Skills for Care

Key lines of enquiry version

All services - change

GO Online: Inspection toolkit

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Consent to care and treatment

Managers and leaders play a vital role in good and outstanding rated care services to ensure that consent is sought, and the service supports people to make their own decisions. Where people lack mental capacity, best interest decisions are made.

The following film provides a summary of this area of inspection. It can help you and your teams learn about what will be inspected and what is important to demonstrate to deliver good or outstanding care.

Introducing consent to care and treatment

Duration 02 min 15 sec

Care and treatment must only be provided with the consent of the person you support.

This area of CQC inspection looks at how you manage and support people’s consent. 

The CQC will want to know how your service is always supporting people to make their own decisions in line with the latest legislation and guidance.

Inducting new staff and refreshing learning is important … but you should also remember to check staff understanding and assess their confidence. Discussions in one-to-ones, team meetings and when shadowing colleagues can help.

Your managers should have a deeper understanding of consent, enabling them to respond to escalated issues from the staff team.

The regular monitoring of people’s mental capacity and associated assessments is important, as well as recording this information.

Where people lack capacity, best interest decisions may need to be made on their behalf.

The inspection may also focus on awareness and understanding of people’s liberty safeguards.

CQC inspectors will seek to interview people, their family, friends, and advocates when looking at consent.

Documented evidence may be asked for, including:

  • Consent to care and treatment records
  • Records of assessments of mental capacity
  • Best interests decision-making records
  • DoLS application forms
  • Do Not Attempt CPR ‘notices’ in files
  • …and associated policies and procedures.

Outstanding services excel at involving people, even where a disability or other impairments could make this very difficult. Any restrictions will be kept in constant review and only used where absolutely necessary.

Some of the reasons why services do not meet this area of inspection include inconsistency of approach. These services may not always try to involve people in decisions, making them on their behalf and not always in their best interest.

To learn more about how to be effective at People’s Consent, look at GO Online’s recommendations, examples, and resources.

CQC Focus

The CQC inspection will focus on the following key line of enquiry when looking at this topic. The additional prompt questions below may be explored as part of their inspection focus.

  • E7 -

    Is consent to care and treatment always sought in line with legislation and guidance?

  • E7.1 -

    Do staff understand the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005 and the Children’s Acts 1989 and 2004 and other relevant national guidance? 

  • E7.2 -

    How are people supported to make their own decisions in line with relevant legislation and guidance?

  • E7.3 -

    How and when is possible lack of mental capacity to make a particular decision assessed and recorded?

  • E7.4 -

    How is the process for seeking consent monitored and reviewed to ensure it meets legal requirements and follows relevant national guidance?

  • E7.5 -

    When people lack the mental capacity to make a decision, how do staff ensure that best interests decisions are made in accordance with legislation?

  • E7.7 -

    Do staff recognise when people aged 16 and over, who lack mental capacity, are being deprived of their liberty, and do they seek authorisation to do so when they consider it necessary and proportionate?

  • E7.M -

    The following questions are specific to CQC monitoring process.  Some prompts will only be asked where relevant to a service type:

    • How are you managing social distancing, and ensuring least restrictions on people’s liberty or using seclusion/segregation during the pandemic period?
    • How does the service promote supportive practice that avoids the need for physical restraint? For example, are positive behaviour support plans in place? Are staff trained in this?
    • Where physical restraint may be necessary, how do you ensure that it is used in a safe, proportionate, and monitored way as part of a wider person-centred support plan?
    • How are you ensuring that you continue to meet Mental Capacity Act Code of Practice requirements?

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