TRUST Consent Policy

Policy Statement

This policy is written to achieve compliance with Regulation 11, “Need for Consent” of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (in force from April 2015), and the accompanying guidance issued by the Care Quality Commission.

Regulation 11 expresses a requirement on all care providers to seek the consent of patients to carry out any proposed treatment and to follow specific procedures in line with the Mental Capacity Act 2005 where people are unable to give their informed consent.

The five key principles of the Mental Capacity Act

● Principle 1 – A presumption of capacity.
● Principle 2 – The right to be supported when making decisions.
● Principle 3 – An unwise decision cannot be seen as a wrong decision.
● Principle 4 – Best interests must be at the heart of all decision making.
● Principle 5 – Any intervention must be with the least restriction possible.

It has always been the policy of Tele-Rehab Ltd to empower its patients to lead their own lives, enabling them to exercise choice and to maximise their independence, while offering them the treatment and support that they need. This involves obtaining patients’ agreement in respect of any proposals or plans for their treatment, making sure that such agreements are fully recorded.

Reflecting our acceptance of patients’ human rights, Tele-Rehab Ltd works on the basis that everyone is competent to make their own decisions about their treatment needs unless it can be shown otherwise. Tele-Rehab Ltd ensures that any patient who may lack the mental capacity to provide informed and valid consent for proposed treatment is thoroughly assessed in accordance with the Mental Capacity Act 2005.

Who When Why

Who – the person responsible for carrying out the mental capacity assessment will be:
Dr Anbananden Soopramanien

Contact details for Tele-Rehab Ltd: Dr Anbananden Soopramanien
Tel: 07753846383
Email: anba.soopramanien@trusttelerehab.com

When will it be carried out: during the initial consultation.

Why: an assessment must only be sought if there is evidence to suggest that capacity might be an issue in terms of the decision that is being made. This may apply when:

● When the individual’s behaviour or circumstances cause doubt about their capacity to make a decision.
● When someone is concerned about an individual’s capacity.
● When the individual has a previous diagnosis of an impairment that might impact their capacity to make some decisions.

It is the responsibility of Dr Anbananden Soopramanien, Registered Manager regarding the mental capacity of a patient of Tele-Rehab Ltd, in relation to any questions or queries, so other staff members know who to approach if they have concerns about a patient’s capacity.

If from the assessment it is clear that the person cannot give their informed consent on account of their mental incapacity, a decision will be taken in their “best interests” following Mental Capacity Act procedures.

To make sure that a decision is in a person’s best interests, Tele-Rehab Ltd will always encourage and enable the person to have the services of an independent advocate if needed. If the treatment proposed implies a deprivation of that person’s liberty in any way Tele-Rehab Ltd will always invoke established deprivation of liberty safeguarding procedures.

Deprivation of Liberty Safeguarding (DoLS) Procedures

These are designed to ensure that any deprivation of a person’s liberty in care settings is lawful, necessary and truly in the person’s best interests. The procedure involves having the arrangements independently assessed to ensure they are in the best interests of the individual concerned and to give those subjects to a deprivation of liberty the means to challenge this.

The essential elements these procedures should include are:

● Application and Authorisation: When a deprivation of liberty is proposed, the “managing authority who has responsibility for the care of the individual” must apply to the local authority (“supervisory body”) for authorisation before proceeding.

● Six Key Assessments: Authorisation can only be granted if all six specific assessments are undertaken and passed, which include:

● Age assessment (person must be 18 or over)
● Mental health assessment (diagnosis of a mental disorder)
● Mental capacity assessment (person lacks capacity to consent)
● Best interests assessment (deprivation is necessary and in the person’s best interests)
● Eligibility assessment (confirming the person is not under Mental Health Act detention)
● No refusals assessment (ensuring no conflict with any advance decision or attorney/deputy decisions).

● Independent Assessment: Assessors must be independent and not involved in the direct care/treatment of the person.

● Appointment of a Representative: A “relevant person’s representative” (such as a family member, friend, or paid representative) must be appointed to support and represent the person being deprived of their liberty. The person also has access to an independent advocate if needed.

● Regular Reviews and Time Limits: Deprivation of liberty must be for a set time and reviewed regularly to ensure it remains necessary and proportionate. Authorisations are typically granted for up to 12 months and must be reassessed for renewal.

● The Right to Challenge: The person (or their representative) has the right to challenge the deprivation of liberty in court (specifically, the Court of Protection) if they believe it is not justified or no longer required.

● Less Restrictive Alternatives: Procedures require consideration of whether there are less restrictive ways to care for and support the person, avoiding deprivation of liberty altogether if possible.

● Best Interests Focus: At all times, the guiding principle is that actions must be in the person’s best interests and the least restrictive option should always be chosen.

● Urgent Authorisations: If immediate action is needed, an urgent authorisation can be granted by the managing authority, but this must be reported to the supervisory body and formally assessed within seven days.

These procedures ensure that deprivation of liberty is never taken lightly and is subject to multiple safeguards, checks, and opportunities for the individual and their advocate or representative to be heard. This process aims to protect individuals’ rights while ensuring their safety and well-being.

Approach to Consent for each Service User Band

This should be consistent, person-centred and grounded in respect for individual rights, ensuring that all patients are equally supported to consent to treatment. This is to include:

● Tailoring consent approaches to individual needs
● Decision-specific and time-specific assessments
● Respecting withdrawal or refusal of consent
● Supporting those who lack capacity
● Staff/ associate responsibility and training
● Consistent documentation
● Ensuring equality in consent practice

Gillick Competence

The term ‘Gillick competence’ comes from the Gillick vs West Norfolk and Wisbech Area Health Authority case (1985). Gillick competency and Fraser guidelines help people who work with children to balance the need to listen to children’s wishes with the responsibility to keep them safe. When health professionals are trying to decide whether a child is mature enough to make decisions about things that affect them, they often talk about whether the child is ‘Gillick competent’ or whether they meet the ‘Fraser guidelines’. In assessing competence:

● The capacity to consent depends on the young person’s ability and maturity to understand and weigh up the options, not on their age.

● The healthcare professional must provide a young person with all the relevant information and discuss it with them thoroughly. Must assess whether they can understand and retain what they are being told about the nature, purpose and possible consequences of any proposed treatment, and whether they can weigh up the information to make a decision, and communicate it.
● It’s important to assess maturity and understanding on a case-by-case basis. A young person who has the ability and maturity to understand and consent to straightforward, relatively risk-free treatment may still lack the competence for more complex treatment with high-risk outcomes.

● A young person’s capacity to consent may be affected by their physical and emotional development, as well as changes in their health and treatment.

Decision-specific Assessments

When a person is thought to possibly lack capacity, a formal assessment should be undertaken with the following key points in mind:

1. Assess Capacity for the Specific Decision at the Relevant Time
Capacity is assessed only for the decision at hand – and at the time the decision needs to be made, for example, deciding on a care plan, managing finances, or consenting to medical treatment.

2. Use Clear and Relevant Information
The person should be given all the information necessary for that decision, presented in a way that is understandable to them, whether through clear language, visual aids, or communication support.

3. Evaluate Understanding and Decision-Making Ability
The assessment tests whether the person can:
● Understand the key information relevant to that specific decision
● Retain that information long enough to make the decision
● Weigh up or use that information to make or communicate the decision.

4. Recognise Fluctuating Capacity
Fluctuating capacity refers to situations where a person’s ability to make decisions or understand information varies over time, meaning they might have capacity to decide at some times but not at others. This can occur due to conditions like mental illness, dementia, brain injury, or temporary factors such as medication effects or fatigue.
Capacity can vary, so assessments should be repeated when circumstances change or when the person may be better able to decide at a later time.

Consent Decision-making Procedures

Tele-Rehab Ltd takes the following actions to make sure that patients are always giving their consent to decisions about their treatment:

a) Patients and their representatives are asked to read and sign all basic agreements about their service provision. They will be consulted on any proposed changes to these, and their consent sought.

b) Where the person’s use of a care/ treatment service has been taken as a “best interests” decision because they lack mental capacity, the fact that they have not been able to give their valid consent is fully recorded and deprivation of liberty safeguarding procedures will be implemented.

c) Patients (or their representatives) are always asked to sign their plan of treatment as an indication they are in agreement with the services being proposed to meet their needs, which include personal, health (including medication), social, psychological and spiritual needs.

d) Any proposed changes to the plans of treatment are always discussed with patients and their representatives in order to obtain their consent, which is recorded on the care plan or review form. Patients’ agreements and signatures are always obtained following regular reviews.

e) Tele-Rehab Ltd expects other healthcare professionals such as GPs and community nurses to be responsible for implementing deprivation of liberty .Where it is considered that the treatment provided might restrict a person’s ability to exercise choice or their freedom of movement, such as when bed rails are proposed, their written consent is always obtained or a “best interests” decision fully recorded.

f) Where verbal consent is being sought for what are usually day-to-day treatment proposals or changes, the reasons for the need to seek consent, the fact that it has been obtained, and how, are all recorded on the person’s treatment plan.

g) Patients’ consent is always sought in relation to any proposed participation in the social and community activities organised or facilitated by Tele-Rehab Ltd. Consent is obtained either directly from the patient or as a “best interests” decision taken in discussion with their relatives and representatives.

h) Tele-Rehab Ltd expects other healthcare professionals such as GPs and community nurses to be responsible for seeking patients’ consent for any treatment that they provide. Tele-Rehab Ltd will help to implement their decisions on the basis that the patient has given their consent to the proposed “best interests” decision that has been taken. Tele-Rehab Ltd will check that this has been the case and make sure that the relevant consent decision has been recorded.

i) Any refusal to give consent or difficulty in obtaining it because of suspected mental incapacity is recorded on the person’s treatment plan together with an account of the actions taken to address the consequences of the decision or difficulty. The person’s decision to refuse consent is always fully respected.

j) Tele-Rehab Ltd encourages and facilitates any patient who might be undecided though able to give a valid consent or who might lack the capacity to give their informed consent to have the services of an independent advocate or representative.

k) If a patient provides Tele-Rehab Ltd with any advance decisions about wishing to refuse treatment in the event of a loss of mental capacity, these will be disclosed under the appropriate circumstances in order for a decision to be made in line with the person’s wishes.

l) Consent is always sought if any proposal or request is made to take part in any research project and “best interests” meetings are held in the cases of anyone who cannot give their informed consent about taking part.

Restraint and Consent

Tele-Rehab Ltd only communicates with patients remotely and does not provide any care or manage any support workers. Tele-Rehab Ltd feels it is important for all staff to be aware of this information as part of their training.

Consent to restraint in care for a person who may lack capacity requires careful, lawful decision-making to ensure rights are upheld.

If a person lacks the capacity to consent to restraint for their care, consent cannot be genuinely obtained from them. Instead, the following conditions must be met:

● The decision to use restraint must be based on a reasonable belief that the person lacks capacity specifically related to the restraint or intervention proposed.

● The restraint must be necessary to prevent harm to the person (or sometimes others), and the use of force must be proportionate to the likelihood and seriousness of that harm.

● The action must be considered to be in the person’s best interests, applying the Mental Capacity Act’s best interests checklist, including consideration of the person’s past and present wishes, feelings and any less restrictive alternatives.

● All possible steps must be taken to support the person to make the decision themselves before concluding that restraint is necessary.

● The use of restraint must be the minimum amount of force used for the shortest possible time.

Once these conditions are satisfied, staff / carers may lawfully use restraint under the Mental Capacity Act even without explicit consent from the person, because the person is deemed unable to give valid consent.

Power of Attorney and Consent

A power of attorney (POA), particularly a Lasting Power of Attorney (LPA) under the UK Mental Capacity Act 2005, authorises a trusted person (the attorney) to make decisions on behalf of an individual, if that person loses the mental capacity to make those decisions themselves. It relates directly to consent in the following key ways:

● There are two main types of Lasting Power of Attorney:
o Health and welfare LPA, which covers decisions about personal welfare, medical treatment, and where the person should live.
o Property and financial affairs LPA, which covers decisions about money and property.

● When does the attorney act?
The attorney can only make decisions and give consent on behalf of the person once the person has lost capacity to make that particular decision themselves. If the person still has capacity, their own consent is required and must be respected.

● Assessment of Capacity
Before an attorney makes a decision or gives consent, they must check if the person has capacity for that specific decision at that time, in line with decision-specific assessments under the Mental Capacity Act.

● Best Interests
The attorney must act in the person’s best interests, following the Mental Capacity Act’s principles, including considering the person’s past and present wishes, feelings, values, and beliefs when making decisions or consenting to treatment or care.

● Legal Authority and Safeguarding
The LPA is a legally binding document registered with the Office of the Public Guardian. It safeguards the donor by ensuring only those appointed as attorneys can make consent decisions on their behalf under the Mental Capacity Act. The actions of attorneys are subject to oversight and can be challenged if they do not act properly.

In practice, consent given by an attorney under an LPA can lawfully substitute for the individual’s own consent when they lack capacity, enabling professionals to proceed with necessary care, treatment, or financial decisions without breaching legal or ethical standards.

Complying with the Accessible Information Standard, Equality Act and UK GDPR

To uphold the rights of all patients, particularly in supporting those with sensory impairments, it is essential that our policy is fully accessible to everyone, including both patients and staff. Compliance with the Accessible Information Standard ensures that individuals with disabilities, impairments, or sensory loss receive information in formats they can access and understand, such as large print, braille, easy read, or through communication support tools.

We will identify, record, and meet the diverse communication and information needs of all service users, guaranteeing equitable access to information and services. This prevents discrimination and aligns with our legal obligations under the Equality Act 2010 to treat all individuals fairly and without bias.

We protect the privacy and data rights of our patients and staff members in accordance with UK GDPR, ensuring personal information is lawfully processed, securely stored, and only shared with appropriate consent or legal authority.

Withdrawal of Consent

A patient with capacity has the legal right to withdraw their consent at any point, even after previously giving it. Consent is an ongoing process, not a one-off event.

When a patient withdraws their consent, healthcare professionals and treatment providers must respect and facilitate this decision, ensure that it is informed and voluntary. Assess capacity if necessary, document the withdrawal clearly, and continue to communicate supportively while following legal and ethical safeguards to protect the person’s rights.

Staff should provide a clear explanation of the likely consequences of withdrawing consent, helping the person understand what might happen if treatment is stopped. This supports informed decision-making.

This approach ensures staff understand their responsibilities and patients have their autonomy and rights upheld throughout the care/treatment relationship.

Training

It is essential that all staff understand and apply decision-specific assessments correctly to:
● Respect each person’s rights and dignity
● Provide appropriate support tailored to the decision and the individual’s abilities
● Avoid unnecessary restrictions on autonomy
● Follow lawful and ethical practice under the Mental Capacity Act.

Associates are expected to cover this under their own mandatory trainings, but Tele-Rehab Ltd will also cover Consent issues in the induction programmes in line with the guidance and standards produced by the relevant social and healthcare workforce development organisations.

Tele-Rehab Ltd Associates and Directors will have their own provision for training in the Mental Capacity Act 2005 in the treatment of the people using the service. Tele rehab Ltd allows only staff who have completed the training, and have shown that they are competent, to take part in “best interests” decision-making in relation to patients who cannot give their informed consent.

This policy applies to the following people in our organisation All Staff, Contractors, Volunteers, and Service Users
Policy Written by Dr Anbananden Soopramanien
Chief Executive Officer / Director
Date Policy written 9 August 2025

Due for Review 9 August 2026

Who has or can give authority to change policy Board of Directors

Where is this policy kept On the companies shared drive.

Date Reviewer Version Date for Next Review Date of recirculation