WHC(2008)10
WELSH HEALTH CIRCULAR
Parc Cathays
Caerdydd CF10 3NQ
Cathays Park
Cardiff CF10 3NQ
Issue Date: 29 February 2008
Status: Guidance
Title: Patient Consent to Examination and Treatment – Revised Guidance
For Action by: Chief Executives of Local
Health Boards and NHS Trusts
Action required Please see paragraph 2
For Information to: See attached list
Sender: Wendy Chatham, Director of Quality, Standards and Safety Improvement, Department for
Health and Social Services, Welsh Assembly Government, Cathays Park, Cardiff, CF10 3NQ, 02920
825528 wendy.chatham@wales.gsi.gov.uk
Welsh Assembly Government contact(s) : Please see paragraph 12.
Enclosure(s): Reference Guide to Consent for Examination or Treatment; Model Consent Forms 1-4
Tel: 0845 010 3300 GTN: 1208
Ffon: 0845 010 4400
Llinell union/Direct line: 029 2082 5528
Ffacs/Fax: 029 2082 3116
Minicom: 029 20823280
http://howis.wales.nhs.uk/whcirculars.cfm
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Revised Guidance: Patient Consent to Examination and Treatment
Dear Colleague
Purpose
1. I have pleasure in enclosing a copy of revised guidance on obtaining valid consent from
patients undergoing examination and treatment, together with four model consent forms.
An updated version of the Good Practice in Consent: Implementation Guide, including a
model consent policy, is also being prepared and will be issued before the end of March
2008.
Action
2. Local Health Boards and NHS Trusts are asked to:
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review their consent policies to ensure they are consistent with the guidance in the
Reference Guide and Model Consent policy (when issued); and
introduce the revised consent to treatment forms into their organisation from March
2008.
Background
3. The Welsh Assembly Government issued guidance on consent to examination and
treatment in April 2002 (WHC(2002) 42), highlighting the need for valid consent to be
obtained before starting treatment or physical investigation, or providing personal care, for
a patient. It set out the legal requirements for obtaining valid consent and gave guidance on
the circumstances in which treatment may be given to a patient who cannot give his or her
valid consent. The circular contained the enclosure “Reference Guide for Consent to
Examination or Treatment", together with model consent forms and a consent policy.
4. Since this guidance was issued, there have been a number of significant developments
which have required it to be revised. These include the coming into force of: the Mental
Capacity Act 2005; Human Tissue Act 2004; and recent case law which has had
implications for medical practice. WHC(2006)06 provided a partial update in relation to
three cases - Glass v United Kingdom, Chester v Afshar, and Burke v GMC.
Consent Advisory Group
5. In developing the revised guidance, we have consulted with the Welsh Consent Advisory
Group. This Group was originally established to advise on the 2002 guidance, and was reformed to advise on the updated guidance. Its membership includes:
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BDA Wales National Director;
BMA Wales;
Cardiff Law School;
Consultant Anaesthetist;
Medical Director of an LHB
Medical Director of an NHS Trust;
National Public Health Service
Nursing Director of an NHS Trust;
Royal College of Nursing (Wales);
Royal College of Surgeons; and
Welsh Board of Community Health Councils.
6. The Consent Advisory Group’s advice has been taken fully into account in developing
the final versions of the documents. NHS bodies, GP surgeries and other persons
providing public health services in Wales should review their consent policies and amend
where necessary to reflect the changes in the law as set out in the Guide. The Reference
Guide is currently more orientated towards the provision of care in secondary care settings,
and we will shortly be seeking the Consent Advisory Group’s advice about the
implementation of the Guide in the primary care sector.
7. The model consent forms and consent policy (when issued) aim to help NHS Trusts and
Local Health Boards ensure that the principles set out in the Reference Guide become a
reality in their organisations. There are four model consent forms:
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Consent Form 1: for patients able to consent for themselves;
Consent Form 2: for those with parental responsibility, consenting on behalf of a child or
young person;
Consent Form 3: both for patients able to consent for themselves and for those with
parental responsibility consenting on behalf of a child/young person, where the
procedure does not involve any impairment of consciousness;
Consent Form 4: for use where the patient is an adult unable to consent to investigation
or treatment.
Consistency of approach
8. Patients and staff may move between a number of different NHS organisations, and so
from a patient safety perspective, it is important that both the consent forms and the
consent policy are used consistently across NHS (Wales). We do however recognise that
local needs may arise which cannot be reflected in national documentation, and
organisations should always seek their own legal advice if they are in any doubt when
dealing with individual cases.
9. Seeking consent to treatment must be about enabling patients to make healthcare
choices which are right for them, and recognising that different patients will make different
choices in apparently similar situations.
10. The law concerning patient consent is the same in Wales and England and, in
developing this guidance, we have liaised with colleagues at the Department of Health who
are issuing guidance for England. Whilst presentationally our guidance is different from the
Department of Health's version, we have worked with them to ensure that our interpretation
of the law is essentially the same so as to avoid confusion for health professionals in the
two countries. However, there are some differences and these mainly relate to the sections
on “Parental Consent in Relation to Young People Aged 16 or 17”, “Self Harm” and
“Withholding Information”. Because of the lack of legal certainty in these areas, the Welsh
Assembly Government’s legal advisers and the Consent Advisory Group have taken a view
on what they believe to be good practice that will comply with the law.
Welsh Language and further Information
11. All of the enclosures with this circular can be downloaded from www.wales.nhs.uk/consent.
Welsh language versions of this circular and annexes are being prepared and will be uploaded as
soon as possible. Hardcopies will also be made available on request.
12. If you would like further information about Patient Consent to Examination and Treatment,
please contact Carl Eley, Head of Healthcare Standards (029) 2082 6842 –
carl.eley@wales.gsi.gov.uk; or Dominic Worsey, (029) 2082 3083 –
dominic.worsey@wales.gsi.gov.uk.
Yours sincerely
Wendy Chatham
Director of Quality, Standards and Safety Improvement
Department for Health and Social Services