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Establish consent for an activity or action and explain what steps to take if consent cannot be readily established

This page is designed to answer the following questions:

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Consent means obtaining an individual’s permission before carrying out a healthcare activity. Establishing consent prior to commencing a healthcare activity or action is an important ethical and legal responsibility for a care worker.

Establishing consent supports a person-centred approach because it respects the individual and the choices they make, empowers them to make their own decisions and promotes independence and dignity. It is also a legal requirement under the Mental Capacity Act 2005 and the Care Act 2014.

Establishing consent

For an individual to provide consent, they must have all the data they need to make an informed decision, including the benefits and risks. This should be impartial information and care workers should not include their own personal beliefs. In cases where an individual does not have the capacity to consent, then consent can be obtained by a representative (such as a family member), however, the decision must be made in the individual’s best interests.

Consent can be established in several ways, including implied, verbal or written:

  • Implied consent is when an individual is cooperating with an action thereby implying that they agree with it, for example, if an individual opens their mouth when you are feeding them.
  • Verbal consent is when an individual gives their agreement through speech, for example saying “yes” when you ask if you can assist them to wash their hands
  • Written consent is when an individual signs a document to give their agreement, for example, signing to say they have read and agree to the updates following a review of their care plan

Best practice is to explain what the task involves in a way that the individual you are supporting can easily understand and then ask if it is okay to go ahead. The individual may consent verbally or by gestures such as nodding or (if you are asking if they want to eat) opening their mouth. By having a good knowledge of their communication needs and preferences as detailed in their care plan, you will better understand how the individual gives consent.

If consent cannot be readily established

If for any reason, consent cannot be established then there may be something else troubling the individual and you will have the opportunity to work with them to identify the reasons why they do not want to give their consent.

Other strategies include leaving the individual for a while and trying again later or asking a co-worker to try to gain consent and carry out the task.

However, you should always respect their right to refuse care and support if that is their wish. They may have a good reason for denying permission!

If you are unable to perform your role because you cannot obtain consent, you should follow your organisation’s agreed ways of working and report it to your manager immediately. Your manager may be able to establish the reasons for the refusal or know what actions to take next.

This may include contacting the individual’s GP or NHS Direct (if, for example, the individual is refusing to have their medication) or the individual’s next of kin.

You should always make a record of the actions you have taken to gain consent, including all conversations and reasons given by the individual for their refusal.

How consent may change depending on the decision

Consent will change depending on what decisions need to be taken. For example, if an individual is receiving daily personal care it would be sufficient to ask if they agree to you performing this task. However, if an individual is offered life-changing surgery that has a significant risk to their health then they would need to be consulted and provided with all the information they need to make an informed decision. They should also be given sufficient time to make up their mind and the opportunity to ask any questions they have. Consent for possible life-changing decisions should always be given in writing.

Example question and answer

You are a senior social care worker and have been asked to mentor a colleague who is finding it difficult to understand the importance of obtaining consent from individuals receiving a service.

In a written account, you must:

  • Describe the different factors that might affect an individual’s ability to express their view.
  • Explain different ways of gaining consent to activities or actions.
  • Explain what to do if the social care worker cannot gain consent or is unsure of the response.

Gaining consent before giving care is extremely important in an adult social care setting, not only because it is a legal requirement but also because it demonstrates respect for the individual, develops trust and because it is easier to provide care to someone that is willing to accept it.

An individual’s ability to express their view could be compromised by several factors. Firstly, they may not have the mental capacity to make an informed choice or may be unable to communicate verbally. They may have physical disabilities that make communication difficult. There may be language barriers, for example with an individual that doesn’t speak English or the individual may not have been given enough information to make an informed choice.

Consent can be given in many different ways. Primarily, verbal consent will be used after the caregiver has explained what they are going to do and requested permission to do it, however, an individual may consent with gestures, such as nodding or using sign language. Written consent can also be obtained, or for individuals that do not have the mental capacity to give consent themselves, an advocate can give consent on their behalf.

Care should not be provided if consent cannot be obtained, or even if you are unsure if the individual has given consent. You should seek guidance from your manager about how to proceed.

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