Mental Capacity Act’s best interests checklist to guide these decisions.
- Support in cases of refusal or withdrawn consent: If a parent or young person refuses recommended care and staff are concerned, the manager should step in to assess the situation. The manager might speak with the family to understand their perspective, provide additional information that might address their concerns, and evaluate any risks arising from the refusal. If necessary, the manager will coordinate with external professionals (such as the child’s GP, social services, or safeguarding leads) to ensure the child’s well-being is protected while respecting the family’s rights. Any decision to override a refusal (for example, seeking a court order for essential treatment) would only be done in extreme circumstances and with appropriate legal advice.
- Family and external liaison: Managers and senior staff engage with parents, legal guardians, and external partners to facilitate smooth consent processes. For example, when starting services for a new child, the manager ensures that the parental consent forms are explained and signed, and that any legal documentation (like proof of guardianship or care orders) are noted. In cases of looked-after children, the manager liaises with the local authority to confirm who may sign consents (e.g., foster carer for routine matters or social worker for significant medical treatment). They also ensure that any court directives (such as specific court orders about medical treatment or contact arrangements) are integrated into the care planning and consent process.
Managers and senior staff act as guardians of this policy’s implementation, making sure that front-line workers have the knowledge, support, and oversight needed to get consent right every time. They also ensure that difficult situations are handled lawfully and sensitively, with the child’s welfare as the top priority.
2.3 Roles in Assessing Competence and Capacity
When questions arise about a child’s or young person’s ability to consent or make decisions, specific roles and steps come into play:
- Front-line competence/capacity checks: Care staff and supervisors perform first-line assessments of a young service user’s decision-making ability. For children under 16, this means gauging the child’s Gillick competence in relation to the decision at hand – for example, can a 15-year-old fully understand what it means to accept or refuse a certain health-related intervention? For those 16 or 17, staff use the two-stage test under the Mental Capacity Act (Stage 1: Is there an impairment of mind or brain? Stage 2: Does it prevent the young person from understanding, retaining, using/weighing information, or communicating a decision?). These assessments are decision-specific; a young person might be able to decide some aspects of their care but not others. Staff must record in the care notes any observations or concerns about the child’s understanding and inform a manager promptly if a formal assessment is needed.
- Managerial oversight of assessments: The Registered Manager or a trained senior staff member reviews any capacity or competence assessments. They ensure documentation is thorough and that the correct criteria have been considered. For a borderline case (e.g., a 14-year-old who partially understands a decision but still struggles with the consequences), the manager might consult with another professional – such as a healthcare professional or psychologist – for a second opinion on the child’s capacity to decide. The manager leads formal best interests decision-making for those deemed unable to consent (see Section 5.4), ensuring that all factors (the child’s wishes, parents’ views, professional opinions, alternatives, etc.) are weighed carefully.
- Escalation for complex or disputed cases: If there is disagreement about a child’s competence or a high-risk decision is involved, the case is escalated. For example, if a capable 15-year-old wants to make a decision contrary to parental wishes, or if a 17-year-old with learning disabilities faces a major medical decision, the manager will likely involve multi-disciplinary input. This could include convening a best interest meeting with the child’s doctor, social worker, possibly an independent advocate for the child, and the parents. In extreme cases (like a refusal of life-saving treatment, or a need to impose very restrictive measures for safety), legal advice is sought and the matter may be referred to the Court (Family Court or Court of Protection, as appropriate) for resolution. Staff are instructed to always err on the side of caution and seek managerial help early in such scenarios.
- Involvement of legal representatives or advocates: While children under 18 cannot appoint Lasting Powers of Attorney (LPAs) for health/welfare (as adults can), some young people (16–17) may have a Court-Appointed Deputy for property or personal welfare if the Court of Protection has made such an order. If so, staff must consult that Deputy regarding decisions within their authority. Additionally, if a 16–17-year-old lacks capacity and has no family to speak for them, an Independent Mental Capacity Advocate (IMCA) should be appointed in line with the Mental Capacity Act – the manager will coordinate this. For younger children in local authority care, there may be a Children’s Guardian or advocate involved via the fostering/child protection process; staff should include them in planning if relevant. In all cases, any legally designated decision-maker’s input and authority must be respected and documented.
- Regular review of decision-making ability: A child’s capacity or competence can change over time. Staff and managers must regularly reassess – especially for conditions that fluctuate (e.g., a 17-year-old’s mental state) or as a child matures. For instance, a 12-year-old might not be competent to consent to a particular treatment today, but by 14 with more information and maturity, they might be. We build periodic reviews into our care plans, and whenever a child has a birthday or significant developmental change, we consider whether their role in decision-making should be adjusted.
By clearly defining these roles and processes, {{org_field_name}} ensures that no assumptions are made about a child’s ability to decide. We neither automatically defer everything to parents nor inappropriately burden a child with decisions beyond their understanding. Instead, we assess and support competence and capacity in a structured way, always with the child’s best interests as the guiding principle.
2.4 Administrative and Office Staff
Administrative and office staff, while not directly providing care, play an important role in managing consent documentation and communication:
- Records management: They maintain secure files of all consent-related documents. This includes signed parental consent forms for care and treatment, records of who has parental responsibility (copies of court orders, if applicable), consent for data sharing or media (e.g., if parents consent to photographs for progress records or social media, where relevant), and any advance decisions or emergency contact instructions provided by parents. These documents are kept up-to-date and accessible to authorized staff when needed.
- Data protection compliance: Office staff ensure that personal information about children and families, especially sensitive health or social care data, is stored and shared in line with GDPR and Data Protection Act requirements. For example, they will ensure consent forms for information sharing with schools or therapists are obtained if required, and that any databases or electronic care records have appropriate consent fields filled. When handling subject access requests (e.g., a parent requesting copies of their child’s care records, or an older young person requesting their own records), the administrative team will verify consent and identity and follow organisational protocols for release of information.
- Communication coordination: Where needed, administrative staff may help arrange translations of written materials (like service agreements or consent forms) for families whose first language is not English, or ensure that information is available in alternative formats (easy-read, large print) to support understanding. They also coordinate scheduling of any consent-related meetings (such as helping set up a best interests meeting by sending invitations to professionals and family members). If a parent or social worker contacts the office with an update to consent (for example, a written notice changing a permission), the office staff relay this information to the care team and update records accordingly.
- Monitoring expirations and updates: Some consents may be time-limited or require renewal (for instance, consent for administering a medication might need updating when the prescription changes, or general consent forms might be reviewed annually). Administrative staff keep a calendar or reminder system for such key dates and prompt managers or care staff to renew consents as needed. They also track any Court authorisations for depriving liberty (for 16–17-year-olds) to ensure renewals are sought on time and that the CQC is notified if required.
In essence, administrative staff provide the backbone of documentation and regulatory compliance, ensuring that all consent and legal authority paperwork is in order so that front-line staff can confidently deliver care within the agreed parameters.
2.5 Other Professionals and External Partners
Our work with children often involves collaboration with other professionals and agencies. This policy extends to and informs how we engage with them in matters of consent:
- Healthcare professionals: We frequently interact with GPs, paediatric nurses, therapists (occupational therapists, speech & language therapists, etc.), and clinic staff as part of a child’s care. We will only share a child’s personal health information with these professionals with proper consent (see Section 7 on data protection). Before sharing reports or discussing a child’s condition, we ensure the parent/guardian (or competent young person) has consented to that exchange of information. In joint meetings (e.g., multidisciplinary team meetings about a child’s care plan), we ensure that consent for our involvement and information sharing has been obtained. We also respect any specific instructions from healthcare providers regarding consent (for example, if a hospital requires a separate consent form for a particular procedure, we coordinate with the family to facilitate that).
- Social Workers and Local Authorities: For children who are under local authority care or who have social worker involvement (such as child protection plans or children in need), we work closely with these professionals. We clarify at the outset what decisions the social worker or authority is authorised to make and which remain with the parents. For instance, under a Care Order, the local authority shares parental responsibility and may have the right to consent to medical treatment – we will obtain written direction on this. If a child is voluntarily accommodated (Section 20 of Children Act 1989), the parent retains full parental responsibility, so we make sure to obtain parental consent for all care as usual, while keeping the social worker informed. Any time we provide care or an outing beyond normal routines, we ensure the appropriate party consents (e.g., a foster carer might consent to a routine activity if that authority is delegated, but a social worker might need to consent to more significant matters like surgery). All such communications are documented.
- Schools, Youth Groups, and Community Organizations: If part of our service involves taking a child to school or a youth club, or working alongside school staff or volunteers, we ensure that boundaries around consent are clear. We will have consent from parents for the child’s attendance or participation in those activities (typically the parent handles consent with the school/youth group directly, but we will confirm this). When at a school or public venue, our staff follow both our consent policy and any applicable policies of that institution. For example, if a school requires separate consent for a school trip, we will not assume the parent’s consent to our service covers it – instead, we’ll coordinate with the school and parent to make sure all permissions are in place.
- Advocates and Guardians ad Litem: In situations where an older child has an independent advocate (for instance, an advocacy service for a looked-after teenager) or a Guardian ad Litem appointed in court proceedings, we respect the role of these individuals in representing the child’s wishes. While they may not have legal authority to consent to treatment, their insights help ensure the child’s voice is heard. With appropriate consent, we will share necessary information with them and involve them in planning meetings.
- Legal representatives: If there are ongoing legal proceedings or if a court-appointed representative (such as a deputy or a child’s solicitor in a family court case) is involved, staff cooperate with them under guidance from management. We may be required to provide records or statements regarding consent matters (e.g., confirming that a parent consented or that a child expressed certain wishes). We do so transparently and with respect for confidentiality protocols.
By working collaboratively with these external partners and clearly defining consent-related communications, we ensure consistency and protect the child’s welfare across all settings. All external parties working with {{org_field_name}} are expected to uphold the same high standards of consent and confidentiality that we do.
3. Legal and Regulatory Framework
Our Consent to Care and Treatment Policy for Children and Young People is grounded in the following legal and regulatory frameworks (as updated to the present date):
- Children Act 1989 (and 2004 amendments): Establishes the fundamental principle that the child’s welfare is paramount. It provides the structure for parental responsibility and decision-making for minors. Under this Act, those with parental responsibility (usually parents, and in some cases the local authority or guardians) have the authority to consent to a child’s care and treatment, except where a competent child’s own decision is deemed paramount. We adhere to the Children Act’s requirements by ensuring consent is obtained from the correct individuals and by involving children in accordance with their age and understanding.
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Regulation 11 “Need for Consent”: A CQC regulation mandating that care and treatment are provided only with consent. For our service, this means we must have valid consent from a child or their parent/guardian (as appropriate) before delivering personal care or any intervention. We are vigilant in meeting this regulation to maintain our registration requirements and high standards of care.
- Mental Capacity Act 2005 (MCA) and its Code of Practice: Applicable to young people aged 16 and 17 in matters of consent. The MCA presumes capacity unless proven otherwise and provides a clear process for assessment and best-interests decision-making if capacity is lacking. We integrate MCA principles (like assuming capacity, supporting decision-making, allowing unwise decisions, acting in best interests if no capacity, and choosing the least restrictive option) in our work with 16–17-year-olds. While the MCA does not cover under-16s, its spirit of empowering individuals and carefully judging capacity informs how we assess Gillick competence in younger teens as well.
- Gillick Competence and Fraser Guidelines: Stemming from the landmark 1985 case, these are not statutes but are critical legal precedents in England. Gillick competence guides us in evaluating if an under-16 has sufficient intelligence and understanding to consent to their own treatment or care decision. The Fraser guidelines (a subset of Gillick, specific to contraceptive advice) exemplify circumstances under which a professional might proceed without parental consent in the child’s best interests. Our policy explicitly incorporates these concepts to guide any scenario where a young person seeks confidentiality or where their wishes might differ from their parents’.
- Human Rights Act 1998: Particularly Article 8 (right to respect for private and family life) and Article 5 (right to liberty and security). These rights underscore the importance of obtaining consent and using the least intrusive interventions. For example, forcing care on a competent young person or removing them from family care without process would breach these rights. We ensure that all actions (especially any that might restrict freedom, such as constant supervision or use of restraints for safety) are lawful, proportionate, and necessary – with appropriate consent or legal authorization.
- Equality Act 2010: Mandates equality and non-discrimination. In the context of consent, this means we must ensure no child or parent is treated less favorably in how we seek or respect consent due to disability, race, religion, gender, etc. We provide interpreters, translated materials, or other adjustments to ensure everyone has an equal opportunity to understand and decide about care.
- Data Protection Act 2018 & UK GDPR: These govern how we collect, use, and share personal information, requiring consent for many activities involving personal data. With minors, typically a parent/guardian’s consent (or authority under law) is obtained for processing data, especially for younger children. We also acknowledge that older teenagers may have rights regarding their own data privacy. Our practice is to uphold confidentiality appropriately (for example, a 17-year-old’s health details may not be shared with a parent against their wishes if the young person is competent, unless there is a safeguarding risk – aligning with GDPR’s provisions on children’s data rights). All handling of children’s data is done lawfully, with clear consent or another legal basis, and we inform families and young people of their data rights (see Section 7 for more details on data consent).
- Care Quality Commission (CQC) Standards and Guidance: CQC expects providers serving children to have robust consent processes. This includes guidance like CQC’s Mythbuster on Gillick competency and Fraser guidelinescqc.org.uk which we follow. We remain up-to-date with any CQC publications or statutory guidance (such as “Working Together to Safeguard Children”) that influence consent and best-interest practices.
- Court of Protection and Family Court rulings: We abide by relevant case law, such as Re D (2019) regarding deprivation of liberty for under-18s, or any specific court orders pertaining to our service users. If a court has made a decision about a child’s medical treatment or living arrangements that impacts consent (for example, a Specific Issue Order or an order authorising a treatment), we incorporate those directives into our care planning.
By embedding these legal frameworks into our policy, we ensure that consent for children and young people is managed lawfully and ethically. All staff are expected to be familiar with the above principles and seek managerial advice whenever they are unsure how a law or regulation applies in a given situation.
(Note: This framework list is not exhaustive; staff should also be mindful of any new legislation or guidance issued after this policy’s last update. Managers will communicate and incorporate such changes through policy reviews and training.)
4. Principles of Consent with Children and Young People
{{org_field_name}} recognizes several core principles that underpin valid and meaningful consent in the context of children’s care. These principles mirror those for adults in many respects (voluntariness, information, specificity, etc.), but with additional considerations given the involvement of parents and the developmental stage of the young person.
4.1 Consent Must Be Voluntary (Free from Coercion)
Consent is only valid if given freely. For children and young people, this principle applies to both the child (if they are old enough to express a view) and their parent or legal guardian:
- No undue pressure on parents/guardians: Staff must ensure that parents or carers are not coerced or unduly influenced when they give consent for their child’s care. We provide information and professional recommendations, but we respect the family’s right to decide. If a parent seems hesitant or feels pressured by, for example, other family members or even the child, we offer private discussion to let them decide without fear of judgment.
- No force or intimidation on the child: Even if a parent has consented, we strive never to force care on an unwilling child except in emergencies. Creating a supportive environment is key – children should feel comfortable saying if they are scared or if something hurts. Staff use gentle encouragement and reassurance, not threats or bribes, to gain a child’s cooperation. Physical restraint or compelling a child to accept care (like forcing a child to take a bath or medicine) is only considered if immediate harm will occur without intervention, and even then it must follow appropriate safeguarding and best-interest protocols.
- Awareness of subtle influence: Children often want to please adults. Staff should be cautious that a child’s “agreement” is not merely compliance due to authority. For example, a child might nod “yes” because they feel they must. To counter this, staff might ask in multiple ways (“Is this okay? You can tell me if you want me to stop at any time.”) and watch body language. With parents, we ensure they know they can change their minds later – consent is an ongoing choice, not a one-time trap.
- Addressing undue influence from others: If we suspect someone is influencing a child or parent inappropriately – perhaps a parent insisting on a treatment the competent teenager doesn’t want, or a situation of potential domestic abuse where a parent is not free to voice refusal – staff should report these concerns to the manager. The manager can then take steps, such as speaking separately to the individuals or involving safeguarding services, to ensure the decision is truly voluntary.
By guarding against coercion, we uphold the integrity of consent. The goal is that any “yes” to care or treatment is genuine and unpressured, coming from trust and understanding, not fear or force.
4.2 Consent Must Be Informed
A consent decision is only meaningful if it’s based on adequate information. We must ensure that parents/guardians and, when appropriate, the child or young person, have all relevant information presented in a way they can understand. Key aspects include:
- Explanation of the care or treatment: We clearly explain what we are proposing to do. For a young child, this might be a simple description (“We will have someone help Alex brush his teeth every morning and night, like we showed you, to keep his teeth healthy.”). For a teenager or a parent, we provide a fuller picture (“The care worker will administer your insulin injections at the scheduled times. This involves using a small needle to inject the insulin under the skin. We will show you exactly how it’s done and it should only take a minute each time.”). We avoid jargon and check understanding by asking them to repeat back or ask questions.
- Benefits and expected outcomes: We inform what the intended benefit or goal of the care is. For example, “Having a care worker assist with exercises will help strengthen your legs so you can walk more steadily,” or to a parent, “This support will give you a break and ensure your child’s needs are met safely, which can improve their overall well-being.” We also communicate the importance of the intervention if it’s critical (e.g., “Taking this medication will help prevent seizures”).
- Risks or discomforts: We honestly share any potential risks, side effects, or downsides of the care or treatment. Many of our domiciliary care tasks are low-risk, but if there are any (like the risk of skin irritation from a particular medical cream, or the small risk of a fall during mobility support), we tell the parent and child (in an age-appropriate way). We also discuss what we will do to minimize these risks (e.g., “We always have two people to help with the hoist to make it as safe as possible.”). For more invasive procedures (perhaps assisting with injections or catheter care), we explain that there might be some discomfort and how we mitigate it.
- Alternatives: We outline any alternative options. For example, if a parent is not comfortable with a certain care approach, are there other ways to achieve the goal? We might say, “If you prefer not to use a hoist for transfers, you could consider adaptive equipment like a transfer board, though that may require more physical effort from you and the child.” Or to a young person, “If you don’t want our staff to help you shower, would you prefer if a male worker assists you, or would you rather a family member do it? We can adjust the plan.” We include the option of doing nothing (and explain consequences of that) in our discussion: “You have the right to decline this support. If you choose not to have help with feeding, we respect that, but we worry you might not get enough nutrition. Perhaps we can find a compromise or try again later.”
- Right to refuse or change mind: We reinforce that saying “yes” now doesn’t lock them in forever. Parents and young people are reminded they can withdraw consent at any time. For example, we tell parents, “If at any point you feel uncomfortable with how the care is going, just let us know and we can pause or make changes,” and to children who can understand, “If you want me to stop, just say ‘stop’ or raise your hand, and I will stop immediately.”
- Use of communication aids: To truly inform, we adapt our communication to the individual. For children, this might mean using storybooks or social stories that depict a character experiencing similar care. We might show pictures of the equipment we’ll use or even do a “show and tell” where we demonstrate on a doll or on ourselves (e.g., putting a bandage on our own arm first) to reduce fear. For parents with limited literacy or English proficiency, we may use interpreters or translated written summaries. If a child has special communication needs (like using Makaton signs or an AAC device), we involve specialists or the family to use those tools during explanation.
In practice, “informed consent” is a process, not a single event. We often need to explain things more than once and encourage questions. We document that we have provided information and the individual appeared to understand (or note if they did not). By ensuring consent is informed, we uphold the ethical standard that consent is not just a formality, but a knowledgeable choice.
4.3 Consent Must Be Specific and Time-Limited
Consent in our context is not a blanket permission forever—it must be specific to particular interventions and is valid only for a defined period or circumstance. We observe the following:
- Task-specific consent: We obtain consent for each type of care or treatment we provide. For example, a parent’s consent for help with personal care does not automatically imply consent for administering medication or taking the child on outings; each of those aspects would be discussed and agreed upon separately. Our care plans itemize the services (e.g., assistance with dressing, meal preparation, mobility support, etc.), and consent is documented for each service.
- Context-specific consent: Consent may vary by setting. A parent might consent to care being provided at home but may have reservations about the child being taken out into the community. We clarify these details in advance. Similarly, if a parent consents to community activities, we specify what kind (e.g., going to specific clubs or public places) and any boundaries (like requiring advance permission for trips beyond a certain distance or high-risk activities like swimming).
- Duration of consent: Consent is not open-ended. We typically treat consent as current for the duration of the agreed care plan or until circumstances change. However, certain consents have natural time limits—for instance, consent for medical treatment might be just for the course of that treatment. When we commence services, we often ask parents to sign forms that cover routine care tasks for, say, the next six months as per the care plan, but we will review this regularly (see 4.5 on ongoing review). If new services are introduced (for example, starting to use a new piece of equipment, or adding an additional weekly outing), we seek fresh consent for those additions.
- Changes require new consent: If there is any significant change in the care or treatment, we consider the previous consent no longer sufficient. For example, if a different procedure is needed, a new caregiver is introduced for intimate care, or the frequency/intensity of support changes, we discuss and reconfirm consent. This protects both the family’s autonomy and us as a provider. We document these updates (e.g., “On [date], discussed and obtained parental consent to add medication administration at lunchtime visit”).
- One-off or emergency situations: Sometimes we need immediate consent for something not previously covered (like attending an unplanned medical appointment, or dealing with an injury). In such cases, we obtain verbal consent on the spot from the parent or young person (if they are competent) for that specific situation. This verbal consent is later documented in writing. If a child needs urgent help and parents are not reachable, we act in the child’s best interests (for example, calling emergency services) and inform parents as soon as possible – such interventions are allowed under common law to prevent serious harm, but we treat them as exceptions.
By ensuring consent is specific and time-limited, we avoid “blank cheque” consents and maintain clear boundaries of what has and has not been agreed. Families thus remain in control of the caregiving process for their child, and young people remain in control of decisions they are capable of making.
4.4 Assessing Capacity or Competence When Necessary
Because minors are involved, determining who can give consent (child or parent) depends on the child’s age, maturity, and mental capacity. Staff must always consider whether the child or young person is able to understand and decide for themselves, and if there’s any doubt, carry out an appropriate assessment:
- Gillick competence for under-16s: If a child under 16 seeks to make a decision about their care or expresses a strong preference that differs from their parent’s, staff should assess the child’s competence regarding that specific decision. This involves engaging with the child to gauge their level of understanding: Can they comprehend what the care involves, its benefits and risks? Do they understand what might happen if they refuse? Can they express clear reasons for their choice? For example, a 15-year-old with diabetes might refuse assistance with insulin injections because they want privacy. We would talk to them about why the injections are needed, ensure they understand the health implications, and assess if they can self-administer or manage with less supervision. If they demonstrate sufficient understanding and reasoning, they may be deemed Gillick competent to decide on that aspect of care, and we would respect their decision (while perhaps negotiating a safe compromise). We document the factors considered in determining competence. If they are not fully competent (perhaps misjudging the consequences), we then rely on parental consent while still involving the young person as much as possible.
- Mental Capacity Act assessments for 16–17-year-olds: Once a young person is 16 or 17, in law they can generally be treated as an adult for consent purposes, provided they have capacity for the decision. If there is any reason to believe a 16/17-year-old might lack capacity (due to learning disabilities, brain injury, severe mental health issues, unconsciousness, etc.), staff must initiate a formal capacity assessment under the MCA. We use the two-stage test: (1) Is there an impairment or disturbance in the mind/brain? If yes, (2) does it make the young person unable to understand, retain, use/weigh information about the decision, or communicate their decision?. This assessment is decision-specific; a 17-year-old might lack capacity for complex medical decisions but still have capacity to consent to simpler aspects of daily care. If the outcome is that they lack capacity for the matter at hand, we then move to a best interests decision (involving parents and professionals – see 4.5 and Section 5.4). If they have capacity, we seek consent directly from them, not just the parents.
- No assumptions based on disability or age alone: Staff must remember that a young person’s disability or diagnosis does not automatically mean they can’t decide. Many 16-year-olds with disabilities are fully capable of understanding their care. Conversely, age alone doesn’t guarantee understanding – an impulsive 17-year-old might not fully appreciate risks in some cases. Each situation is judged individually. Also, a child’s competence can develop over time; we might find a 13-year-old not competent to consent to managing their medication one year, but at 14 or 15, with support and education, they become competent. So we remain open to re-assessing competence as children grow.
- Involving experts if needed: For tricky assessments, we will involve relevant experts. For example, if it’s hard to tell how much a non-verbal child understands, we might get input from a child psychologist or speech and language therapist. If a 16-year-old’s capacity is unclear, we might seek an opinion from their doctor or refer to a specialist. We may also involve an advocate to help elicit the child’s true wishes. The goal is to get it right – neither denying a capable young person their right to decide, nor burdening a child with a choice they cannot fully grasp.
When there is doubt about a child’s capacity or competence, the default is to assume they do not have full capacity until an assessment indicates otherwise (this is slightly different from adults, where we assume capacity – but with children, developmental maturity is a factor). We then proceed with appropriate safeguards, always documenting the rationale for our decision on who consents.
4.5 Consent Is Ongoing and Can Be Withdrawn at Any Time
Consent is not a one-off event; it is a continuous, revocable agreement that can change as circumstances change. For children’s services, this principle means:
- Parents/guardians can change their mind: A parent who consented to a service or treatment yesterday has the right to withdraw that consent today, even if we believe the service is beneficial. They might do so because of a change in personal circumstances, new information, or simply a change of heart. We must respect this. For instance, if a parent decides they no longer want a care worker to take their child out to the playground, we will immediately cease that activity and adjust the care plan, rather than insist on continuing because it was previously agreed. We will discuss their concerns and see if any adjustments could address them, but we will not continue against their wishes.
- Children and young people can withdraw consent/assent: If a young person who has given consent (or assent) decides to withdraw it, we also respect that. For example, a 17-year-old who agreed to daily physiotherapy might later refuse to continue. Provided they have capacity, that refusal stands – we will inform their parents and doctor about the decision and the potential consequences, but we will not force therapy. If a younger child who cannot formally consent still clearly withdraws cooperation (like a 5-year-old who one day absolutely refuses to let the care worker help with toileting), we interpret that as the child communicating dissent, and we would not proceed at that moment. Instead, we’d pause, inform the parent, and try to understand the child’s feelings. Perhaps the child is experiencing pain or embarrassment that needs addressing.
- Documentation of withdrawal: Any withdrawal of consent (whether by the parent or the young person) must be promptly and clearly documented in the care record. We note what was withdrawn (e.g., “Parent withdrew consent for respite care outings effective immediately”), when, and if a reason was given. We also document our response (e.g., “Explained potential risks of not continuing medication; parent understands and still declines. Advised to contact GP to discuss alternatives. Care plan updated accordingly.”). This documentation helps ensure all staff are aware of the change and protects the organisation by showing we responded appropriately.
- Risks and safeguarding on withdrawal: In some cases, withdrawing consent could pose a serious risk to the child’s health or safety. For example, if a parent refuses a critical medication or a young person with capacity refuses life-sustaining treatment. In such situations, we have a duty of care to the child. We will sensitively explain the risks to whoever is refusing and attempt to find solutions (maybe there’s an alternative they’d accept?). If the risk is of significant harm, we treat it as a safeguarding matter: we might need to involve the child’s GP urgently, inform the local authority if it could be seen as medical neglect, or seek legal advice on whether an intervention should be sought via the courts in the child’s best interests. These steps are taken with caution and usually as a last resort. Our policy is to use persuasion and support to encourage needed care, not coercion, but we won’t passively allow a child to come to serious harm if there are lawful avenues to prevent that.
- No retaliation or prejudice: If consent is withdrawn, we do not penalize or treat the family differently. For example, a parent is free to decline part of the service without fear that we will withdraw other services in retaliation. We continue to provide any other agreed care in a professional manner and keep communication open, in case they reconsider in the future or new solutions are found.
In summary, consent is an ongoing conversation. We periodically reconfirm consent during care reviews or even informally (“Is everything still okay with the plan we discussed?”). We remain alert and responsive to any indication that a parent or child is no longer comfortable with something. By doing so, we honor their autonomy and maintain trust.
5. Decision-Making Procedures for Care of Children and Young People
This section outlines how {{org_field_name}} puts the above principles into practice, with step-by-step procedures and guidance for common scenarios. Our aim is to support sound decision-making that respects the child, empowers the family, and meets legal obligations.
5.1 Supporting Children’s Involvement in Decision-Making
We are committed to helping children and young people participate in decisions about their care to the fullest extent possible. This means creating an environment and using methods that make it easier for them to understand and express themselves:
- Tailoring communication to the child’s level: Staff should always explain what they are doing or planning in a way that suits the child’s age and cognitive level. With very young children, this might mean using a warm tone, smiles, and simple words (“Now it’s time for a bath, okay?”). For school-age children, we can give slightly more detail and maybe choices (“Do you want your carer to help you with a shower tonight or would you rather a bath? We can play your favorite song during bath time.”). Teenagers generally appreciate being spoken to nearly as adults – we use clear, respectful language and avoid talking down to them.
- Using visual and interactive tools: Many children, especially those with communication difficulties, benefit from visual aids. We might use picture cards or a visual schedule that shows the steps of their routine (“First dinner, then TV, then bath time with help”). Some children respond well to social stories (short illustrated narratives) that depict them doing a task with the caregiver, which can reduce anxiety and give them a sense of control. We also encourage children to use tools like communication boards, sign language, or apps if they have them – staff receive training to use these effectively.
- Encouraging questions and feelings: We let children know it’s okay to ask questions or even say if they don’t like something. For example, a child might ask, “Why do you have to do that?” when we clean a wound. We would answer honestly but gently (“To keep it from getting germs and hurting more later. I know it stings a bit now, but I’ll be quick and careful.”). If a child says “I don’t want you to do that,” we explore why – maybe it’s fear of pain or shyness. This dialogue can lead to solutions like using numbing cream or having a parent present. The key is children feel heard.
- Offering choices: Even when a child cannot choose whether to receive care (because the parent’s consent ultimately governs essential care), we can still offer choices in how it’s delivered, which gives the child a sense of agency. For instance, “Which toy will you hold while I change your dressing?” or “Do you want to take your medicine with apple juice or water?” or “We need to do exercises for your leg – should we do it before or after your favorite TV show?” These little choices can make a big difference in cooperation and comfort.
- Involving children in care planning (age-appropriately): For older children and teens, we invite them to care plan reviews or parts of it, if they wish. We might ask a 14-year-old, “How do you feel about the help you’re getting? Is there anything you’d like done differently?” or “What goals do you have that we can help with?” Some might be shy, so we might gather their views separately and bring them to the meeting. For children who can’t speak for themselves, we observe their reactions to care and note what seems to make them happy or upset, bringing those observations into planning (“He seems to enjoy when you sing during the bath, maybe we should always do that because it keeps him calm.”).
- Advocacy services: If a young person has difficulty expressing their views or if decisions are particularly complex, we inform them and their family about advocacy. An independent advocate (especially for those in care or with special needs) can help ensure the child’s voice is not lost. With consent, we welcome advocates into discussions and heed their input.
By proactively supporting children’s involvement, we ensure that care is not something merely “done to” them but a collaborative process in which they are active participants as much as possible. This leads to better outcomes and a stronger sense of trust and empowerment.
5.2 Assessing Gillick Competence (Under 16) in Practice
When a child under 16 seeks to make a significant decision about their care or treatment, or when we feel they may be mature enough to have a say beyond what is typical for their age, we carry out a Gillick competence assessment. Here’s how staff approach this:
- Identify the decision and the stakes: First, be clear on what specific decision is at hand. Is it about consenting to a medical treatment? About sharing information with a parent? About accepting or declining a particular service? Also, assess how serious the consequences are. The more serious, the more carefully we must tread (especially if the child’s view conflicts with medical advice or parental wishes).
- Discussion with the child: A suitably trained professional (this could be our Registered Manager, a senior nurse if involved, or the care coordinator) will have a private, age-appropriate conversation with the child or young person. In this, we gently probe their understanding. For example, if a 15-year-old diabetic client says they don’t want our staff overseeing their insulin, we’d ask: “Can you tell me what happens if your blood sugar gets too high or low? What would you do if you started feeling sick?” etc. We’re checking if they grasp the importance of the treatment, the risks of not doing it or doing it incorrectly, and if they have a plan.
- Criteria for competence: We consider key factors, much like a mental capacity assessment but without the formal MCA structure. Does the child understand the nature and purpose of what’s being decided? (e.g., they know what insulin does). Can they understand the potential benefits of one choice and the harms of another? (e.g., continuing treatment vs stopping). Can they weigh those pros and cons in their mind and arrive at a reasoned preference? And can they communicate their decision clearly? A competent child might say, “I know I need insulin to stay healthy. I just don’t want someone coming to my school to give it; I can manage it with the school nurse instead.” This shows understanding and reasoning. Another child might say, “I hate needles so I’m not taking insulin anymore,” without appreciating that it could be life-threatening — indicating a lack of competence about the consequence despite understanding the immediate act.
- No fixed age threshold: There is no specific age where a switch flips. Some 14-year-olds might be as mature as a typical 16-year-old; some 15-year-olds might have very limited understanding. So we take it case by case, and often in consultation with others (parents, healthcare providers who know the child, etc., while respecting the child’s privacy if needed). We avoid making assumptions (“he’s 15, so he must be competent” or “she’s only 13, so she can’t possibly understand”) and instead gather evidence from dialogue.
- Documenting the decision: If we conclude the child is Gillick competent for that decision, we document the basis: e.g., “After discussion on [date], [Child’s Name], 14 years old, demonstrated a clear understanding of [issue]. He can explain in his own words the benefits and risks and has consistent reasoning. Assessed as Gillick competent to consent to/decline [specific treatment].” We would then proceed in line with the child’s wishes, possibly still informing the parents depending on the situation (noting that if the child explicitly wants confidentiality – like a sexual health matter – we may not inform parents, in line with Fraser guidelines and safeguarding checks). If we find the child not competent, we document that too: “Child unable to adequately understand/weigh the information at this time; will seek parental consent for this decision.”
- Respect and revisit: Being deemed Gillick competent in one area doesn’t mean the child runs all decisions, but it sets an important precedent in that area. We will continue to involve them closely and respect their choices on that matter. If a competent child consents to something against a parent’s objection, we may still need legal input (as parents could challenge), but generally the child’s competent consent is enough to proceed with care. If a competent child refuses a service or treatment that the parent wants, things can be more complex – often healthcare professionals or courts might need to get involved for serious matters (since a refusal that leads to harm can be overridden). Our role is to support the child’s voice and ensure any override is done lawfully and as a last resort. We will regularly revisit competence as the child grows; competence can increase, and rarely, decrease if circumstances change.
In summary, assessing Gillick competence is about recognizing and empowering those young people under 16 who have the maturity to make their own decisions, while continuing to safeguard their welfare. It’s a delicate balance, but one that is crucial for respecting young people’s rights.
5.3 Decision-Making for 16–17-Year-Olds under the Mental Capacity Act
For 16 and 17-year-olds, the law generally treats them more like adults regarding consent to treatment and care. We presume a 16+ young person has capacity to make decisions about their care, unless evidence suggests otherwise. Our procedures for 16–17-year-olds are:
- Presume capacity, engage directly: By default, we will seek consent directly from a 16 or 17-year-old for the care and support we provide to them, just as we would for an adultcqc.org.uk. We still involve their parents in discussions (especially if the young person is living at home and the parents are part of their support network), but we respect the young person as the primary decision-maker. For example, in planning a 17-year-old’s personal care routine, we ask them what they want and get their agreement on the plan, while also taking parents’ views into account for practicality or additional insight.
- Capacity assessments when needed: If there’s reason to think a 16/17-year-old cannot make a specific decision, we carry out a Mental Capacity Act assessment (as described in 4.4). This might be the case if the youth has a significant cognitive impairment, is unconscious, or has severe mental health issues affecting judgment. We ensure assessments are decision-specific – someone might be able to consent to daily care but not manage financial decisions, for instance. If the outcome is has capacity, then their decision (consent or refusal) stands, even if parents disagree (parents cannot override a capacitated 16/17-year-old’s decision to accept or refuse care, though again, courts can intervene in extreme cases like refusal of life-saving treatment). If the outcome is lacks capacity for that decision, we proceed to best interests as below.
- Best interests process (MCA) for 16–17 lacking capacity: When a 16 or 17-year-old is assessed as lacking capacity, we then follow the formal best interests checklist of the MCA. We involve the young person as much as possible (even if they can’t decide, they may express feelings or preferences). We consult their parents/guardians and anyone else who cares for or knows the young person well (e.g., other relatives, caregivers, healthcare professionals). We consider the young person’s past and present wishes – maybe they wrote something or consistently showed a preference earlier. We consider all options (including what would happen if we do nothing). We choose the option that seems to best serve the young person’s overall welfare and personal values, and that is the least restrictive of their rights and freedoms. For instance, if a 17-year-old with severe learning disabilities can’t consent to receiving in-home support and shows some resistance, we still provide it if it’s needed for their safety, but we do so in the gentlest way and explore if there are approaches that might make them more comfortable or require less intrusion. All this is documented in a Best Interests decision record.
- Parents’ role for 16–17-year-olds: Parents of a 16/17-year-old do not automatically lose involvement. We find in practice that most decisions at this age are made collaboratively with family. If the young person is capacitated and wants their parent heavily involved or even to decide on their behalf, that’s their choice (some teens might say “I’ll do whatever my mum thinks is best”). If the young person lacks capacity, parents are usually the main consultees in best interests decisions, and often what the parents believe is best for the child will carry significant weight, unless it clearly conflicts with the child’s rights or known wishes. Legally, parents can sometimes give consent for a 16/17 who lacks capacity as part of caring for them, but since the MCA gives the decision to the service/provider in best interests, we make sure to formally use the MCA process while honoring the parents’ views. Essentially, we aim for consensus with families wherever possible, using formal mechanisms if needed to resolve disputes or uncertainty.
- Legal protective measures: For certain significant interventions on a 16/17-year-old lacking capacity (like something that might deprive them of liberty or a serious medical treatment), we will seek proper authorisation (e.g., Court of Protection approval). Also, if any safeguarding concerns exist (for instance, if we suspect a parent is not acting in a truly best interests way, or there’s conflict of interest), we might involve an IMCA or the local authority to ensure the young person’s rights are protected. Fortunately, these cases are rare; usually all parties aim for the best for the young person.
By handling 16 and 17-year-olds in line with the MCA, we ensure this transitional age group is given autonomy where appropriate and extra support where needed. It readies them (and us) for adult services while still recognising the continuing role of family and children’s services in their lives until 18.
5.4 Best Interests Decision-Making When a Child Cannot Consent
When a child (whether under 16 and not Gillick competent, or 16–17 and lacking capacity) cannot make their own decision, any decision about their care or treatment must be made in their best interests. The concept of “best interests” for children aligns with the Children Act’s welfare principle and, for those 16+, the MCA’s best interests checklist. Our procedure is:
- Involve the parent or legal decision-maker: Typically, if a child is too young or not competent, the person with parental responsibility will make decisions on their behalf. So in practice, obtaining consent from the parent is usually the best interests decision, as parents are expected to act in their child’s best interests. We rely on parents’ judgment for everyday care decisions. However, we still consider the child’s perspective (as parents should too). If a parent’s choice seems questionable, we may gently discuss it or seek guidance (e.g., if a parent refuses pain medication for a child due to personal beliefs, we’d be concerned about the child’s suffering and might need to advocate for the child).
- Consider the child’s views and wishes: A best interests decision isn’t just what adults think is best in a vacuum. We try to discern the child’s own wishes, feelings, and values. For a non-verbal or very young child, this comes from observation (do they consistently resist a particular routine? do they seem happier with one caregiver over another?). For an older child lacking full competence, we ask them in simple terms and observe body language. For example, a child with limited understanding might not comprehend “Do you want this treatment?” but may show joy when able to play and discomfort when they miss out due to illness – which might imply certain treatments that keep them healthy align with what they’d want (to feel well and play). We incorporate any such insights.
- Broader consultation: In complex or serious decisions (like medical procedures, significant changes in living arrangements, or if there’s disagreement among caregivers), we convene a meeting or at least gather input from those concerned. This could include family members, healthcare providers, teachers or caregivers who know the child’s day-to-day behavior, and social workers if involved. We lay out the decision to be made and invite perspectives. Each person may highlight different factors – a teacher might note the child’s progress when a certain therapy was in place, a grandparent might recall the child’s past likes/dislikes. All these feed into painting a picture of what’s best for the child.
- Options and least restrictive choice: We list all viable options, including doing nothing. For each, we consider how it affects the child’s welfare in the short and long term. We eliminate options that clearly are not in the child’s interests (e.g., a treatment that offers no benefit but causes pain). We weigh the remaining ones. We especially strive for the least restrictive option – meaning the choice that meets the need in a way that least infringes on the child’s freedoms or normal life. For example, if a child with severe autism is at risk of harming themselves, one option might be to restrain them physically at times, another might be to adjust the environment to remove hazards and use soft protective gear. The latter might be less restrictive and thus preferable if it works.
- Documenting the best interests decision: We write down the decision reached and the rationale – what factors were considered, who was consulted, and why we concluded this is best for the child. If consensus was reached, note that. If there was disagreement, note whose views differed and why the chosen path was taken. For children under local authority care, often the social worker or a court will ultimately sanction major decisions, so we align with those processes (e.g., getting a court’s approval for surgery if needed).
- Implementing and reviewing: Once a best interests decision is made, we implement it as sensitively as possible. For instance, if in a child’s best interests we have to carry out a somewhat unpleasant treatment, we plan how to make it less distressing (maybe using sedation or distraction, or scheduling it at a time least disruptive). We monitor the outcome – are things improving? We remain open to revisiting the decision if new information comes or if the situation changes. Best interests is a dynamic assessment; what’s best at one time might change, especially as a child grows or if they gain capacity later on.
Our approach ensures that when children cannot decide for themselves, they still receive thoughtful, person-centred decision-making that strives to mirror what they would choose if they could, and what maximizes their well-being and happiness.
5.5 Involvement of Parents, Guardians, and Care Authorities
Decisions for children inherently involve those who care for them and have legal authority for them. It is crucial to clarify and respect the roles of parents, legal guardians, and (for looked-after children) the local authority or foster carers in consent matters:
- Identifying who has Parental Responsibility (PR): Upon starting services, we record who has legal parental responsibility for the child. Usually, it’s the mother (automatically) and father (if married to mother or listed on birth certificate after a certain date, or through court order/PR agreement). If the child is subject to a care order (Section 31, Children Act 1989), the local authority gains PR (shared with parents, but the authority can limit parental exercise of PR if needed for the child’s welfare). If the child has a legal guardian or a special guardianship arrangement, we note that and obtain copies of relevant orders. In cases of foster care under a care order, the foster carers do not have PR (the authority does), but they may have delegated authority for day-to-day decisions. In voluntary care (Section 20), parents keep PR. Why is this important? Because consent must come from someone with PR unless it’s an emergency or the child is competent to consent themselves. We therefore always seek consent from a person with PR (e.g., one of the parents, or the social worker if they have authority for a certain decision) for significant decisions. We also verify if there are any court orders restricting someone’s PR (like a prohibition on medical treatment without court consent, or a specific issue order giving one parent sole decision power on something).
- Routine decisions vs significant decisions: In everyday practice, many decisions are routine and can be made by the on-the-spot caregiver or parent. For instance, a foster carer might consent to a routine medical check-up or a short trip as part of delegated authority. But significant decisions (like surgery, or taking the child abroad) often require the consent of the local authority or even the court. Our staff are trained to escalate any non-routine consent needs to management, who will then liaise with the appropriate authority. We keep a care file note of what a foster carer can and cannot consent to, based on the placement agreement, so staff don’t inadvertently ask the wrong person.
- Partnering with parents: For children living at home, we see parents as partners in care. We encourage them to be involved according to their comfort and schedule. Some parents might want to be present for every care task initially (to ensure the child and worker are comfortable), others may step back to allow the child some independence with the worker. Both approaches are fine; we accommodate their involvement and transition gradually if more independence is the goal. We maintain open, respectful communication, informing parents about how each session went, any issues, and listening to their feedback. If a parent has a concern (“My child seemed upset after the session yesterday”), we address it promptly. If a parent instructs, “Please don’t take her to the park if it’s raining,” we honor that preference. Essentially, we recognise parents’ expertise about their child. At the same time, if we have professional recommendations (like establishing a consistent routine for the child’s benefit), we discuss them, but ultimately the parent consents to any changes.
- Navigating disagreements: Sometimes parents may disagree with each other (if separated, for example) or with others involved (like a social worker or doctor). Our role isn’t to take sides, but to ensure the child’s best interests remain central. We encourage parents to resolve differences amicably. If parents have joint PR and disagree on a major issue (e.g., one consents to a vaccine, the other refuses), we may need to involve the child’s GP, safeguarding team, or legal counsel to determine the way forward – possibly the court if it’s serious. Until resolved, we might hold off on the disputed intervention if safe to do so. We document such situations thoroughly.
- Children under care orders or in foster care: For looked-after children, we follow the care plan established by the local authority. The consent for our involvement and tasks will usually be covered in that plan (e.g., the social worker consents to our service on behalf of the local authority, after consulting the child if old enough and the parents depending on the order). We still involve the child’s foster carers in day-to-day decisions and keep them informed, but we know legal accountability sits with the authority. In practical terms, this might mean sending regular reports to the social worker, notifying them of any incidents, and obtaining their consent for significant changes. We are careful to respect any court-ordered contact arrangements or restrictions (for example, if a parent isn’t allowed to know the foster placement address, we ensure our communications maintain confidentiality, etc.). Our staff are also trained in the additional emotional support looked-after children may need – including reassurance about their rights and listening to their wishes perhaps through their LAC (Looked After Child) reviews.
By clarifying roles and maintaining good communication, we aim to ensure that there’s no confusion about who decides what, and that the child’s care proceeds with all necessary approvals in place. This collaboration with those who have the child’s legal and personal interests at heart builds a safety net around the child, ensuring consistent and lawful care.
5.6 Right to Refuse Care and Managing Refusals
Both children (when competent) and parents/guardians have the right to refuse recommended care or services. Respecting this right is fundamental, even if the decision might not be what we as professionals would prefer. Our approach to refusals is as follows:
- If a parent/guardian refuses on behalf of the child: We first ensure the parent fully understands the implications of refusal. We calmly and clearly explain any potential risks or negative outcomes of not receiving the care or treatment. For example, “If we don’t assist with exercises, Jenny’s mobility might worsen and she could experience more pain or falls.” We also explore if their refusal is conditional or rooted in a specific concern – maybe they are not comfortable with the particular staff member, or they worry about cost, or cultural reasons. By understanding why, we might address the issue (e.g., assign a different female care worker if a male worker was not acceptable for personal care due to religious reasons, rather than the family refusing care entirely). We document that we provided this information. If the parent still refuses, we accept their decision. We then adjust the care plan accordingly, inform any other relevant professionals (so they know, for instance, that therapy is on hold because the parent declined it), and keep the door open for future discussions if they change their mind.
- If a competent young person (16–17 or Gillick-competent under 16) refuses: We treat it as we would an adult’s refusal. We ensure they understand the consequences (in language they get), asking them to articulate back to us to be sure. We counsel them on any safer alternatives if available, and encourage them to involve their family in the decision unless they object (some competent teens might not want parents knowing about certain refusals, e.g., a mental health counseling offer). We then respect their choice. We will likely notify the parent that the service isn’t being taken up (without breaching any confidences the young person asked us to keep, except if it’s a serious risk issue). For example, a 17-year-old refuses further help with bathing because they want privacy; we respect that and maybe offer equipment to help them self-bathe safely rather than a worker, informing parents that the plan changed at the teen’s request.
- Documenting refusals: We record the refusal in the daily notes and escalate it to a supervisor/manager via an incident or communication note, especially if it involves something significant or health-critical. The record should include who refused, what specifically was refused, the reasons (if given), information we provided about consequences, and the outcome/next steps. This provides a clear trail showing we didn’t neglect the service but rather it was declined, and that we responded appropriately by informing and adapting.
- Continuing duty of care: Even when care is refused, we still have some responsibility. We don’t just walk away; instead, we consider if the refusal itself could indicate a safeguarding concern or a need for alternate support. For instance, if a child consistently refuses to be alone with a particular care worker, we wonder if there’s a trust or even potential abuse issue (and we’d investigate that). If a family refuses all help due to fear or pride, perhaps we connect them with a support group to alleviate their worries. If refusal leads to a dangerous situation (say, a parent refuses needed medication for a child out of misunderstanding), we might involve healthcare professionals to re-educate or a social worker if the child’s health is truly at risk. Always, the tone is supportive, not punitive.
- Safeguarding overrides: There are extreme cases where a refusal might be overridden in law to protect a child (like life-saving treatment). Such actions are not taken by us unilaterally; they would involve legal processes. For example, if parents refuse a life-saving blood transfusion for a child, a hospital would seek a court order to proceed despite refusal. In our domain of personal care, it’s unlikely to be that acute, but consider a scenario: a child’s hygiene is so poor (due to refusal of all care) that it’s causing health issues. We’d treat that as potential neglect and involve safeguarding authorities to find a solution in the child’s best interests. Another example: if a 17-year-old with anorexia refuses to eat or accept care and is in danger, medical professionals might invoke the Mental Health Act or other legal means to treat them despite refusal. Our role would be to escalate to those professionals and not just acquiesce to a life-threatening refusal.
- After a refusal: If after some time the family or young person is open to revisiting the decision, we re-engage with open arms. We do not judge or say “told you so.” Trust can be rebuilt by showing we respect their space and are ready when they are. In regular follow-ups or reviews, if appropriate, we might gently ask, “How are you managing without [service]? Let us know if you’d like to try again or if circumstances change.”
By handling refusals respectfully and systematically, we maintain ethical standards and good relationships. Everyone has the right to say no, and our job is to ensure that “no” is honored while still doing all we can to keep the child safe and healthy within the bounds of that decision.
5.7 Identifying and Responding to a Potential Deprivation of Liberty
In providing care and supervision to keep children and young people safe, there’s a risk (albeit rare in domiciliary settings) that our interventions could become so restrictive that they amount to a deprivation of liberty. This is a legal concept meaning the person is under continuous supervision and not free to leave, which normally triggers formal safeguards. While typical home care rarely meets this threshold, we stay vigilant, especially for older teenagers with severe disabilities or complex needs, and some younger children in extraordinary circumstances. Our approach:
- Use the “acid test” for deprivation: We consider whether (a) the child/young person is under continuous supervision and control, and (b) they are not free to leave their place of care (not free to go somewhere else without permission). For example, if a 17-year-old with profound autism has two-to-one care at all times, door locks to prevent them running away, and they cannot go anywhere without close escorts – this might satisfy the acid test of a deprivation of liberty. Another example for a minor: a child in foster care who has to be under line-of-sight supervision 24/7 due to self-harm risk might be deprived of liberty. We assess each intensive support scenario: Is our control more than what’s normal for a child of that age? (Note: normal parental restrictions, like a toddler being in a playpen or a 10-year-old not being allowed out alone, are generally not considered deprivations because they fall under typical parenting. But if it goes beyond that, e.g., 24/7 one-on-one guard and physical restraint, it likely is a deprivation). Staff are trained to flag to management if they feel the measures being used to care for someone are exceptionally restrictive.
- Least restrictive approach: If we identify that we are approaching or exceeding that threshold, our first step is to see if there are less restrictive alternatives. Could we maintain safety with periodic checks instead of constant watch? Is there technology that can reduce the need for human monitoring (like sensor mats) and allow more freedom? Could positive behavior support strategies reduce the need for physical constraints? We convene a review with relevant professionals (social workers, doctors, behavior specialists) to brainstorm ways to scale back restrictions while still protecting the child. We implement any viable changes and document why fully removing restrictions isn’t possible if that’s the case.
- Legal authorization: If it appears that a deprivation of liberty is truly necessary to keep a 16 or 17-year-old safe, we cannot simply continue indefinitely on our own say-so. Unlike adults, we cannot use the DoLS scheme via local authority for under-18s; instead, an application to the Court of Protection is required to lawfully authorize the arrangement. If the young person is under 16, the High Court’s inherent jurisdiction may need to be invoked by the local authority or hospital to authorize a deprivation if it goes beyond normal parental powers. In practice, we would alert the local authority and likely they (or the commissioning body) would lead on making the court application, with us providing evidence of the care needs and restrictions in place. We assist in this process by documenting exactly what restrictions exist (e.g., “Child is within sight of carers 24 hours a day, doors are locked to prevent exit, child not allowed outside except on accompanied walks in garden,” etc.) and why they are needed (risks of harm). We then comply with whatever the court decides, which might impose conditions or a time limit on the authorization.
- Immediate action when identified: The moment staff suspect a deprivation of liberty may be occurring (even before formal authorization), they must inform the Registered Manager. The manager will then implement interim safeguards: e.g., increase monitoring of how staff implement restrictions to ensure no more force than necessary is used, ensure the parents or guardian and social services are aware and in agreement, perhaps assign an independent advocate for the young person. The manager would arrange a best interests meeting urgently to confirm that all agree the level of restriction is currently unavoidable. All steps (like contacting the local authority legal team for advice) are taken promptly; we treat unauthorized deprivation as an emergency that needs correction either by reducing measures or getting approval.
- Documentation and CQC notification: We keep a detailed record (often called a DoL care plan or log) for any individual where this is an issue. This includes the capacity assessment (for 16/17-year-old) and outcome, notes of best interests meetings, what alternatives were considered and why they won’t ensure safety, the details of any court application made (dates, interim orders), and the final court order with its conditions (like an end date or requirement for periodic reviews). We also record ongoing monitoring: staff notes on how the person is each day, any incidents, any attempts to reduce restrictions even temporarily (e.g., “Tried leaving bedroom door open at night without a staff at threshold; unfortunately, client became very anxious, so returned to previous monitoring level”). If and when an order is granted, as a CQC-regulated service we notify CQC of the authorization and any significant changes or if it lapses, as per their notification rules. We maintain a register of such cases to ensure none slip through cracks for renewal.
Our ultimate goal is to never deprive a child or young person of liberty unless absolutely no other safe option exists – and if it does, to minimize the duration and impact of such measures. We treat any child under restrictive measures with utmost compassion, regularly reviewing to see if we can restore more freedom as their condition or environment improves. This is in line with human rights obligations and our person-centred values.
6. Obtaining and Documenting Consent
Having established who can consent and under what conditions, this section describes how we go about actually obtaining consent and ensuring it’s properly recorded. Good documentation of consent protects the child, family, and our staff by making clear what was agreed and when.
6.1 Explanation of Care, Risks, and Alternatives
Before we ask anyone to consent to a care plan or specific intervention, we must first ensure that they have a full understanding of what they are agreeing to. The explanation process typically covers:
a. Nature of the Care or Treatment – We start by describing the care in plain terms: what will be done, how, when, where, and by whom. For example, if the service involves personal care, we explain which tasks (bathing, toileting, dressing, menstrual care, etc.) and at what times of day. We might say, “Our care worker will come every morning at 7:30 to help John out of bed, get washed, and dressed for school. This usually takes about 45 minutes.” If equipment is used (hoists, feeding tubes), we show it and explain its purpose (“This is a hoist that helps lift and move him safely from bed to wheelchair. It will support his weight so no one gets hurt.”). If treatment is involved, like wound care or medication administration, we detail the procedure (frequency, route, any sensations the child might feel). We also clarify who will deliver care: their qualifications and that all are DBS-checked. This helps build trust. We encourage families to meet the care staff beforehand if possible, to discuss any details or demonstrations.
b. Potential Benefits – We outline how the proposed care will help the child or young person. For instance, “Having a care worker assist with exercises each day will help improve Sam’s muscle strength and prevent stiffness, so he can be more comfortable and possibly gain more mobility over time.” For supportive outings, benefit might be social inclusion and learning life skills. We connect the care to goals that matter to the child/family, like improved health, comfort, development, or family respite. If applicable, we mention any evidence or professional recommendations behind it (e.g., “The physiotherapist advised these exercises to prevent contractures, which can cause pain, so doing them daily with our help is beneficial.”). Seeing tangible benefits makes it easier for parents and young people to say yes.
c. Risks or Discomforts – We honestly and sensitively discuss any risks or downsides. No intervention is entirely risk-free. If we’re administering medication, we mention common side effects to watch for. For physical support, we note risks like possible falls during transfers (and how we mitigate that with proper technique and equipment). If we will handle intimate care, we acknowledge the potential for emotional discomfort or embarrassment and assure that we maintain dignity and privacy at all times (like using towels to cover the child, etc.). For invasive procedures (like feeding tubes, injections), we describe any pain or discomfort and how we minimize it (numbing creams, gentle techniques). Also, if there are broader risks, like infection risk in wound care, we explain our hygiene measures to counter that. It’s important families hear these from us upfront rather than feeling they were not warned. We frame risks realistically – not to scare, but to prepare. We encourage questions, like “Do you have any concerns about this process?” Sometimes a parent’s “risk” concern might be less medical and more personal, e.g., worry about loss of privacy – we address those too.
d. Alternatives Available – If there are alternative ways to meet the child’s needs, we inform them. For example, if a child needs feeding support, alternatives might be: parent continues doing it, our staff do it, or using a different tool like special utensils. If the family is unsure about a service, perhaps an alternative is fewer days a week or trying it for a trial period. We make it clear that accepting our service is not the only path: “You could manage all care on your own without our help – many families do – but it might be tiring and you might not get breaks. Or you could hire a private nanny instead of our trained staff, though they might not have the clinical training if needed.” We also mention what happens if they refuse the care altogether: “If you decide not to have a care worker help, then [child] might miss school more often due to not getting ready in time, or you may injure your back lifting him alone. But of course, it’s your choice; we just want you to have the full picture.” By discussing alternatives, we empower the family to weigh options. We ensure they know that saying no is an alternative we will respect (though we’ll outline any likely consequences to health or well-being).
During this explanation phase, staff should pay attention to non-verbal cues – are the parents nodding, looking confused, upset? Is the child fidgeting or frightened at some description? We pause and address those: “I see this is a lot of information – take your time” or to a child “It looks like you’re worried; want to tell me what part bothers you?” After explaining, we often summarize and double-check understanding: “Could you tell me in your own words what you understand about what will happen? I want to make sure I was clear.” We also provide written materials if available (like a leaflet on the condition or a summary of the care plan) for them to review later. Only once we are satisfied that the family (and young person, if appropriate) has a clear understanding do we proceed to ask for consent. An informed “yes” at this point is what we seek – and if we sense they are not yet fully informed or comfortable, we do not push for a decision until we’ve done our due diligence in explaining or resolving concerns.
6.2 Types of Consent: Parental, Child’s Assent, Verbal, Written, and Implied
Consent can be communicated in different ways. We recognize and accept various forms of consent, depending on the situation and the level of formality required. In all cases, we ensure that the consent comes from an appropriate person (parent/guardian or competent young person) and is properly noted. The main types include:
a. Written Consent – This is the most formal type and involves a signed document. We seek written consent for significant aspects of care or where required by regulation. For example: signing the initial care agreement and plan (where the parent/guardian or competent 16/17-year-old signs to indicate they consent to the outlined services), consent for specific medical treatments or interventions carried out by our staff (like administering medication, or using a feeding tube), and consent for sharing information with third parties (GP, school, etc.). Written consent is also obtained for any photography or video recording (e.g., taking a photo of a wound to send to a nurse – we ask permission first). The advantage of written consent is clarity – everyone knows what has been agreed to. We use forms that include the child’s name, the specific service/intervention, any key information (like acknowledging understanding of risks), and space for signature of the parent or young person (and sometimes a witness/staff signature). These forms are stored in the care record. We explain anything on the form that’s unclear before asking them to sign, and we never rush signing – we can leave a form with them to consider if needed.
b. Verbal Consent – Day-to-day, much of our consent process is verbal. A parent might say over the phone, “Yes, you have my permission to take Jamie to the clinic appointment tomorrow.” Or a teenager might tell their care worker, “I’m okay with you helping me comb my hair now.” Verbal consent is appropriate for routine tasks that are part of the agreed care plan, or for minor changes that come up (like adjusting a visit time, or spontaneously deciding to go for a walk with the child if weather permits). Staff are trained to always seek at least verbal confirmation from the immediate decision-maker (“Shall we go ahead with your shower now? Is that alright?”). While verbal consent is less formal, it’s still valid if informed. We make a quick note in daily records of any noteworthy verbal consents or refusals (“Parent gave verbal consent for outing to park today during visit.”). If a decision was discussed in a meeting and verbally agreed, minutes of that meeting serve as documentation. Should any confusion later arise (“I didn’t realize I agreed to that!”), our notes help clarify. It’s important staff use clear language when obtaining verbal consent – not just “We’re doing X now” but “May we do X now?” or “Is it okay if we…?” – truly giving the person a moment to say yes or no.
c. Implied Consent – Implied consent is understood from actions rather than words. In context of care, if a parent brings their child to the door and lets our worker in at the scheduled time, we interpret that as implied consent to start the routine for that day (since they haven’t said no and are facilitating it). If a child lifts their arms when the care worker says “Let’s put on your shirt,” that’s an implied agreement to proceed with dressing them. Implied consent is often seen in younger kids or non-verbal individuals who show cooperation through body language. However, we have to be careful: implied consent is valid only if it’s clear and not ambiguous. A smile and a nod can imply yes; silence or lack of resistance might not be enough if the person is shy or afraid to object. Staff are trained not to read implied consent in the absence of any explicit or enthusiastic cooperation. We always prefer a verbal yes if possible. Implied consent is mainly relevant in continuing tasks – for example, we don’t ask every single time to do a repetitive motion in a therapy exercise if the child is clearly following along, because their continued participation implies ongoing consent. But if at any moment the child’s body language changes to resistance (pulling away, frown, crying), that implied consent is withdrawn and we stop to check in. Documentation of implied consent is tricky – usually we just note that the task was completed with the child’s cooperation. If there was any doubt, we would have paused, so proceeding and completing is evidence that consent (at least assent) was present.
d. Child’s Assent vs. Consent: We should clarify that often, especially for children not old enough to give legal consent, we seek their assent – which means the child’s agreement or willingness, even if the legal consent comes from the parent. While not legally required, a child’s assent is ethically important. For example, a parent may consent to a vaccination, but we still might ask the 10-year-old, “Is it okay if the nurse gives you the injection now?” If the child assents (maybe nervously but saying “okay” or holding out their arm), it makes the process smoother. If the child vehemently dissents (screams “No!” and hides), we wouldn’t hold them down (unless it’s critical emergency) – instead we’d pause and discuss with the parent on how to proceed, possibly delaying to another time or using techniques to reduce fear. We document if a planned intervention didn’t occur due to child’s dissent, and make a new plan.
Important Considerations: In all forms, consent should never be presumed. If there is any doubt whether consent has been given or is still in effect, staff must stop and clarify. For instance, if a usually cooperative child is unusually withdrawn and not responding, don’t just proceed on auto-pilot – gently ask if they’re okay with continuing. Additionally, non-communication is not consent – e.g., a non-verbal older child who doesn’t resist might still be uncomfortable, so we look for other cues or find alternative means to confirm they’re okay (like asking them to squeeze our hand for yes, or checking with parent if the child seems off that day). Finally, for any high-risk or invasive procedure, implied consent is generally not sufficient – we want explicit (verbal or written) consent. We use implied consent mostly for low-risk daily activities where it’s practical (like a toddler raising their arms to be picked up implies consent to lift them).
By recognizing these forms and when each is appropriate, we maintain flexibility in our interactions (not everything needs a form every time), while also ensuring we have the right level of proof and clarity for more significant matters.
6.3 Regular Review of Consent
Consent is not static. Especially in a child’s world, things change – children grow, health conditions evolve, family circumstances shift – all of which can affect earlier consent decisions. Therefore, we implement a process of regular review:
a. When to Review Consent:
- Developmental Changes/Age Milestones: As a child matures, their ability to partake in decision-making increases. A consent process that was entirely between staff and parent when a child was 5 will look different when that child is 10, and very different at 16. We intentionally review at key age milestones (e.g., around 13, when some may begin demonstrating Gillick competence in certain areas, and at 16 when MCA applies). We proactively discuss with the family how to involve the child more – “Now that Sara is turning 14, would she like to start signing part of her care plan too, or at least voicing her agreement? How do you feel about giving her more say in [particular task]?” We document any shift in consent approach (like a note that “Sara will now consent directly to day-to-day care decisions, with parent’s knowledge”).
- Health or Capacity Changes: If a child’s medical condition or mental capacity changes, we review consent. For instance, if a 17-year-old suffers a head injury and it affects their cognition, they may no longer be able to consent as they did before – we’d then rely more on parental involvement and consider capacity assessment. Conversely, a child with a temporary incapacity (like recovering from a coma) might regain capacity, so we then restore their direct consent role. Also, improvement or deterioration in conditions like autism or mental health might either enable more involvement or necessitate more support – we adapt accordingly.
- New Interventions or Services: Whenever a new element is introduced – be it a new medication, a new type of therapy, a different care worker, or a plan to attend a new community activity – we do not assume prior consent covers it. We treat it as an opportunity to inform and seek consent specifically for that addition. For example, “We’d like to start taking John swimming once a week as part of physiotherapy – here are the details, do we have your permission to include that in his plan?” This might happen at a care plan review or separately.
- Changes in Family Circumstances or Legal Status: If parents divorce, or a foster placement changes, or a child becomes subject to a care order, we revisit who consents and how. Maybe previously either parent could consent, but now a court said a specific decision (like a surgery) must have both agreeing or needs a judge – we adjust our approach. If a new guardian takes over, we update documentation and ensure that person is now giving consent.
- Periodic Check-ins: Even absent major changes, we like to review consent formally at least annually (often coinciding with annual care plan reviews). We go over the consent forms and decisions on file: “Are these still accurate? Are you still okay with everything outlined? Is there anything you want to withdraw or add?” This gives families a structured chance to rethink earlier choices. Many times, it stays the same; sometimes they might say, “Actually, now that she’s older, I don’t think we need a carer present when she uses the toilet, she can call if she needs help.” That effectively withdraws consent for constant supervision in the bathroom – we update the plan accordingly (assuming it’s safe).
b. Documentation of Consent Reviews:
- Recording updates: Every time a consent is reviewed and changed, we document the discussion and outcome. If the result is a new consent form (like signing a new care plan or an updated agreement to cover changes), that is placed in the record, and the old one might be archived for reference. If consent was withdrawn for something, we note the date and reason if offered (“Parent withdrew consent for feeding via gastrostomy on 12/03/25, as child now eating orally. Gastrostomy care handed over to district nurse only.” or simply “… as they prefer to manage this themselves now.”). If the review confirms all consents remain in place, we note “Consent for current care plan reconfirmed on [date] during annual review; parent and child (age 11) both agreeable to continuation.”
- Care plan and consent alignment: Our care plans have sections that detail what consents are needed (for medical decisions, for outings, etc.). When reviewing, we make sure the plan matches the consents: for instance, if a parent now declines a particular service, that service is removed from the plan. Any specific instructions (like “No male carers for personal care – per parent’s updated request”) are clearly reflected so all staff know.
- Communicating changes to the team: If consent changes, the manager or coordinator will inform all relevant staff in the team, so everyone is aware moving forward. This might be through an updated care plan distribution, a note in a communication log, or a team meeting briefing. For example, “As of Monday, the family no longer wants us to handle medication; they will do it themselves. Do not prompt or administer meds; just document if not taken.” Everyone signs off understanding. This prevents any accidental overreach after a consent change.
- Handling mid-period withdrawals: If consent is withdrawn unexpectedly (outside of a scheduled review), we treat it similarly. It effectively triggers a mini-review: “What does this change mean for the rest of the plan? Do we need to adjust anything else?” We might call a quick case review meeting if the withdrawal is significant (like if they decide to pause all services). Otherwise, we incorporate that change and continue, flagging to discuss at the next formal review if needed.
In summary, reviewing consent regularly helps ensure that our services remain in line with the current wishes and best interests of the child and family. It is a chance to catch any dissonance (“We didn’t realize you were uncomfortable with that—let’s fix it now”) and to reaffirm mutual understanding, thereby preventing future conflicts or surprises.
6.4 Best Practices for Documenting Consent
Documenting consent is as important as obtaining it. Proper records provide proof that we followed due process and serve as reference for staff and external parties (like inspectors or health professionals) about what has been agreed. Our best practice guidelines for documentation include:
- Clearly state who consented and to what: Each consent entry or form should identify the child (full name, DOB ideally for forms), and exactly what is being consented to. For example: “Jane Doe (DOB 01/01/2012) – Consent for assistance with bathing and dressing, given by mother (Mary Doe) on 05/09/2025.” If the young person themselves consented, we note that (“consented by [Name], age 17, self-consenting under MCA”). This avoids any ambiguity. In narrative notes, if a conversation happened, we might write, “Discussed commencing mobility exercises; [Father’s Name] gave consent to proceed.”
- Date and time stamp: Always include the date (and time when relevant, especially for one-off consents). This is crucial for tracking when consent was in effect and if it was prior to delivering the care. For instance, if a question ever arises “Did you have permission to do X on Tuesday?”, we can show in records that consent was obtained Monday at 3 pm. Our consent forms have a signature date line, and our electronic records or care notes automatically timestamp entries.
- Method of consent: Note whether it was written, verbal, via phone, etc., and if any witnesses. E.g., “Verbal consent obtained via telephone from parent at 14:00 on 10/10/25, witnessed by [Staff Name] (coordinator).” Or “Written consent form signed (copy in file).” This helps validate the authenticity of consent; for example, phone consents are typically followed up with written confirmation, but noting it ensures continuity in the interim.
- Key points of information given: Particularly for significant decisions, it’s helpful to record that we informed them of risks/alternatives. For instance, in a consent form or notes: “Mother informed of potential side effects of medication and agrees to administration.” We don’t necessarily transcribe entire conversations, but big points are logged. This is both good practice and a protective measure; it demonstrates informed consent.
- Any conditions or limits: Sometimes consent is conditional: a parent might say “I consent to physio, but only once a week, not twice as originally planned,” or “You can take him to the park, but not near the lake.” Such conditions must be recorded so all staff are aware. Our care plan would reflect this limitation clearly.
- Documentation of refusal or withdrawn consent: As mentioned earlier, we document if consent was refused or later withdrawn, including reason if provided. This should be as prominent as consents given, so that someone reading the file doesn’t miss that something is no longer allowed. Sometimes we mark withdrawn consents in bold or a specific section, e.g., “Consent Status: Parent has withdrawn consent for overnight respite as of 01/11/2025.”
- Capacity and best interest records (if applicable): If a young person’s own consent is in question due to capacity, we include the capacity assessment outcome in the documentation. E.g., “MCA assessment on 03/07/25: [Youth Name] lacks capacity to consent to financial matters; best interests decision made by parent and social worker to manage fund on his behalf.” Or if they have capacity, note that (“deemed to have capacity to consent to day-to-day care; her consent obtained directly with father’s knowledge”). This is important if later someone challenges “Why did you listen to the 17-year-old and not the parent?” – we have recorded justification.
- Accessible storage and confidentiality: All consent records are kept in the child’s care file (physical file and/or electronic record). We ensure they are easily accessible to staff who need to see them but also protected from unauthorized access. We follow data protection in storing these (they often contain personal data and possibly sensitive health info). Consent forms or details are often among the first things a regulator asks for during inspection to see if we’re doing things right, so we keep them well-organized.
- Review logs: We keep a log or section for consent reviews as well (like a summary sheet that might list each area of consent and the date of last review or renewal). This helps in audits to quickly check that nothing is outdated.
By diligently documenting consent, we maintain transparency and accountability. It ensures continuity of care (any staff member reading the file can immediately know what’s allowed and what isn’t) and provides legal protection because it evidences compliance with consent laws and guidelines.
6.5 Documentation for Potential or Authorised Deprivation of Liberty
In the uncommon event that a child or young person’s care plan involves restrictions amounting to a deprivation of liberty (discussed in 5.7), our documentation must be especially thorough and meticulous. This is both for legal compliance and oversight. Our records for such cases include:
- Capacity and/or Competence Assessments: For a 16–17-year-old under restrictive care, we file the Mental Capacity Assessment that was completed for the relevant decision(s) – typically the decision about their living and care arrangements. It includes the date of assessment, who did it, and the conclusion (lacks capacity to consent to the care arrangement, for instance). If it’s an under-16 scenario, we’d document an analysis of why the normal parental consent isn’t sufficient (like a note explaining that the restrictions go beyond what a parent alone can authorise).
- Best Interests Meeting Notes: We keep minutes or detailed notes of any best interests meetings held to discuss the restrictive care plan. This should list attendees (parents, social worker, any advocates, healthcare professionals, etc.), options considered, and the rationale for deciding that this level of restriction is necessary for the child’s safety/welfare. It should reflect the child’s perspective too, if known (e.g., “Child expresses unhappiness with constant supervision but is not fully understanding risks”). These notes show we didn’t take the decision lightly and involved the right people.
- Less Restrictive Options Explored: A section of the record (or meeting notes) should explicitly state what alternatives were considered and why they were not suitable. For example: “Tried having only one staff overnight instead of two – result was an incident of self-harm, so deemed unsafe. Tried use of half-door instead of locked door – child climbed over it, so did not ensure safety.” Documenting this satisfies the requirement that we only use DoL as a last resort.
- Details of the Authorisation Process: Once a court application is made (for 16–17-year-olds, Court of Protection; for under-16 possibly High Court), we keep copies of the application submitted and any interim orders. When the final court authorisation (order) is granted, we place that legal document in the file. We also create a summary in plain language noting: the date of authorisation, duration (start and expiry dates), any conditions the court imposed (e.g., requirement for therapy to be provided alongside, or increased visiting rights for family, or maybe a named advocate to visit monthly), and any schedule for review. We highlight the expiry date clearly, so we know when it needs renewal if still needed. We also have a place to note if an authorisation was refused or not yet obtained (in which case restrictive measures should ideally be eased or a plan B in place).
- CQC Notifications: We log the date and content of any notification sent to CQC regarding the DoL. For instance, “Notified CQC on 02/02/2025 of Court of Protection authorisation for (Child) lasting 6 months (attached order reference).” If an urgent situation forced some restrictions before authorisation, that too would be logged and notified appropriately as an incident.
- Ongoing Monitoring Notes: We maintain daily or weekly notes specifically around the restrictions: staff might complete checklists like “Still requires door alarms, no outings this week because attempts to run away, etc.” But beyond that, we have a running narrative on efforts to minimise the impact. For example, “This week, trialled giving [Child] 10 minutes alone in garden with staff watching from distance; [Child] handled well – will continue gradually to increase freedom as tolerated.” We note any improvements or regressions. If the child has a chance to express feelings about their care (maybe to an advocate or through behavior), we document that. Also, any appeal or legal review actions (if the child through a representative challenges the DoL, etc.) is recorded. If an IMCA or Guardian visits, their reports are logged. Essentially, we want our records to show that while under these restrictive measures, we are actively working to ensure the person’s rights are considered – things like offering them activities, explaining their rights to them in a way they might understand (for older teens, informing them they can ask a court to review, etc.), and making sure they have avenues to complain or express objections.
- Central Register: The organisation likely keeps a central list of any service users under DoL (or similar) authorisations. We ensure the child/young person is on that register with key dates (application made, outcome, next review due). The Registered Manager oversees this. This avoids any lapse where an order might quietly expire without renewal.
By maintaining comprehensive documentation for deprivation of liberty cases, we create transparency and allow external scrutiny (by CQC, by child protection officers, by the court in reviews). It demonstrates that we understand the gravity of depriving liberty and are fulfilling all legal requirements while caring for the child’s needs and striving to reduce restrictions whenever possible.
7. Consent and Data Protection
Obtaining consent doesn’t just apply to care and treatment; it also extends to how we handle the personal and health information of children and their families. Confidentiality is a cornerstone of our service, and we adhere to data protection laws which intersect with consent. This section outlines how we protect private information and the scenarios in which we may share data, with or without consent.
7.1 Consent for Sharing Personal and Health Data
We collect and use a range of personal information about the children and families we support – from basic details (name, address, date of birth) to sensitive health and social care information (diagnoses, care plans, reports from other professionals). Under the GDPR and Data Protection Act 2018, we must have a lawful basis to process and share this data. Often, that basis in social care is consent (especially for sharing information beyond the core care team) or legitimate interests/duty (like safeguarding). Key practices include:
- Explicit consent for external sharing: We ask parents/guardians (or competent young people) for consent before sharing information with professionals outside our organisation, except when there’s another legal basis like safeguarding. For example, we might say, “With your permission, we will send a copy of our care plan to Johnny’s school so they know how to support him during the day,” and obtain a signed or verbal consent for that. Or, “Can we discuss Claire’s progress with her physiotherapist? It can help coordinate efforts,” again seeking consent. This way, families aren’t surprised by information flow and can have a say in who knows what.
- Routine communications as part of care: Certain sharing is implied by consent to care; for instance, if we’re providing care funded by the local authority or NHS, we assume consent to share updates with them as necessary for that service (this is usually covered in the service agreement the family signs). However, even then, we inform them, e.g., “We provide monthly reports to your social worker as part of the review process.” If a family objects to some detail being shared, we take that into account and clarify if we are still obliged by contract or law.
- Emergency or Required by Law: There are times we share without consent, which we cover in 7.4 (safeguarding, etc.), but otherwise, we treat consent as our default approach.
- Information given to children and families: We ensure families know their data rights. We provide or explain a privacy notice at the start of service, detailing what information we collect and how we use it. For older children/teens, we explain in simpler terms what we record about them and who might see it. We make sure they know that they can ask to see their records or request corrections (with parental involvement as appropriate).
- Documenting data consent: Similar to treatment consent, we record any consents for data sharing. Many organisations use general consent forms for data at intake (e.g., consenting to us holding records, and maybe separate ones for media use or case studies if relevant). We might have checkboxes like “I consent to the service communicating with my child’s school/doctor/social worker as needed” which the parent signs. If any box is unchecked (like maybe they don’t want photos used in any materials), we honor that. We periodically confirm these preferences haven’t changed, e.g., during annual review, “Are you still okay with us emailing the OT monthly updates?”.
Types of Protected Data: Personal identifiable data (name, DOB, address, etc.), health data (diagnoses, medications), social care info (family background, safeguarding notes), and even things like photos or videos of the child (these are personal data too). We consider all of these within the scope of needing consent or careful handling.
By treating information sharing with the same respect as hands-on care, we maintain trust. Many families entrust us with very sensitive information, and part of respecting them is ensuring that info isn’t shared loosely or without their knowledge.
7.2 Compliance with GDPR and the Data Protection Act 2018
We abide by the core principles of data protection law in all our handling of children’s and families’ data. In practice, our adherence looks like this:
- Lawfulness, Fairness, Transparency: We only collect and use personal data if we have a valid reason (lawful basis) – typically because it’s necessary for providing care (performance of a contract with the family or task in the public interest if via local authority), or with consent for extra uses. We handle data fairly – meaning we don’t use it in ways people wouldn’t expect or that could unjustly harm them. We are transparent by informing the family what data we collect and why (through consent forms, privacy notices, or discussions as mentioned). For children capable of understanding, we explain in simple terms. For example: “We keep a file about you which has things like what you like to eat, your doctor’s notes, and our notes of how you’re doing, so everyone on the team knows how to help you best.”
- Purpose Limitation: We collect data for specific purposes related to the care and safeguarding of the child, and we do not use it for completely unrelated matters. If we collected emergency contact info for the care plan, we won’t use that to, say, send marketing for fundraising events unless we got separate permission. For instance, sometimes families might be fine with being informed of parent support groups or events – but we’d ask them first if they want to opt into those communications rather than just using their contact info because we have it.
- Data Minimisation: We collect only what we need. For example, we need medical history relevant to care, but we don’t ask for or keep data that has no bearing, like parent’s income (unless needed for funding paperwork handled elsewhere) or private family disputes that don’t affect the child’s care. In forms and notes, staff are trained to note what’s necessary and not overstep. E.g., if a parent volunteers sensitive info not needed, we might not record it fully to minimize sensitive data on file.
- Accuracy: We strive to keep information up to date. Children’s situations can change (address, medication, school, even surname if family changes). We verify details at reviews or sooner if we hear of changes. If a parent or young person tells us something is incorrect in our records, we correct it promptly (or mark it disputed if it’s something like a professional opinion they disagree with). For instance, if our file wrongly listed an allergy or mis-spelled a name, we fix it and document the correction.
- Storage Limitation: We retain data for only as long as is necessary for the purpose. Children’s records, by regulation, might need to be kept for a number of years after service (often until child is, say, 25 or 8 years after they leave service, to cover possible late-arising issues). We follow legal retention requirements and our internal policy. After that, we securely dispose of the data (shredding paper, deleting electronic files). We certainly don’t keep old data indefinitely “just in case,” to respect privacy. We also avoid hoarding incidental data – e.g., if we took a video to assist in training a new staff on the child’s physiotherapy routine (with consent), we’d delete it once it’s served its purpose and not needed.
- Integrity and Confidentiality (Security): We keep personal data secure from unauthorized access. This means locking physical files in cabinets (with staff access limited to those involved in care), password-protecting electronic records with tiered access, encrypting sensitive data if transferring it (like emailing a report to a health professional – we use secure email or password-protected files). Staff are briefed not to discuss a child’s case in public or with anyone who doesn’t have a right to know. If staff use laptops or devices in the field, those are encrypted. We also ensure any third-party platforms (like an electronic care planning system) are compliant and secure. Confidentiality agreements are signed by staff.
Additionally, children’s rights under GDPR are acknowledged. For children mature enough, they have rights like subject access (to see their data), to rectify errors, and sometimes to have data erased or restrict processing if appropriate. Usually parents exercise these rights for younger kids. We have procedures in place: if someone requests their records, we handle it within legal timeframes, making sure not to release third-party info without consent. We rarely deal with things like a 17-year-old asking to delete data, but if, say, a care leaver at 18 requested deletion of some records, we’d consider if we can (bearing in mind legal reasons we might need to keep some record of care given, one can’t usually fully delete care records due to safeguarding). However, things like removing them from a contact list or correcting an error are straightforward and we comply quickly.
By following these principles, we ensure that the information entrusted to us is respected and safeguarded, maintaining families’ trust and meeting our legal obligations.
7.3 Data Security and Confidentiality Measures
To protect the sensitive information of children and families, we enforce strong data security and confidentiality practices among all our staff. Key measures include:
- Secure Record Storage (Physical): Any paper records (care plans, consent forms, assessment reports, incident logs) are stored in locked filing cabinets or secure file rooms at our office, accessible only to authorised staff. Home visit notes or documents are not left lying around where others (including other family members or visitors) can see them. If a staff member has to carry a paper file for a home visit, they keep it with them and return it to the office – not leaving it in a car seat in plain view, for example. Documents no longer needed are shredded.
- Secure Electronic Systems: We use password-protected computer systems for electronic records. Each staff member has their unique login (no sharing of accounts) and is granted access only to the information needed for their role (principle of least privilege). Our systems have time-out locks if left idle. We also ensure regular backups are done securely to prevent data loss, and those backups are protected too. For any data stored on portable devices (laptops, tablets used in the field), we employ encryption so that if a device is lost or stolen, the data cannot be read. We advise against storing sensitive data on personal devices; instead, use the secure cloud or VPN to access files.
- Safe Information Sharing: When sending personal information externally, we use secure channels. For instance, we use encrypted email or a secure portal to send a child’s support plan to a school SENCO, not a generic unsecured email if it contains detailed health info. If we must fax something (rare nowadays, but possibly to a GP), we call ahead to ensure someone is waiting at the machine (to avoid it sitting out). For phone discussions, we verify the identity of the person we’re talking to before sharing sensitive info (for example, if a new social worker calls asking details, we might ring them back through an official number to confirm identity).
- Confidentiality Training and Culture: All staff receive training on confidentiality and data protection. They learn practical do’s and don’ts: e.g., don’t talk about a case in a public place or even in the office where someone not involved might overhear; don’t post anything about work on social media; always double-check email recipients (to avoid sending to wrong person); use initials or ID numbers if discussing cases internally in an open area; and so on. We instil that breaching confidentiality is a serious offense. Care records are only discussed among team members who are directly involved or need to know for supervision. If staff need to seek advice, they anonymize details unless speaking to a designated supervisor.
- Managing Photographs/Video: Sometimes we take photos (with consent) for care purposes (like wound healing progression, or to create a social story book for the child). These are treated as sensitive data. They are stored securely (in our system) and not on personal phones. Staff are instructed never to use their personal phones to take pictures of service users. If a photo is needed spontaneously, we have work devices or we get parent to take and send securely. We also clarify usage – e.g., not used for any external publication without explicit additional consent.
- Reporting Data Incidents: We have a clear procedure for any data breaches or near-misses. Staff must immediately report if, say, they misplaced a file or sent an email to the wrong address, or if they lose a company phone. We then take steps to mitigate (maybe remotely wiping a device, or contacting the unintended recipient to secure deletion). We evaluate if the breach triggers any duty to inform the affected family or the ICO (for serious breaches under GDPR). Our culture is blame-minimizing in reporting – we encourage reporting mistakes quickly so we can fix them, rather than hiding them.
- Access by Young People: If an older youth requests to see their records, staff know to route that through the manager or data protection lead to handle properly (we wouldn’t just hand over raw notes without redactions because there might be third-party or sensitive info). But we facilitate their right appropriately. Parents generally have a right to see their child’s records too (unless the child is Gillick competent and objects or if there are safeguarding concerns in the record about the parent). We handle these carefully, often involving social services if needed to ensure one parent’s access doesn’t violate any custody agreements, etc.
In essence, we treat personal data with the same care as we treat the person themselves – with respect and protection. These security measures help prevent accidental or malicious breaches that could harm our service users or our organisation’s trustworthiness.
7.4 When Data Can Be Shared Without Consent (Exceptions)
While our standard practice is to obtain consent for sharing information, there are particular situations where we are legally or ethically allowed – even obligated – to share personal information without consent. Staff must understand these exceptions so they can respond appropriately when they arise. The primary exceptions include:
- Safeguarding and Child Protection: If we have reason to believe that a child or young person is at serious risk of harm (for example, evidence or disclosure of abuse, neglect, or exploitation), we are duty-bound to report this to the appropriate authorities (like the Local Authority Children’s Services, Multi-Agency Safeguarding Hub, or the police) even if the parent or young person does not consent to that sharing. Protecting the child from immediate or future harm takes priority over confidentiality in these cases. For instance, if a child confides to our staff that they are being harmed by someone or if we observe unexplained injuries or fear, we would share relevant information with child protection agencies. We do so following the guidelines: only share what is necessary for the purpose (not all records, just the pertinent info), and with the proper authorities. We then record what we shared and why (linking it to safeguarding rationale). Similarly, if a parent’s actions or refusals put the child in danger (like medical neglect), we may need to involve social services or a court, sharing information about the child’s condition and needs. Our safeguarding policy cross-references here: staff are trained to recognise signs and know how to escalate them.
- Medical Emergencies: In a medical emergency where the child or young person is unable to give consent (unconscious, incapacitated) and immediate information sharing could save their life or prevent serious harm, we share relevant health information with medical personnel. For example, if paramedics arrive and the parent is not present or also incapacitated, our staff would inform them of known allergies, current medications, or conditions (like “He has epilepsy and is on X medication,” or “She has a Do Not Resuscitate order” if known, etc.). The priority is the child’s vital interests – i.e., life and health – which GDPR also recognises as a lawful basis. In such emergencies, we don’t delay to get formal consent. After the fact, we’d inform parents/guardians as soon as possible about what happened and what info was shared.
- Court Orders or Legal Requirements: If a court of law orders us to provide information or if there’s another legal requirement (for instance, a legal investigation, or an order under the Children Act, or inspectors using their statutory powers), we must comply even without consent. For example, if there’s a family court case, the court might direct us to provide a report on the child’s care or any concerns. We do so objectively and share only what’s asked. Similarly, regulatory bodies like CQC have rights to access certain records for inspection – that is covered by law; we don’t need individual consent to show CQC an anonymized or even identified record during an inspection, as they are bound by confidentiality too. Or if police come with a warrant or a serious crime inquiry where they need info, we share as legally required. We always verify the authority of requests – e.g., ask for identification or written order, to ensure it’s legitimate.
- Public Interest or Vital Interest: Occasionally, sharing without consent may occur if it’s overwhelmingly in the public interest or in the vital interest of the subject – closely related to the above. Vital interest is life-or-death scenarios (we covered under emergencies). Public interest could be, for instance, if not sharing could put other children at risk as well (like a contagious disease outbreak – we might share info with public health officials without waiting for consent to help contain it). These are rare and usually involve consultation with higher management or a data protection officer to judge if it’s warranted.
Whenever we share without consent, we follow a “need-to-know” principle: share only with the people who need to know and only the details necessary. We then document what was shared, to whom, when, and under what justification (e.g., “Called duty social worker at 5:00 pm, provided details of unexplained bruises and child’s statement, as safeguarding referral.”). We also usually inform the family that we have shared information, unless doing so would further endanger someone (like informing an abusive parent about a referral could escalate risk – in such cases the authorities guide us on not tipping off). But generally, transparency is maintained when safe – for trust and honesty.
These exceptions are in place because confidentiality is never absolute; the welfare of the child and others can override it. Staff understand that they should not hesitate to share info in these scenarios out of misplaced loyalty to confidentiality, but nor should they breach privacy without strong justification. It’s a careful judgement area, which is why training and sometimes consultation with a senior (like a safeguarding lead or manager) is encouraged if time permits. Ultimately, by knowing these rules, we ensure that we don’t let confidentiality become a barrier to safety or justice.
8. Training and Staff Responsibilities
To implement this policy effectively, {{org_field_name}} ensures that all staff are well-trained and aware of their duties regarding consent and the care of children and young people. A knowledgeable and responsible workforce is essential for maintaining high standards and complying with the law.
8.1 Mandatory Training on Consent and Capacity for Working with Children
All staff who work in our service (from frontline care workers to managers) receive training that covers the critical aspects of consent as it applies to children and young people, as well as related legal and ethical frameworks. Key components of training include:
- Understanding Consent in Pediatric Care: Staff learn about the importance of obtaining consent and the differences between consenting for adults and for minors. This covers the role of parents and guardians, and why children should be involved to the extent possible. Real-life scenarios are used (e.g., role-playing how to ask a child for permission to help them, or how to explain a procedure to a parent) to build communication skills. We emphasize respecting refusals and understanding that “no” can be valid from a capable young person, even if it complicates things. We also highlight cultural sensitivity – e.g., some cultures expect more parental authority; staff learn to navigate these respectfully while still upholding the child’s rights.
- The Legal Framework – Gillick and Fraser Competency: Training details the concepts of Gillick competence and Fraser guidelines so staff know when a child under 16 might make decisions alone and how to assess that informally (with escalation for formal decisions). We use examples such as a 15-year-old wanting to manage their medication to illustrate. Staff also learn that while they should encourage parental involvement, they must respect confidentiality for a competent young person in certain sensitive matters (bearing in mind safeguarding always overrides if needed). This part of training often references case studies or CQC guidance to cement understanding.
- Mental Capacity Act 2005 (for 16–17-year-olds): We train staff on the five statutory principles of the MCA as they apply to young people: presume capacity at 16+ unless proven otherwise, support decision-making (maybe through communication aids or repeated explanation), respect unwise decisions (a teen might make a choice we disagree with but have the right if they understand), always act in best interests if they lack capacity, and seek the least restrictive option. Staff practice the two-stage capacity assessment in hypotheticals – for instance, a scenario of a 17-year-old with a learning disability refusing therapy: does he understand the info? If not, how to support? If still not, then best interests. Staff also learn about involving deputies or IMCAs in those cases.
- Consent and Safeguarding Intersection: Our training connects the dots between consent and safeguarding. Staff are taught how to recognize when a lack of consent or a refusal might itself be a sign of something (e.g., a child always refusing a particular caregiver could hint at abuse – requiring inquiry, not just acceptance). Conversely, staff learn that sometimes acting without consent is necessary if a child is in danger (as discussed in 7.4) and how to handle that (reporting processes).
- Communication and Engagement Techniques: A significant portion deals with practical skills: how to talk to children at different developmental levels, how to use visual aids or play to gain trust, how to listen actively to both child and parents. We cover working with interpreters for families with limited English, using sign language or pictures for non-verbal children, and collaborating with speech therapists or using assistive tech devices. By equipping staff with these tools, we help them obtain genuine informed consent rather than just a form signature.
- Data Protection and Confidentiality: We include training on handling personal information (aligned with Section 7). This ensures staff also know the rules around sharing information and obtaining consent for that, as well as when to break confidentiality for safety.
This training is not a one-off. New hires receive it as part of induction (with child-specific modules if they come from adult care backgrounds), and we refresh it periodically (usually annually or whenever laws change). We may also provide additional targeted workshops if we notice areas of practice that need reinforcement – for example, if we find staff are unsure about assessing competence, we might do a focused session with case discussions.
By making consent a prominent part of mandatory training, we embed it in our care culture so that every staff member, from carers to drivers to admin, understands how critical it is to respect and uphold the choices and rights of the children and families we serve.
8.2 Managerial Responsibilities for Compliance
Managers and senior staff have a key role in ensuring that this consent policy is not just paper, but practice. Their responsibilities include oversight, support, and intervention when necessary:
- Policy Implementation and Updates: Managers must ensure that the procedures outlined in this policy are integrated into daily operations. This could involve developing checklists (e.g., admission checklist includes obtaining necessary consents), updating care plan templates to prompt consent documentation, etc. They also stay abreast of any changes in law or guidance related to children’s consent (like if Liberty Protection Safeguards are implemented, or new CQC guidance emerges) and update the policy and staff training accordingly. Essentially, they act as custodians of the policy’s relevance and accuracy.
- Monitoring Staff Practice: Through regular supervision sessions, spot checks, and audits, managers verify that staff are indeed obtaining and respecting consent properly. For instance, a manager might occasionally observe a care session to see if the care worker is asking the child’s permission and explaining things – and later give feedback (“I noticed you started feeding Ali without really asking if he’s ready – remember to get his go-ahead, even if he usually is fine with it”). They might audit a sample of care records each month to ensure consents are documented and up to date. If they find gaps (like missing signatures, or a noted refusal not followed up), they address them with the team or individual.
- Support in Difficult Situations: If staff encounter challenging scenarios – e.g., a parent and teen conflict over care decisions, or uncertainty if a child has capacity – managers should be readily available to advise or step in. They might convene case discussions or multi-disciplinary meetings for complex consent issues. In essence, they serve as the point of escalation when the right course of action isn’t clear at frontline level. For example, a care worker might say “The parent insists on this, but the child is hysterical and refusing – what do I do?” and the manager would then help mediate or involve external help.
- Ensuring Documentation and Legal Compliance: Managers ensure that all legal conditions (like Court authorisations for DoL) are sought and in place as needed, and that notifications (like informing CQC or local safeguarding boards) are made. They maintain the aforementioned central registers (like DoL register, consent forms tracking). They also review incident reports that relate to consent (like a report of care being refused or a breach of confidentiality) to see if policy was followed and what can be improved. If an inspection or audit happens, managers gather the evidence of compliance (like pulling all consent forms, training records) – so they have to be sure those are intact to begin with.
- Staff Accountability and Performance: Managers tie compliance with consent policy into performance appraisals and competency assessments. Staff are evaluated on how well they uphold consent principles – such as feedback from families (“Does the staff listen to you and ask permission?” can be a question in satisfaction surveys). If a staff member persistently fails to follow consent guidelines, managers are responsible for corrective action: additional training, closer supervision, and if needed, disciplinary measures. Conversely, managers also recognize and praise good practice, reinforcing the desired behavior. They set the tone that consent is non-negotiable. For example, in team meetings, managers might share a positive story (“I want to acknowledge how Jane respected a young person’s wish not to have a male carer; she rearranged schedules without fuss – that’s exactly the person-centred approach we expect.”).
Managers also often liaise with external agencies (social services, health partners) and thus help maintain a consistent multi-agency approach to consent and information-sharing. They ensure that any inter-agency protocols (like consent for sharing an Education, Health and Care Plan with us) are followed and that our policy dovetails with those of others for continuity in the child’s journey.
In sum, managerial vigilance and leadership ensure that the principles of this policy filter down to every interaction. Compliance is not left to chance or solely individual ethics; it’s actively managed.
8.3 Monitoring Compliance and Continuous Improvement
To ensure that our consent practices remain effective and up to standard, {{org_field_name}} engages in ongoing monitoring and quality improvement activities. This not only catches any issues early but also drives us to refine our approach as needed. Key elements include:
- Regular Audits: We periodically audit care records and consent forms for completeness and accuracy (as touched on above). For example, a compliance officer or manager might review a certain percentage of client files each quarter. They check: Are all required consent forms present and signed? Are notes indicating that updates were reviewed? Were any capacity assessments done correctly? Are there signatures/time stamps on entries about verbal consents? The results of audits are documented, and any shortfalls are addressed with an action plan. If, say, an audit finds that in 20% of files, the Gillick competence discussion wasn’t recorded for older kids, we implement a fix – maybe update forms to prompt that or re-brief staff.
- Feedback from Families and Young People: We actively seek the input of those we serve. Through surveys, feedback forms, or meetings, we might ask questions like, “Do you feel you (and your child) are involved in decisions about care?” “Were things explained to you in a way you understand?” A teenager might be asked privately, “Do you feel your care workers listen to your opinions and choices?” This feedback is valuable – if a trend appears that parents feel not listened to or children feel coerced in small ways, we treat that seriously and make improvements. Positive feedback (e.g., “My child’s carer always asks her permission; it’s really respectful”) is also shared with the team to reinforce behavior.
- Incident and Complaint Analysis: We log any incidents related to consent (like a care session had to be halted due to refusal, or a parent complained that something was done without permission). Each is reviewed by management. For incidents, we ask: Was policy followed? Could it have been prevented? Do we need to adjust anything (maybe that staff needed more training or maybe the care plan was not clear)? For complaints, similarly, we investigate and respond formally, potentially updating procedures if a gap was identified. For example, if a complaint revealed that a new staff wasn’t aware of a certain consent restriction (maybe they didn’t know child is not to be taken outside after dark per parent’s rule), we improve our handover and communication processes to avoid repeats.
- Team Meetings and Reflective Practice: We incorporate consent topics into team meetings, supervisions, and case reviews. This creates a continuous learning environment. A case that had a tricky consent issue may be anonymized and discussed so everyone learns from it. We encourage staff to voice any uncertainties they have about consent in meetings – better discussed openly than making a mistake. Reflective practice (thinking about what went well or not in a situation) is promoted, and often a manager might ask in supervision, “How did you ensure Jack was okay with that new routine? How did he show you he agreed?” These conversations keep staff mindful.
- Annual Policy Review: As indicated in Section 9, we review the policy itself at least annually (and sooner if needed by changes). This is also part of compliance – ensuring our written guidance stays current with law and best practice. We consider internal audit results, feedback, and any external changes when updating it. For instance, if regulatory standards shift emphasis or new research on children’s consent comes out, we incorporate that. We also might consult with external experts (like a child rights consultant or safeguarding lead) in our review to get an outside perspective.
Through these monitoring and improvement processes, we demonstrate to regulators like CQC that we don’t just have a policy on paper, but an active system for making sure it’s followed and evolving. Moreover, it ensures that families consistently receive high-quality, rights-respecting service – and if we ever fall short, we catch it and correct course promptly.
9. Monitoring and Review of this Policy
To maintain the effectiveness and relevance of the Consent to Care and Treatment Policy for Children and Young People, {{org_field_name}} will review and update it regularly:
- Regular Review Schedule: This policy will be reviewed at least annually. The review will consider any changes in legislation, statutory guidance, or standards issued by regulators (e.g., CQC) that relate to consent or the care of children. For instance, if new regulations emerge under the Health and Social Care Act or if the Mental Capacity Act code of practice is updated (perhaps with Liberty Protection Safeguards coming into force), those changes will be reflected in the next revision of the policy.
- Interim Reviews: We will also undertake an immediate review if an incident, audit finding, or complaint suggests that there is a gap or ambiguity in the policy. For example, if it came to light that staff are consistently confused about a particular consent scenario not well covered here, we won’t wait for the annual cycle – we’ll amend the policy (and communicate the changes) as soon as appropriate to prevent any ongoing issues. Similarly, a significant court judgment or legislative change would prompt a timely update.
- Staff and Stakeholder Input: In reviewing the policy, we may gather input from those who use it day-to-day (our staff) and even from service users or families when appropriate. Staff can offer practical insights (“this section isn’t clear when we have divorced parents – can we clarify it?”) which we can incorporate. We aim for the policy to be user-friendly and truly reflective of best practices in the field. We might also consider feedback from inspections or external bodies.
- Monitoring Compliance: As detailed in section 8.3, compliance is monitored through audits, supervision, and feedback. The results of these monitoring activities feed into the review process. If monitoring shows high compliance, that’s reassuring (though we remain vigilant). If it shows certain sections aren’t being followed, we analyze why – was the policy unrealistic? Did staff need more training? Should we tweak procedures? The policy review will address those areas, possibly adding clarity or adjusting expectations to better align policy with practice without compromising standards.
- Communication of Updates: After each review, any changes to the policy will be clearly communicated to all staff. This could be through dedicated training sessions on the updates, distribution of the revised policy (with a summary of key changes), and discussions in team meetings to ensure understanding. We require staff to sign an acknowledgement that they have read and understood the revised policy. For major changes, we might also inform families if it affects how we obtain consent from them (e.g., “We have updated our consent procedures; from now on, you’ll see a new form regarding X,” etc., to keep transparency with our clients).
- Record of Review: We maintain a record at the end of the policy document (and in our policy file) noting when it was last reviewed and by whom (e.g., “Reviewed on [date] by [Name/Role]. Next review due by [date].”). This record might also note any major changes made. It provides an audit trail and assures everyone that the policy is current.
By vigilantly reviewing and monitoring this policy, we ensure that it remains a living document – one that evolves with the legal landscape and our service context – always aiming to provide the best possible framework for ethical and person-centred care of children and young people.
Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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