Autonomy and consent in social care

Too often in care settings we hear the question, “Why did no one tell me?” No care provider wants the people they support to feel unheard or uninformed, that’s why autonomy in care is so important to ensure service users are fully involved in their own care.

Why autonomy matters to service users and their families

It matters because it’s their care and they should be at the centre of it. In many care situations, your service users and their loved ones may already feel like they’re losing control – of their body or mind, and of the life they hoped to have – simply because of the circumstances that led them to seek support. That’s why involving service users and their families in decision-making around their care is so critical to helping them retain as much autonomy as they can.

In order to properly involve your service users in decision-making about their care, you may need to tailor conversations around care plans to match your clients’ needs – what are their specific concerns, their attitude to risk and their understanding of the possible outcomes of receiving or refusing the care?

The 2016 CQC review, Not Seen, Not Heard, recommended that service users are engaged at each stage of their care planning in order to help them be involved in, and take ownership of, their own treatment and care.

"I’m not a case; I’m not a piece of paper. I’m a human. I need you to see that if you’re going to help me."
A recent care leaver | The Who Cares? Trust (CQC, 2016)

Why consent matters to service users and their families

Consenting to care means that services users are at the heart of the plans put in place to support them. Giving your service users all the information they need to make confident and competent decisions empowers them to be fully involved in their own care.

A record of signed consent informs families and friends that their loved one is receiving the high-quality care they deserve. Moving a relative to a care home can be a difficult time for families, but knowing that their family member still has autonomy and is fully informed about the care they are receiving, can help with that transition.

Why consent matters to care providers

Obtaining consent is best practice for care delivery. It keeps services users and their families involved, minimises your risk as a care provider and improves the quality of care. Discussing care plans is a way of keeping those you support fully involved in their own care. You’re helping them make informed decisions and remove the risks associated with those, on their behalf. By establishing consent, you can show your service users that they are at the heart of care delivery and you respect them as individuals.

"Consent to care should be obtained prior to starting any form of support. It shows that the person and/or their representative has been fully involved in any decisions. Without this, it can put care workers and organisations at risk."
Mark Topps | Regional Business Manager, Essex Cares Limited

Reduce risk

As with most things in life, there’s an element of risk with every care measure or treatment. When giving consent, your service user accepts those risks. On the other hand, when withholding consent, they agree to the risks of not getting the care or treatment suggested. Essentially, it’s a process of changing who will take responsibility for what could go wrong and transferring risk from you as the care provider to the service user.

As a care provider, having a signed record of this consent or withholding of consent can be invaluable, should those risks become reality. But remember, for the consent you obtain to be valid, it must be voluntary, informed and given by someone with the capacity to do so. It’s therefore critical that you provide your service user with all the knowledge they require to be able to evaluate the risks of the suggested care or treatments.

Not getting consent right, can lead to complaints, criminal liability, liability for damages, disciplinary action and more. However, consent obtained correctly can protect you and your staff.

Improve care quality and be person-centred

Delivering high-quality, person-centred care means involving service users in decision-making processes whenever possible. They know their own preferences and needs better than anyone else. This is an opportunity to initiate discussions with your service users and their loved ones about the care that might benefit them and help you develop care plans that really suit them.

Obtaining consent is an ongoing process that reflects your service users’ changing opinions and capacities. Having up-to-date records signed by the individual illustrates that you’ve considered their preferences and needs when seeking consent.

Legal requirement

As well as being beneficial for you and your service user, having a record of consent is a legal requirement that regulatory bodies, like the Care Quality Commission (CQC) or the Care Inspectorate, check diligently, and will affect how they evaluate your service as a whole.

Your staff should also be aware of when, where and how they need to establish a service user’s consent, and should be knowledgeable enough about the individual they’re seeking consent from to enable them to make an informed decision about their care.

When a person decides against their proposed care, the risks, benefits and alternative options should be explained, but as long as they have capacity their decision must be respected – even if you don’t agree with it.

If someone in your care loses the capacity to make a decision, it’s important to check if they’ve made an advance decision about giving or refusing consent.

"It’s important that consent is reviewed and people’s wishes to decline are respected. This ensures care workers are supporting people to meet their needs effectively and there’s no breakdown in trust or professional relationship."
Mark Topps | Regional Business Manager, Essex Cares Limited

Consent best practices

Here are a few high-level best practices to keep in mind when establishing consent:

• Fully involve your service users in their care – discuss care plans and give them all the information they need to make competent decisions.
• Ensure your staff are sufficiently informed of your services users’ needs and requirements when seeking consent to help them explain the proposed care in a way that is relevant to the individual.
• Give your service users enough time to think about their consent decisions, respect their right to refuse to consent and regularly review all consent decisions against their changing opinions and capacity.
• Remove the risks associated with making decisions on behalf of your service users by establishing consent and giving them the responsibility for what could go wrong when receiving or refusing care.
• Keep time-stamped digital documentation of signed consent – this protects you if that consent is ever called into question and is a legal requirement that regulatory bodies check diligently when it’s time for inspection.
• Make capturing consent a part of your process with a standardised approach.

How we support you to manage consent

By using our consent management feature you can easily manage your service users’ individual consent records electronically (exclusive to our Pro and Group Tiers). Service users or their Legal Power of Attorney can digitally sign one or multiple consent and lack of capacity forms directly from the Care Office. You can then schedule reminders to review these records together with the client at a later, pre-defined time.

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Not using our software yet? Why not give our consent management feature a go? Start your free 30-day trial now and see if it’s the right fit for your care service.

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