Ensure patient involvement in all treatment and care decisions

The Index has not yet recorded a verbatim government response to this recommendation.

The NHS Act 2006 places a duty on NHS England to promote patient involvement.

The NHS Constitution furthermore provides that the NHS aspires to the highest standards of excellence and professionalism and to provide high quality care that is safe, effective and focused on patient experience. This requires that staff involve patients, their families, carers or representatives fully in decisions about prevention, diagnosis, and their individual care and treatment. Provisions to ensure patients are involved in decision about their care include:

Regulation

Regulation 11 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the 2014 Regulations) sets out requirements regarding consent to ensure that all people using a service, and those acting lawfully on their behalf, have given consent before any care or treatment is provided. Failure to comply with Regulation 11 is a criminal offence. The Care Quality Commission (CQC) can prosecute registered providers for a breach of this regulation. (A registered provider is a person registered with CQC for the purpose of providing a regulated activity.).

In addition, the CQC can take civil enforcement action against a registered provider for breach of Regulation 11 (and other fundamental standards). Such civil enforcement action might be to suspend, vary or cancel the provider’s registration.

Regulation 9 of the 2014 Regulations states that in planning and reviewing the care or treatment which a service user receives, the provider must employ shared decision-making, using supporting tools and techniques approved by the co-ordinating commissioner.

All NHS and independent sector providers are regulated by CQC. Assessments include how services ensure that patients understand and are involved in decisions regarding their care. The CQC Inspection framework for NHS acute hospitals covers services provided for children up to the age of 18. NHS Standard Contract

As set out in the NHS Standard Contract 2024/25 (Service Condition 9), providers must publish, maintain and operate a service user consent policy which complies with good practice and the law. Service Condition 12 also stipulates how providers must communicate with and involve service users and staff. The provider must also comply with Regulation 9 of the 2014 Regulations. (Service Condition 10) Professional guidance

The professional regulatory bodies such as General Medical Council (GMC) also publish guidance on shared decision-making and consent. This includes information that doctors should give to patients when discussion options.

The Academy of Medical Royal College’s (AoMRC) guidance is also reflected in NICE guidance on shared decision-making.

The Government agreed with this recommendation.

In its January 2002 response, the Department of Health said it had introduced a ‘good practice in consent’ initiative to ensure patients were able to be involved in their own healthcare decisions. The Department of Health also referred to guidance for patients on consent being available throughout the NHS and the issuing of a model consent policy and model consent forms in November 2001. Implementation was to be monitored through clinical governance, the Clinical Negligence Scheme for Trusts, the Controls Assurance Framework and inspection by the Commission for Healthcare Improvement.