Consent and communication

Also called Informed consent, Consent to treatment, Consent to care, Regulation 11

Consent given by sign, symbol, device, blink or gesture is consent. The service's job is to give the information in a form the person can use and then hear the answer.

What it is

Consent is a person's agreement to treatment, care, an examination, a photograph, a move, a plan. For it to be valid the person must have capacity for the decision, must have enough information, and must give it freely. Nothing in the law says consent has to be spoken or written. The Mental Capacity Act in England and Wales explicitly counts communication "by any means"; the Adults with Incapacity Act in Scotland requires the person to be helped to communicate.

In health, the NHS's own consent guidance applies across the UK and says the same thing: information must be given in a way the person can understand, and the answer accepted in whatever form it comes.

Who it can help

Anyone who cannot easily say "yes, I agree" out loud or sign a form: people who use AAC, people with aphasia, Deaf BSL users, people with a learning disability, people with locked-in syndrome. Also clinicians and care staff who want to get it right and are unsure whether a nod or a symbol counts. It does.

It is not a shortcut. A symbol pressed without understanding is not consent, and a person who was never given the information in a usable form has not consented to anything. The work is in the explanation.

How it works

Three steps. Information: the clinician explains what is proposed, why, what the alternatives are and what happens if nothing is done, in the person's format: easy read, pictures, BSL through an interpreter, a demonstration on a doll, a video. Understanding: the person is given time and asked to show what they have understood, not just asked "do you understand?". Decision: the person says yes or no in their mode, and the clinician records what was said and how.

Where a person genuinely cannot consent even with support, treatment can go ahead in their best interests, but the assessment and the reasons must be recorded and the person must still be involved. Consent to routine care in a care home, washing, dressing, medication, works the same way, every day, and a service that never asks is failing the regulator's consent standard.

Getting started

If a procedure or a decision is coming up for someone you support, ask the clinician in advance how they will explain it and in what format, and offer to bring the person's board and passport. Ask for the explanation to happen on a separate day from the decision. Ask for the yes and no to be checked more than once.

If you use AAC yourself, add the words you need for consent to your vocabulary: agree, refuse, not sure, explain again, stop, later. The Talk board's yes and no and manners sets carry most of them, and you can speak them aloud so the room hears your answer, not a carer's version of it. Ask that the notes record your answer in your own words.

Where to get help

The NHS page on consent to treatment is the plain authority. The Care Quality Commission sets the consent standard for care providers in England. Mencap publishes guidance on consent for people with a learning disability. SCIE covers the Mental Capacity Act side. See also supported decision-making and saying no.