Text size: a | a | a

Consent to treatment

 

Key message

People who lack capacity to consent to medical treatment should receive treatment that is in line with the law and have their capacity to consent regularly reviewed.

Why we are interested in consent to treatment.

People should receive medical treatment that is in line with the law. From the visits we carry out to hospitals, care homes and in people's own homes we know that often this is not happening. If people are not able to consent to their own medical treatment then hospitals should use the law properly to safeguard them. For people unable to give valid consent, their treatment must comply with the Adults with Incapacity (Scotland) Act 2000(AWIA) and part 16 of the Mental Health (Care and Treatment) (Scotland) Act 2003 where indicated.

What we expect to find

Part 5 of the AWIA gives a general authority to treat a person who is incapable of consenting once a certificate of incapacity has been issued.For people who require them,  we would expect to find Section 47 AWIA (certificates of incapacity) in place and an attachedtreatment plan for people requiring multiple or complex healthcare interventions.

What we found

We found incomplete compliance with Part 5 of the Act.

We reviewed the individual case records of people that we thought required a Section 47 certificate. We based our judgement on who needed a certificate by talking to the person, the nursing staff and reviewing the care file.

Of the people we identified as needing a Section 47 certificate, we found about a third of the people seen in dementia assessment wards and functional assessment wards were without appropriate Section 47 certificates.In combined assessment wards the proportion without Section 47s where needed was much higher, at nearly two-thirds.

Action needed

  • All assessment wards for older people must have procedures in place to assess and review people's capacity to consent to treatment and to ensure completion of appropriate legal certificates when required.
  • Assessment of capacity to consent to medical treatment should be carried out at the point of admission. Capacity to consent to medical treatment must be assessed as a matter of course and be subject to regular review.
  • NHS Boards should regularly audit compliance with Part 5 of the Act.
  • All wards should have access to Part 5 AWIA Code of practice and General Medical Council Consent guidance:patients and doctors making decisions together
  • All wards should make available the information leaflet Caring and consent- information for carers