Consent to treatment is the principle that a person must give permission before they receive any type of medical treatment, test or examination and is generally requested on the basis that an explanation of the required treatment, test or procedure has been received from a Clinician.

Consent from a patient is needed regardless of the procedure, whether it’s a physical examination, organ donation or something else.

The principle of consent is an important part of medical ethics and international human rights law.

Defining consent

For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.

These terms are explained below:

• voluntary– the decision to either consent or not to consent to treatment must be made by the person themselves, and must not be influenced by pressure from medical staff, friends or family
• informed– the person must be given all of the information in terms of what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment doesn’t go ahead
• capacity– the person must be capable of giving consent, which means they understand the information given to them and they can use it to make an informed decision

If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected.This is still the case even if refusing treatment would result in their death, or the death of their unborn child.

If a person doesn’t have the capacity to make a decision about their treatment, the Healthcare Professionals treating them can go ahead and give treatment if they believe it’s in the person’s best interests.

Clinicians must however take reasonable steps to seek advice from the patient’s friends or relatives before making these decisions.

Read more about assessing the capacity to consent.

How consent is given

Consent can be given:

• verbally– for example, by saying you are happy to have an X-ray
• in writing– for example, by signing a Consent Form for surgery to be performed

Someone could also give non-verbal consent, as long as they understand the treatment or examination about to take place – for example, holding out an arm for a blood test.

Consent should be given to the Healthcare Professional directly responsible for the person’s current treatment, such as:

• a Nurse arranging a blood test
• a GP prescribing new medication
• a Surgeon planning an operation

If someone is going to have a major medical procedure such as an operation, their consent should ideally be secured plenty of time in advance, so that they have time to obtain information about the procedure and ask questions.

If a paitent changes their mind at any point before the procedure, they are entitled to withdraw their previous consent.

Consent from children and young people

If they’re able to, consent is usually given by patients themselves. However, someone with parental responsibility may need to give consent for a child up to the age of 16 to have treatment.

Read more about the rules of consent applying to children and young people.

When consent isn’t needed

There are a few exceptions when treatment may be able to go ahead without the person’s consent, even if they’re capable of giving their permission.

It may not be necessary to obtain consent if a person:

• requires emergency treatment to save their life, but they’re incapacitated (for example, they’re unconscious) – the reasons why treatment was necessary should be fully explained once they’ve recovered
• immediately requires an additional emergency procedure during an operation – there has to be a clear medical reason why it would be unsafe to wait to obtain consent, and it can’t be simply for convenience
• with a severe mental health condition such as schizophrenia, bipolar disorder or dementia, lacks the capacity to consent to the treatment of their mental health (under the Mental Health Act 1983) – in these cases, treatment for unrelated physical conditions still requires consent, which the patient may be able to provide, despite their mental illness
• requires Hospital treatment for a severe mental health condition, but self-harmed or attempted suicide while competent and is refusing treatment (under the Mental Health Act 1983) – the person’s nearest relative or an approved Social Worker must make an application for the person to be forcibly kept in Hospital, and two Doctors must assess the person’s condition
• is a risk to public health as a result of rabies, cholera or tuberculosis (TB)
• is severely ill and living in unhygienic conditions (under the National Assistance Act 1948) – a person who is severely ill or infirm and is living in unsanitary conditions can be taken to a place of care without their consent

Consent and life-sustaining treatments

A person may be being kept alive with supportive treatments – such as lung ventilation – without having made an advance decision based on information which outlined the care that they may have refused to receive.

In these cases, a decision about continuing or stopping treatment needs to be made based on what that person’s best interests are believed to be.

To help reach a decision, the Healthcare Professionals responsible for the person’s care should discuss the issue with the relatives and friends of the person receiving the treatment.

They should consider, among other things:

• what the person’s quality of life will be if treatment is continued
• how long the person may live if treatment is continued
• whether there’s any chance of the person recovering

Treatment can be withdrawn if there’s an agreement that continuing treatment isn’t in the person’s best interests.

The case will be referred to the Courts before further action is taken if:

• an agreement can’t be reached
• a decision has to be made on whether to withdraw treatment from someone who has been in a state of impaired consciousness for a long time (usually at least 12 months)

It’s important to note the difference between withdrawing a person’s life support and taking a deliberate action to make them die. For example, injecting a lethal drug would illegal.

Complaints

If you believe you’ve received treatment you didn’t consent to, you can make an official complaint, please write to the Practice Manager, who will assist you with this process.

NHS England Consent – Further information

Clinical Trials help Doctors understand how to treat a particular disease or condition. It may benefit you, or others like you, in the future.

If you take part in a Clinical Trial, you may be one of the first people to benefit from a new treatment.

However, if you do take part you should also be aware that there is a chance that the new treatment turns out to be no better, or worse, than the existing standard treatment.

Our Practice is committed to providing a safe, comfortable environment where patients and staff can be confident that best practice is being followed at all times; the safety of everyone is of paramount importance.

All medical consultations, examinations and investigations are potentially distressing. Patients can find examinations, investigations or photography involving the breasts, genitalia or rectum particularly intrusive (these examinations are collectively referred to as ‘intimate examinations’). Consultations involving dimmed lights, the need for patients to undress or intensive periods of being touched may also make a patient feel vulnerable.

Chaperoning is the process of having a third person present during such consultations to provide support, both emotional and sometimes physical, to the patient, to provide practical support to the Doctor as required, and also to protect the Doctor against allegations of improper behaviour during such consultations.

Introduction

This Policy is designed to protect both patients and staff from abuse or allegations of abuse, and to assist patients in making an informed choice about their examinations and consultations.

Guidelines

Clinicians (male and female) will consider whether an intimate or personal examination of the patient (either male or female) is justified, or whether the nature of the consultation poses a risk of misunderstanding.

• The Clinician will give the patient a clear explanation of what the examination will involve
• They will always adopt a professional and considerate manner and be careful with humour as a way of relaxing a nervous situation, as it can easily be misinterpreted
• The patient will always be provided with adequate privacy to undress and dress
• A suitable sign will be clearly on display in each Consulting or Treatment Room offering the Chaperone Service.

The above guidelines are to remove the potential for misunderstanding. However, there will still be times when either the Clinician, or the patient, feels uncomfortable, and it would then be appropriate to consider using a Chaperone.

Patients who request a Chaperone will never be examined without a Chaperone being present. If necessary, where a Chaperone is not available, the consultation/examination will be rearranged for a mutually convenient time when a Chaperone can be present.

Complaints and claims have not been limited to Doctors treating/examining patients of the opposite gender – there are many examples of alleged assault by female and male doctors on people of the same gender.

Consideration will always be given by staff to the possibility of a malicious accusation by a patient, and a Chaperone organised if there is any potential for this.

There may be occasions when a Chaperone is needed for a home visit in which case the following procedure will be followed.

Who can act as a Chaperone?

A variety of people can act as a Chaperone in the practice, but staff undertaking a formal Chaperone role will have been trained in the competencies required. Where possible, Chaperones will be clinical staff familiar with procedural aspects of personal examination.

Where the Practice determines that non-clinical staff will act in this capacity, the patient will be asked to agree to the presence of a non-Clinician in the examination, and for confirmation that they are at ease with this. The staff member will be trained in the procedural aspects of personal examinations, be comfortable acting in the role of Chaperone, and be confident in the scope and extent of their role. They will also have received instruction on where to sit/stand and what to watch and listen for. A Chaperone will document in the patient notes that they were present, and detail any issues arising.

Confidentiality

• The Chaperone will only be present for the examination itself, with most of the discussion with the patient taking place while the Chaperone is not present.
• Patients are reassured that all Practice staff understand their responsibility not to divulge confidential information.

Procedure

• The Clinician will contact reception to request a Chaperone
• Where no Chaperone is available, a Clinician may offer to delay the examination to a date when one will be available, as long as the delay would not have an adverse effect on the patient’s health
• If a Clinician wishes to conduct an examination with a Chaperone present but the patient does not agree to this, the Clinician will explain clearly why they want a Chaperone to be present. The Clinician may choose to consider referring the patient to a colleague who would be willing to examine them without a Chaperone, as long as the delay would not have an adverse effect on the patient’s health
• The Clinician will record in the notes that the Chaperone is present, and identify the Chaperone
• The Chaperone will enter the room discreetly and remain in the room until the Clinician has finished the examination
• A Chaperone will attend inside the curtain/screened-off area at the head of the examination couch and observe the procedure
• To prevent embarrassment, the Chaperone will not enter into conversation with the patient or GP unless requested to do so, or make any mention of the consultation afterwards
• The Chaperone will make a record in the patient’s notes after examination. The record will either state that there were no problems, or give details of any concerns or incidents that occurred. The Chaperone must be aware of the procedure to follow if any concerns require to be raised
• The patient can refuse a Chaperone, and if so this must be recorded in the patient’s medical record.

There are two ways you can make a complaint: 

• You can make a complaint about the service you received at our practice directly to us. To do this please contact reception who will be able to assist you with your complaint.
• You can complain to the commissioner of the service: this is the organisation that paid for the service or care you received.

After 1 July 2023 if you want to make a complaint about primary care services to the commissioner you will now contact the Black Country Integrated Care Board instead of NHS England.

You can do this by: 

Telephone: 0300 0120 281
Email: bcicb.time2talk@nhs.net
Writing to us at: Time2Talk, NHS Black Country Integrated Care Board (ICB) Civic Centre, St Peter’s Square, Wolverhampton, WV1 1SH

If you want to make a complaint directly to the provider of the primary care service, you still can – that does not change on the 1 July 2023.

Please see the Black Country ICB Compliments, concerns and complaints leaflet here.

Ongoing complaints
If you have an ongoing complaint placed on or after 1 July 2022, you will receive a letter from NHS England informing you that the Black Country ICB is now handling your complaint, this will include confirmation of your case handler.

If you have an ongoing complaint placed before 1 July 2022, you will receive a letter from NHS England informing you that your complaint is being retained by NHS England, this will include confirmation of your case handler.

What information will be needed to make my complaint?

Your name, address, telephone number and an email address (if available), and
the same details if you are complaining on behalf of someone else.
The date of birth and NHS number (if known), for the person the complaint
relates to.
Tell us what happened and when.
Where did this happen?
A list of things that you are complaining about.
What changes are needed to improve experiences in the future.

In General

If you have a complaint to make, you can either contact the Practice Manager or ask the Receptionist for a copy of our Complaints Procedure. We will endeavour to:

1. acknowledge any letter or Complaints Form within 3 working days of receiving it.
2. deal with the matter as promptly as possible – usually within 20 working days – dependent on the nature of the complaint.

Who can complain

• Complainants may be current or former patients, or their nominated or elected representatives (who have been given consent to act on the patients behalf).
• Patients over the age of 16 whose mental capacity is unimpaired should normally complain themselves or authorise someone to bring a complaint on their behalf.
• Children under the age of 16 can also make their own complaint, if they’re able to do so.

If a patient lacks capacity to make decisions, their representative must be able to demonstrate sufficient interest in the patient’s welfare and be an appropriate person to act on their behalf. This could be a partner, relative or someone appointed under the Mental Capacity Act 2005 with lasting power of attorney.

Appropriate person

In certain circumstances, we need to check that a representative is the appropriate person to make a complaint.

• For example, if the complaint involves a child, we must satisfy ourselves that there are reasonable grounds for the representative to complain, rather than the child concerned.
• If the patient is a child or a patient who lacks capacity, we must also be satisfied that the representative is acting in the patient’s best interests.

If we are not satisfied that the representative is an appropriate person we will not consider the complaint, and will give the representative the reasons for our decision in writing.

Time limits

A complaint must be made within 12 months, either from the date of the incident or from when the complainant first knew about it.

The regulations state that a responsible body should only consider a complaint after this time limit if:

• the complainant has good reason for doing so, and
• it’s still possible to investigate the complaint fairly and effectively, despite the delay.

Procedure

We have a two stage complaints procedure. We will always try to deal with your complaint quickly however if it is clear that the matter will need a detailed investigation, we will notify you and then keep you updated on our progress.

Stage one – Early, local resolution

• We will try to resolve your complaint within five working days if possible.
• If you are dissatisfied with our response, you can ask us to escalate your complaint to Stage Two.

Stage Two – Investigation

• We will look at your complaint at this stage if you are dissatisfied with our response at Stage One.
• We also escalate some complaints straight to this stage, if it is clear that they are complex or need detailed investigation.
• We will acknowledge your complaint within 3 working days and we will give you our decision as soon as possible. This will be no more that 20 working days unless there is clearly a good reason for needing more time to respond.

Complain to the Ombudsman

If, after receiving our final decision, you remain dissatisfied you may take your complaint to the Ombudsman.

The Ombudsman is independent of the NHS and free to use. It can help resolve your complaint, and tell the NHS how to put things right if it has got them wrong.

They can review the way in which your complaint has been handled, but you will need to contact the Ombudsman about your case within 12 months of the final local outcome of your complaint.

Email: PHSO.enquries@ombudsman.org.uk
Telephone: 0345 015 4033
Website: www.ombudsman.org.uk

Confidentiality

All complaints will be treated in the strictest confidence.

Where the investigation of the complaint requires consideration of the patient’s medical records, we will inform the patient or person acting on his/her behalf if the investigation will involve disclosure of information contained in those records to a person other than the Practice or an employee of the Practice.

We keep a record of all complaints and copies of all correspondence relating to complaints, but such records will be kept separate from patients’ medical records.

Statistics and reporting

The Practice must submit to the local primary care organisation periodically/at agreed intervals details of the number of complaints received and actioned.

View our complaints leaflet here.