Health and Social Care - What care workers can do when consent is witheld

Why is consent sometimes withheld, and what can care workers do to establish consent?

This blog expands on issues around consent that candidates studying Levels 2 and 3 of the Health and Social Care Diploma, BTEC Health and Social Care, Dementia Care units and other courses relevant to the field of health and social care will encounter.

What is consent?
Consent is giving permission to do something. In health and social care settings it usually means that the individual gives consent to take part in an activity or to accept some kind of care or treatment.

It is important to remember that:

• It is a legal requirement that consent is established before any intervention or care-giving activity takes place
• Establishing consent is one way care workers can demonstrate they respect the individual and the individual’s personal dignity
• The process of establishing consent is instrumental to developing trust between care worker and the individual 
• The individual is more likely to want to take part in an activity they have given permission for

Consent can be given in a number of ways: verbally, in writing or through actions.  The individual might also allow another person to do something with or to them, perhaps by raising an arm to be supported when dressing, and thereby imply consent.  Informed consent is given when the individual understands what they are consenting to.

However, it is not always possible to readily establish informed consent, and in some circumstances, consent might be withheld.  

Why would consent be withheld?
Individuals might withhold their permission for an action to be performed because care workers:

• Do not understand the individual’s needs, condition or capacity to make decisions 
• Do not have the relevant information or be able to impart information in a form that is understandable to the individual
• Do not themselves understand available options, and potential or actual risks to the individual

What can care workers do to establish consent when it is withheld? 

1. Ensure they understand and act on understanding of the health status or condition of the individual
2. Ensure they understand the individual’s needs and preferences
3. Ensure they understand the individual’s ability to make decisions
4. Ensure they have available the relevant information in a form that the individual can understand
5. Ensure they themselves understand the information and options open to the individual
6. Listen to the individual and observe for other responses 

Conclusion
Consent is giving permission for something.  Sometimes permission is withheld but there are actions that care workers can take to establish consent where it is withheld.  These actions are in keeping with an approach to care that respects the individual, improves care and sits securely within the legal framework for practice.

John Rowe works for the Open University and has a wealth of practice experience in health and social care settings.