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Consent to Medical and Dental Treatment in Care Homes (Wales) Policy

Policy Statement

This document sets out the values, principles and policies underpinning {{org_field_name}}’s approach to the consent of people who use services to medical and dental treatment. It is based on best practice guidance on seeking and obtaining of consent in healthcare and is in line with the person-centred principles that underpin the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 and accompanying statutory guidance, and the Social Services and Well-being (Wales) Act 2014.

{{org_field_name}} recognises that every individual has the right to the same access to medical and dental treatment as any other person. The home also recognises that everybody has the right to decide what is done to their own bodies and that medical or dental care should be provided only after the full, informed consent of the person has been obtained, wherever possible. Where a person refuses consent then this should be respected. Where a person who uses services lacks the mental capacity to provide informed consent then the provisions of the Mental Capacity Act 2005 should be implemented.

Policy Background

{{org_field_name}} understands informed consent to be an agreement given by a person for a health professional to provide care or treatment. People may indicate consent non-verbally, orally or in writing. For the consent to be valid, the person must:

1. be competent to take the particular decision
2. have received sufficient information to take it
3. not be acting under duress.

Consent Policy

{{org_field_name}} believes that:

1. all people who use their services have the right to make their own decisions about whether or not they want to receive certain medical or dental treatments
2. it is a legal and ethical duty that consent should be sought from the person in every dental or medical care or treatment decision, no matter how minor or serious
3. reasonable efforts and opportunities must be taken to try to gain a person’s consent but they should be able to make decisions about their own health or dental care free from pressure or persuasion
4. people have the right to receive sufficient information so they can make a balanced judgment whether or not to give their consent — full details of the proposed treatment should be explained to the person in a way that they can understand, including the implications of refusing to give consent
5. a person who uses services’ inability to give informed consent to medical or dental treatment should not bar them from receiving any necessary treatment
6. no one should be denied treatment on the grounds of their condition or disability
7. under common law, a mentally competent adult person has the right to withhold consent to treatment, even where it would clearly benefit their health
8. where it is suspected that a person does not have the mental capacity to competently give informed consent then the provisions of the Mental Capacity Act 2005 should be implemented and an assessment completed of the person’s mental capacity — a copy of the assessment of capacity should be included in the individuals notes along with a statement by the health professional explaining why they believe the treatment to be in the person’s best interests, and the involvement of people close to the individual such as relatives, carers or advocates
9. if a person who uses services is likely to need treatment requiring consent, this should be addressed at an early stage (although this will not be possible in the case of emergencies)
10. whether or not a person is able to give informed consent, employees should endeavour to help them prepare for the proposed treatment and minimise any worry or distress
11. all consent decisions or withholding of consent should be fully documented, as should any decisions about mental capacity
12. people who use services may, if they wish, withdraw consent after they have given it, whether or not they have signed a consent form or merely given verbal consent; a signature on a consent form is evidence of the process of consent-giving, not a binding contract.

Informed Consent

Informed consent applies when a person can be said to have given consent based on a clear appreciation and understanding of the facts, and the implications and consequences of an action.

In {{org_field_name}}:

1. people must be given sufficient information about any proposed treatment/ treatments, possible alternatives and any risks involved, so that they can decide whether or not to give their consent
2. information should be given in a way that the person can understand, though employees may need to help explain the proposed treatment
3. if a person capable of giving or withholding consent refuses treatment then their decision should be respected, recorded in their notes and the keyworker or care home manager informed
4. if a member of care staff, or a healthcare professional, believes that a person who uses services has not fully understood the full implications of a treatment then the treatment, unless urgent, should be delayed until further explanation can be provided.

Decision-making Capacity

In {{org_field_name}}, the provisions of the Mental Capacity Act 2005 will be adhered to at all times and it should never be assumed that a person is unable to make their own consent decisions. Where a person is thought to lack capacity each medical or dental decision will be considered on its own merits at the time that it needs to be taken.

{{org_field_name}} understands that treatment may be given without the person’s consent only in the following cases:

1. treatment for mental (but not physical) disorder of a person detained in hospital under the Mental Health Act 1983
2. treatment for physical disorder where the person is incapable of giving consent by reason of their mental capacity or disorder and the treatment is in their best interests (as long as it has not been refused in advance in a valid and applicable advance directive or decision).

The term “mental disorder” includes “arrested or incomplete development of the mind” and may therefore be applicable to some people with learning disabilities but it is important to remember that:

1. not everyone with a learning disability is mentally disordered; their degrees of competence will vary
2. the presence of mental disorder does not necessarily mean that a person is incapable of making decisions
3. a person’s capacity to give informed consent can vary over time and each situation must be considered separately
4. mental capacity must be carefully assessed — an apparent lack of capacity to give or withhold consent may in fact be the result of communication difficulties rather than genuine incapacity and it is therefore good practice to involve appropriate colleagues in making such assessments of incapacity, such as specialist learning disability teams and speech and language therapists, unless the urgency of the situation prevents this.

Training

In {{org_field_name}}, all new care staff will receive training in the principles of consent, informed consent and the Mental Capacity Act 2005 during induction. This policy will be explained to them. Further refresher training will be provided as required, particularly for care home management and keyworkers.

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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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