Everything we do in social care relies on someone, usually the service user, providing their informed consent. Looking at various forums and having discussed this issue with many nursing and care staff over the years, it is however apparent that many people working in social care don’t really understand informed consent. After my previous blog about the fundamental standard of consent I was questioned about my assertion that informed consent was a process and not a one-off event, this blog is in response to that question.
Let’s not forget also, that consent is one of the fundamental standards: https://www.cqc.org.uk/about-us/fundamental-standards.
Some care staff think informed consent is a one of event undertaken by the manager when a person is admitted to the service, this could not be further from the truth. That said, the way consent is treated by regulators could quite easily give this impression, when inspectors tend to look for written consent in care plans rather than asking service users whether staff ask their permission to do things each time they approach them.
“What’s that?” I hear you ask. “Ask for consent every time I approach a service user?”. Well yes.
Consider this simple scenario. When you approach Joan in the morning do you say “it’s time to get up Joan” or do you say ” would you like to get up now Joan”. The first is a command, the second a question which implies informed consent is needed.
Why is this important? Well, asking, rather than telling service users:
Let’s face it, do you like other people deciding things for you and more to the point, do you like people deciding things for you all of the time?
Informed consent is not a one-off event. Just because Joan has signed a form to say she is happy for the delivery of personal care while in your care, does not mean that this happens on your terms, when you want to deliver the care and how you want to deliver the care.
Some of you will now be thinking, but what if Joan does not have capacity? There is nothing in the Mental capacity Act that suggests that someone lacking capacity should not be asked for consent, in fact quite the opposite.
The MCA suggests that even people without apparent capacity can make some decisions for themselves. And as a carer you should also ask the question “just because Joan does not have capacity in all things do I no longer respect her as a human? Should her care not be person-centred? Is asking her not the right thing to do? Is this the sort of culture in which I want to work?”.
I would suggest that any carer who thinks the answer to any of these is yes, needs to consider what they are doing working in a caring profession. They need also to think about how they would feel if someone else made all of their decisions for them, including when they get up and go to bed, what they eat and drink and how they dress, and never asked for their opinion. Such behaviours are dehumanising and have no place in health and social care.
Informed consent is therefore not a one-off event. Consent in social care, as in life, is a process and as such is ongoing and needs to be sought every time care is delivered, you can record this on Careis in the care and support plan, https://www.careis.net/, by stating I asked Joan what she would like to eat for lunch, for example.
Not only does this make a care setting a better place to be, but it also creates culture of care which are obviously caring and responsive.