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8.2 Consents

SCOPE OF THIS CHAPTER

This Guidance relates to all children in care.


Contents

  1. Placement Planning 
  2. General Guidance Regarding Consents
  3. Children who Seek Advice/Treatment without Consulting Parents 


1. Placement Planning

Before a child is placed in foster care or residential care, consent must be obtained wherever possible, usually from the parent, or a person with Parental Responsibility, for the following:

  1. Urgent or emergency medical treatment;
  2. First aid, health care assessments, medical advice and treatment, including immunisations;
  3. Allowing the child to participate in swimming, outdoor or other pursuits which have a risk attached to them; 
  4. Whether the child can be administered home remedies/non-prescribed medicines (such as paracetamol)
  5. Overnight stays with friends away from the foster home or residential home

Where there is a person who holds Parental Responsibility, such consent must be given, in writing, when completing the Placement Plan/Placement Information Record.

Having secured initial overarching consent it may be necessary for the child’s social worker to seek further specific consent for the child to participate in activities/events which are outside the normal scope of those which a child in care would usually access - see Activities for Children Procedure.

Specific consent will usually also be required for holidays - see Holidays and School Trips Inside the U.K. Procedure and Holidays and School Trips Outside the U.K. Procedure.

When the parent or person with Parental Responsibility gives consent to medical assessments, treatment and advice, it should be understood that children aged sixteen and over, and others under that age who have sufficient understanding, may override the consent in some circumstances.  This is explained below. 


2. General Guidance Regarding Consent

  1. Written consent must be obtained from a parent or person with Parental Responsibility when a child comes into care as set out in Section 1, Placement Planning.
  2. If consent is refused or any conditions are placed upon the consent, details of the refusal or conditions must be recorded in the child’s Placement Plan/Placement Information Record.  This must be brought immediately to the attention of senior management, and legal advice sought.
  3. Children of 16 and over have the right to consent to medical treatment and some children below 16 may be regarded as of sufficient understanding and maturity to consent to medical treatment without the need for parental consent (sometimes referred to as a Gillick competent child..
  4. Other than in exceptional circumstances, all reasonable steps should be taken to inform the parent(s) or others with Parental Responsibility before medical advice or treatment is sought for a child in care.  If this is not achieved, they should be informed as soon as practicable thereafter. The level of information imparted should reflect the current Care Plan.  See also Section 3, Children who Seek Advice/Treatment without Consulting Parents.
  5. Steps should always be taken to promote decision-making on the part of children and to ensure their views and wishes are obtained, considered and accounted for. 
  6. It is the responsibility of the child’s social worker, together with residential staff and foster carers, to support the child to engage with medical professionals. The older and more mature a child, the greater weight should be given to their views (see Section 3).  Indeed, a doctor may regard a child as capable of giving or refusing to give consent, even if under sixteen. This will be the decision of the medical professional involved. For such consent by a child to be valid, it must be informed and freely given for those under as well as over 16 years. This is referred to as “Gillick competence”
  7. In an emergency, when urgent medical treatment is required and every effort has been made to locate parents or a person with Parental Responsibility, the following may apply:
    1. A child who has reached his/her sixteenth birthday may give consent.
    2. A responsible adult acting in loco parentis, may give consent on the parents' behalf so long as all reasonable steps have been taken to consult the parent(s) or those with Parental Responsibility and such action is not against their expressed wishes. 
    3. Dependent on his/her age and level of understanding, a child who has not reached the age of sixteen may be regarded by a doctor as capable of giving consent (“Gillick competent”).
    4. In a ‘life or limb’ situation, a doctor may decide to proceed without any consent.
    5. Wherever possible, consent should be obtained in writing, but it is equally valid if given verbally, provided it was informed and freely given.  Written consent is preferred where children are in receipt of services away from home and may require urgent medical treatment in an emergency.  Where it is only possible to acquire verbal consent, it should be given in the presence of a reliable witness who must record the fact that verbal consent has been given and the reason why written consent was not provided. 


3. Children who Seek Advice/Treatment without Consulting Parents

Steps should always be taken to promote decision-making on the part of children and to ensure their views and wishes are obtained, considered and accounted for.  To this end, children should be encouraged to seek advice or treatment (including dental care and contraceptive advice) from medical or other healthcare practitioners after discussing matters of concern with their parent(s) if appropriate,  those looking after them, or any other adult with whom the child chooses to relate.

Where such a situation occurs, it should be treated with care and sensitivity; within the overall context of the duty to promote and protect the welfare of the child.

It is recognised that children may wish to seek advice or treatment without reference to parent(s) or those responsible for them, or they may decide to limit the information or consultation.

Children who have reached the age of sixteen can seek the advice of a medical practitioner without referral to or the consent of parent(s) or those with Parental Responsibility and may decide to keep that advice and any subsequent treatment confidential.  In such circumstances, they may share certain information with staff or carers - and may request that it is only shared with specified, other people.  Such requests should be respected, unless to do so would place the child or others at risk of injury or harm.

Children who have yet to reach the age of sixteen should be treated in a manner consistent with their age and level of understanding.  If possible, their wishes should be respected, but all reasonable steps should be taken to encourage them to discuss concerns with their parent(s) or a close relative.

However, if children refuse to consult their parents or others and they appear to have made a reasoned decision that is not likely to place them at risk of injury or harm, they should be supported in that decision; and any request for information to be kept in confidence should be respected.

Once the arrangements have been made for a child to see a medical practitioner, the child can request that they do so unaccompanied; such a request should be respected.

Whilst it may be unusual for a doctor or other health care professional to provide advice or treatment to a child under sixteen without parental knowledge or advice, they can do so if they believe the child is of an age and level of understanding to understand the implications of the decision they are taking (referred to as being “Gillick competent”).  They may also do so if they are satisfied that to share the information with parent may place the child at risk.  The doctor or other health care professionals should always seek to encourage the child to share this information with their carers.

Decisions about whether to provide advice or treatment without consent or consulting carers are for a medical practitioner's clinical judgement. 

For advice about sexual health, sexual relationships and contraception, a doctor may provide advice or treatment without consent or consulting carers if s/he regards a child as Fraser Competent.


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