It is one of the odd things in social care that everyone knows that consent is a fundamental element of good practice and forms the cornerstone of everything we do, but people have, in general, very widely differing views and opinions as to what consent is. Fundamental to care, the Mental Capacity Act (2005), CQC fundamental standards and the care act is the notion that all adults with capacity have the right to make choices about their care.

All adults have the right to accept or refuse treatment according to their own wishes and beliefs if they have the mental capacity to do so

What then does consent look like, how do we practice it and show that we have followed in it in the care setting?  Consent is made up of a number of elements all of which must be in place for the consent to be valid these are:

  • Capacity
  • Information and Understanding
  • Choice
  • Freedom from coercion

By capacity, we mean that the person must have the mental ability to be able to understand the choice they are faced with and the information about that choice and be able to use that information to inform their decision making.

Information and understanding are placed together here because giving information to someone is not the same as ensuring it is in a form they can understand and use to help them make a decision.  So for consent to be genuine the carer needs to ensure that the information they give someone is clear and in a form the person can use to inform their decision making.  This might mean avoiding using jargon when presenting information, for example talking about swallowing difficulties and not dysphagia

Choice means that there must be a genuine alternative to what is being offered, this may include just saying no.  For example, the simple act of gaining consent from someone to undertake personal care might, quite reasonably, be refused by the individual – the alternatives here being to have the personal care or not.

Freedom from coercion, means that care staff should not apply pressure on the person over the decision they are making.  This is not the same as withholding information, it simply means the avoidance of threats or manipulation.  Saying something like “well John if you don’t have a wash you will be smelly and I won’t come near you or give you any other care or food today” is a whole lot different to saying “if you don’t have a wash today you do realize that you will start to smell a bit don’t you John?”.  The first statement puts conditions on the interaction which pressure John into complying, while the atter provides John with information to inform his decision making.

People in the receipt of care have the right to expect that their choices will be respected, this includes, in the words of the CQC:

“You (or anybody legally acting on your behalf) must give your consent before any care or treatment is given to you”

This means that “Care and treatment of service users must only be provided with the consent of the relevant person”.

Clearly this does not always mean stopping and filling in a consent form prior to doing anything with a service user.  there are some simple strategies which demonstrate that the staff in a service understand and care about consent.  The main strategy is to develop a culture of asking rather that telling:

“Put you arm out” is not the same as “Please could I get to your arm to do your blood pressure John?”. The first sentence is a command and the second seeks consent via providing choice and information about what is happening, there is no coercion and assuming John has capacity, this ticks all the boxes for consent in action.

This example also demonstrates one aspect of consent services often get wrong, and again one which reflects on the culture of care, consent is a process and not a one off event.  So gaining written consent from John when he joins the service to provide his personal care does not mean John has to agree to it every time it is offered to him in the future.

In brief then, consent is as much about how care staff behave as it is anything else.  Consent requires attention to various elements to make it valid and is about the relationships with individual service users.