Policy Practice and Governance Your next patient is an 84 year old female patient who has presented to A&E having suffered a fall. You suspect a fra

Policy Practice and Governance Your next patient is an 84 year old female patient who has presented to A&E having suffered a fall. You suspect a fractured neck of femur and she appears deliriousHow policy and governance impact patient care

Week 1

How do the following relate to the case? The NHS constitution Civil and criminal law Human rights Consent

Week 2

How, if at all, do the following relate to the case? Reflecting on your own identity and the UK population Explore equality, diversity and human rights health inequalities

Week 3

How do the following relate to the case? Safeguarding Accountability Mental capacity act Mental health act

Week 4

How do the following relate to the case? 7 pillars of clinical governance

Week 5

How do the following relate to the case? Confidentiality Information sharing

Week 6

How do the following relate to the case? Working with risk Risk assessment Learning from significant events

Week 7

This session will discuss research and evidence based practice in preparation for your major project in year two

Your next patient is an 84 year old female patient who has presented to A&E having suffered a fall. You suspect a fractured neck of femur and she appears delirious.

This module is assessed by a 3000 word essay.

During the course of this module I will ask you to consider this patient and any NHS policy that may apply to her care.

Examples of some NHS policies;

Duty of candour

Mental capacity

Safeguarding

Consent

Confidentiality

Every two sessions you will be given a written task to write 600 words on a particular aspect we will be assessing in your final submission.

Week 2 - 600 words on why we need policy, how policy might impact patient care and why its important that we all follow the same/similar policies throughout the NHS

Assignment;

This assessment will focus on Learning outcome 1; discussing the role of policy and its influence on patient care

Remember that this section is about policy in general. You may wish to identify one or two policies at this stage that you might use in assignment task 4, or you may wish to keep this section really general, in which case you could use public health policy.

Week 4 - 600 words on how governance impacts and relates to the care of your patient

Assignment;

This assessment will focus on Learning outcome 2; Exploring clinical governance processes as an essential mechanism to inform and deliver quality patient care

Remember that this section is for you to demonstrate your overall understanding of clinical governance. However, you should choose one particular pillar of clinical governance to concentrate your main focus on and apply it to your patient

Week 6 - 600 words on the potential risks you could face associated with your patient

Assignment;This assessment will focus on Learning outcome 3; Critically evaluate the concept of risk in clinical practice

This section is for you to demonstrate your understanding of how risk management plays a part in clinical care. Identify a risk that could occur in the course of this patients clinical care and evaluate how the risk may be mitigated against.

Week 7 - 600 words on how your selected policy applies to your patient, focusing on why continuous review is required.

Assignment;This assessment will focus on Learning outcome 4; Outline how clinical policy and governance safeguards patients within the NHS

In this section you will be demonstrating how your chosen policy applies to your given patient and explaining how the policy safeguards her.

You will then have written 2400 words to contribute to your final 3000 word submission. Your remaining 600 words can be used to tie the 4 elements together in a completed essay, including introduction and conclusion.

Welcome to Policy, Practice and Governance

Welcome to Policy, Practice and Governance. This module has been designed to consider the broader aspects of clinical practice as a Physician Associate. It will not only be a foundation to help you work towards your major projects next year, but will also provide you with an overview of the backbone of clinical practice, beyond our clinical knowledge, skills and acumen. The module will introduce the ideas behind why we take the actions we do as health care professionals; putting the individual patient, not just their medical conditions, at the heart of our work. We will also review how, why and when things go wrong in healthcare and what we can do to mitigate risks.

This module comprises of 7 sessions where we will explore different aspects of policy, practice and governance and the module is assessed with a 3000 word written assignment. You will be guided through your assignment with written tasks every 2 weeks which will form part of your final submission.

Session 1: Patients rights and valuing the individual

Session 2: Equality, diversity and the ethical issues impacting patient care

Session 3: Safeguarding

Session 4: Clinical governance

Session 5: Confidentiality and information sharing

Session 6: Working with risk and reflective practice

Session 7: Research and evidence-based practice

Session Topic What we'll cover Assignment details - All due on Friday 6th August

1 Patients rights and valuing the individual Understand the rights that all individuals have and the principles that support these rights, so that care can be delivered effectively 2 Equality, diversity and the ethical issues impacting patient care Ensure that equality, diversity and respect is universal in healthcare and considers relevant legislation that supports ethical decision making regarding the individuals in your care 600 words on why we need policy, how policy might impact patient care and why its important that we all follow the same/similar policies throughout the NHS

3 Safeguarding Protection of the rights of individual and in particular how we protect the rights of the vulnerable 4 Clinical governance Exploring the framework of accountability, continuous improvement and standard of care 600 words on how governance impacts and relates to the care of your patient

5 Confidentiality and information sharing Principles of keeping patient information protected 6 Working with risk and reflective practice Development as a reflective, evidence based practitioner 600 words on the potential risks you could face associated with your patient

7 Research and evidence-based practice Role of research, evidence based practice and clinical audit. Introduction to QIPs. 600 words on how your selected policy applies to your patient, outlining why continuous review is required.

You will have written 2400 words to contribute to your final 3000 word submission. Your remaining 600 words can be used to tie the 4 elements together in a completed essay, including introduction and conclusion.

On successful completion of this module the student will be expected to be able to:

Knowledge and understanding learning outcomes:

1. Discuss the role of policy and its influence on patient care

2. Explore clinical governance processes as an essential mechanism to inform and deliver quality patient care.

3. Critically evaluate the concept of risk in clinical practice

Intellectual, practical, effective and transferable skills learning outcomes:

4. Outline how clinical policy and governance safeguards patients within the NHS.

These learning outcomes can be understood in the following ways:

Learning Outcome 1 relates to the role of legislation, law, NICE guidelines and professional guidelines in patient care.

Learning Outcome 2 means that you will gain an understanding of what clinical governance means and how this impacts on patient care. You will learn about key processes that protect patients.

Learning Outcome 3 relates to risk and how this can be identified and mitigated for individuals in healthcare. During the module we will discuss failures in healthcare and the learning that can take place from these. Strategies that can support partnership models of care will be discussed.

Explain Learning Outcome 4 will explore the developments in patient care that can come from effective research and how evidence based practice ensures that excellent care is standardised throughout the NHS.

Learning outcomes in this module are grouped into two themes:

(1) Knowledge and understanding and

(2) The Intellectual, Practical, Affective and Transferable Skills.

The module assessment provides the opportunity to demonstrate you have met these outcomes. This last sentence is particularly important When completing an assessment you need to use the learning outcomes, on which the assessment criteria have been developed, to demonstrate to the marker you have met them.

In this section of the module information are the learning outcomes for this module, and you can see the two groupings. Importantly, when reading the learning outcomes note the verb(s) used. These verbs tell you what you need to do to in relation to the noun(s) to be successful. To demonstrate this, below is a sample learning outcome: 'Recall the locations of each Anglia Ruskin University campus'. In this example the verb is 'recall' and to meet this outcome you would have to memorise the locations of each campus. We could assess this by asking you to write these down as a list.

In education, knowledge and thinking skills can be thought about / described in terms of levels. For example, thinking processes at the lower level may include: (1) recall, (2) list, (3) write and (4) describe whereas others are much higher: (1) analyse, (2) reflect and (3) evaluate. This can be summarised in in the diagram below:

Therefore, when reading a learning outcome you need to identify the verb(s) and the adverb(s) to determine the level and action you need to take. It is important to note that some verbs can be used across multiple levels. The table below details some verbs used to construct learning outcomes and their associated student activity.

Level The student can... Verb examples

Knowledge (lower level): remember material by showing s/he knows terms used in his/her field, facts, rules and conventions, methods, principles or theories. Define, describe, identify, label, list, match, name, outline, reproduce, select, state, recall, record, recognise, repeat, draw on, or recount

Comprehension understand content and has grasped the meaning. Students could show understanding by translating what they learned in a book into actual practice or by interpreting what is known in one context when used in another context. Convert, defend, distinguish, estimate, explain, extend, generalise, give examples, infer, paraphrase, predict, rewrite, summarise, clarify, judge, restate, locate, recognise, express, review, or discuss.

Application use what they learned in new or concrete situations Change, compute, demonstrate, discover, manipulate, modify, operate, predict, prepare, produce, relate, show, solve, use, schedule, employ, sketch, intervene, practise, or illustrate.

Analysis can break down material into its component parts so that its underlying structure can be understood. Break down, make a diagram, differentiate, discriminate, distinguish, appraise, test, inspect, illustrate, infer, outline, relate, select, investigate, analyse, make an inventory, calculate, question, contrast, debate, compare, or criticise.

Synthesis put parts together to form a new whole, perhaps to produce something, which is unique, creative, or showing a new pattern of events Categorise, combine, compose, arrange, plan, assemble, prepare, construct, propose, start, elaborate, invent, develop, devise, design, plan, rearrange, summarise, tell, revise, rewrite, write, modify, organise, produce, or synthesise.

Evaluation (higher level) judge the value of something for a given purpose, usually using criteria designed either by him/herself or by others. This is usually seen as the highest domain in terms of cognitive learning because it requires students to use all the others activities already covered above. Appraise, compare, conclude, contrast, criticise, discriminate, judge, evaluate, choose, rate, revise, select, estimate, measure, justify, interpret, relate, value, or summarise

Prereading week 1

During our first session we will be discussing the rights of the service user within healthcare. If we think about our own healthcare experiences then we expect our views and wishes to be taken into account by the individuals that treat us. We expect to be dealt with honestly and in a manner that respects us as individuals.

The rights that service users have are underpinned by law, ethics and professional and practice guidelines. This is extensive and within this lesson we will be concentrating on the Human Rights Act in relation to health care and considering the case law which underpins consent.

In order to prepare for this session you will need to read through The NHS Constitution for England - GOV.UK (www.gov.uk) (Links to an external site.) and make notes on the key concept. You will be discussing some of these areas during this weeks session

Week 1 Introduction

Reading week 2

Welcome to our first session on policy practice and governance. Today's session will focus on the individual within healthcare.

We will be exploring

The NHS constitution

Civil and criminal law

Human rights

Consent (Please note this section has been moved to week two)

By the end of session you will have an understanding of;

The rights and values set out by the NHS constitution

How the law applies to medicine

Rights of the individual as laid out by the HRA

The importance of consent within medicine

Week 1 NHS Constitution

The NHS constitution

"The NHS belongs to the people.

It is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives."

(Department of Health, 2015)

Group Activity

Looking at

Principles

Values

Patient rights, pledges and responsivities

Staff rights, pledges and responsibilities

"Things that we value or find value in. Something that is desirable, useful or important. The ability of something to cause an effect or serve a purpose."

(Duncan, 2010)

Discuss:

Who does the NHS treat?

What conditions should it treat?

In what order?

Who decides?

Week 1 Civil & Criminal Law

Civil & Criminal Law

An Individuals Rights Within Healthcare

Discuss:

What rights do you have as a person?

Common legal system in England and Wales

Scotland and NI have a different systemsWelsh assembly has the authority to pass some legislation

Two sources of law

Statute law

Common law (case law)

Judicial precedent;follow previous decisions; bound by precedent

interpretation of statute law

similar cases must be treated in a similar fashion

judgements can be appealed

Public law, inc. criminal law and Private law, inc. civil law are both made up of statute law and case law;

Health Professionals and Criminal Law

Discussion

Can you think of any cases where criminal proceedings have bene brought against HCPs?

Stepping Hill Hospital

Early July 2011 - 44 year old Tracey Arden and 71 year old Arnold Lancaster die at Stepping Hill Hospital, despite both patients being on the road to recovery

12th July 2011 - Hospital staff contact police after finding contaminated vial of saline and discovery of low blood sugar levels in 5 patients, only one of which was diabetic

14th July 2011 - 84 year olds George Keep and Vera Pearson die at the hospital

15th July 2011 - Police announce that they are dealing with an investigation into the tampering of saline solution. Eleven other patients are also identified as being affected and a batch of 36 saline ampoules in a storeroom are found to be leaking, having clearly been tampered with. After testing they are found to contain insulin

19th July 2011 - The coroner opens an inquest into the deaths of Tracey Arden, Arnold Lancaster and George Keep

20th July 2011 - nurse Rebecca Leighton is arrested on suspicion of murder

Deaths at Stepping Hill Hospitalleft000

21st July 2011 - 83 year old Alfred Weaver dies at Stepping Hill Hospital after suffering a hypoglycaemic episode

22nd July 2011 - Rebecca Leighton is charged with criminal damage intending to endanger life, criminal damage being reckless as to whether life would be endangered and theft of medicine. She is remanded in custody and a trial date of February 2012 is set

2nd August 2011 - Nursing and Midwifery Council suspends Rebecca Leighton from its register pending trial

5th August 2011 - Rebecca Leighton is refused bail at Manchester Crown Court

2nd September 2011 - CPS discontinue the case against Rebecca Leighton due to insufficient evidence. She is released from prison. The NMC continues it's suspension of Rebecca from the register pending it's own investigation. GMP reveal they are investigating a further 4 deaths and potentially up to 40 victims

12th September 2011 - Police state that Tracey Arden, Arnold Lancaster and Derek Weaver were all unlawfully administered insulin but that their cause of death has not been established

21st September 2011 - Criminal profiler brought in by police to help identify the potential culprit

17th October 2011 - Police confirm that 17 patients were poisoned at the hospital

2nd December 2011 - Rebecca Leighton is sacked by Stepping Hill Hospital following an internal disciplinary hearing into theft of opiate-based drugs from the hospital. She said they were for her own use to treat a throat infection

31st December 2011 - an 82 year man dies at Stepping Hill Hospital after claims that his medications were contaminated

2nd January 2012 - Nursing staff at Stepping Hill Hospital noticed crude alterations to the drug charts of 6 patients. Prescribed doses had been altered and the wrong dosage had been administered to one patient

5th January 2012 - After a Venn diagram of working patters was drawn up by GMP nurse Victorino Chua was arrested. He was not charged with any offence and was placed on police bail

29th March 2014 - Victorino Chua was charged with the murders of Tracey Arden, Arnold Lancaster and Alfred Derek Weaver, and 31 other offences including GBH and attempted poisoning. He was remanded into custody

18th May 2015 - Victorino Chua is convicted of two count of murder, attempting to cause grievous bodily harm with intent by poisoning on 21 counts and eight offences of unlawfully administering or causing to be taken by another person any poison or destructive or noxious thing with intent to injure, aggrieve or annoy, or attempting to do so, after deliberately altering prescriptions. He received 25 life sentences and was told that he would spend a minimum of 35 years in jail before he would be eligible for parole

Jack Adcock

Operation Roxburg - Sentencing of Victorino Chualeft000

Click this link and read through the following case;The inside story of a six-year-old boy's death and the trainee doctor who took the blame (Links to an external site.)Discussion

How do these cases differ?

How are they the same?

What are the main differences and similarities?

Health Professionals and Civil Law

The single most common reason for HCPs to be taken to court is for negligence. In order to be found liable for negligence the claimant needs to prove;That a duty of care was owed

That they breached that duty by failing to exercise reasonable care

That the breach of duty caused the claimants injury

Is there a duty of care?

Discuss

What is duty of care?

Who owes a duty of care?

Scenario 1;

A junior doctor is enjoying a night at the theatre with his friend. The performance is interrupted by an announcement asking for medical assistance as someone in the audience has become unwell. As the junior doctor looks behind him he notices a person on the ground and someone performing CPR on them. The junior doctor gets up and leaves the theatre. Has this junior doctor neglected his duty of care?

Scenario 2;Dr Jones is an experienced GP on his way to work at a GP surgery. Unfortunately he is running about 30 minutes late due to a flat tire. He is aware that his morning clinic starts in 5 minutes. He is a quarter of a mile away from the surgery when he witnesses two cars collide. After a brief pause in the traffic he notices one of the drivers bleeding from a head wound. He is very worried about his clinic running late today as his youngest daughter has a ballet recital this evening that he has promised he will attend. He makes the decision to follow the traffic and continue on his way to work. Has this GP neglected his duty of care?

What is the standard of care?

The Bolam Test

"....it is sufficient if he exercises the ordinary skill of an ordinary man exercising that particular art"

Medical Law - Medical Negligence and Bolam Test - Tort Lawleft000

Did the breach of duty cause the patients harm?

Discussion

Negligence cases often made complex by;aetiology of medical conditions

presence of underlying illness

Chester v Afshar [2004] is an important case regarding causation in medical negligence.

Ms Chester was referred to neurologist Dr Afshar with lower back pain for 6 years. This became quite severe and at times she was unable to walk or control her bladder. An MRI scan revealed that there was disc protrusion into her spinal column and she was advised to have surgery. However he did not inform her of the small risk of these operations going wrong and as a result of the surgery she suffered from cauda equina syndrome. The trial judge found that the surgeon had not been negligent in performing the operation but his failure to warn her of the risk was a breach of duty. It was found that there was a failure to inform Ms Chester of the risk and if she had been informed, she would have sought further advice or alternatives.

The role of professional guidelines

Used when determining best standard of care

if a decision is made to deviate from guidelines then documentation of reasons for this is the best defence

Guidelines are seen to be the reasonable standard of care so not using them would need to be defended

Week 1 The Human Rights Act

The Human Rights Act

Everybody (subtitled)left000

The Universal Declaration of Human Rights 1948

The Human Rights Act 1998 makes rights from the European Convention on Human Rights (ECHR) enforceable against public bodies such as hospitals.

With qualified right [which include the right to respect for private and family life (Article 8), religion and belief (Article 9), freedom of expression (Article 10), assembly and association (Article 11)] interference with them is permissible only if what is done:

has its basis in law, andis done to secure a permissible aim set out in the relevant Article, for example for the prevention of crime, the protection of public order or health, and

is necessary in a democratic society, which means it must fulfil a pressing social need, pursue a legitimate aim and be proportionate to the aims being pursued

How does the Human Rights Act work?

Section 2 states: a court considering a question connected with a Convention right must take into account any relevant judgments, decisions, declarations or opinions of the European Court of Human Rights

Section 3(1) states: "So far as it is possible to do so, primary legislation (i.e. Acts of Parliament) and subordinate legislation (i.e. regulations and rules) must be read and given effect in a way which is compatible with the Convention rights."

Articles that are important in Healthcare

Article 2: Right to life

"Everyone's right to life shall be protected by law. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction of a crime for which this penalty is provided by law"

Imposes a positive duty on the state to protect life

But there are limitations

And there is no corresponding right to die

https://youtu.be/96W9fMWgkvsCase 4 Nicklinson v Ministry of Justice [2012] -

Nicklinson applied to the High Court for a declaration that either:

It would be legal for a doctor to assist in his suicide; or

The present legal regime concerning assisted suicide is incompatible with the European Convention on Human Rights

Judgements

High court - refused the declarations that Mr Nicklinson sought

Court of Appeal - dismissed Nicklinson's appeal on the basis that the defence of necessity should not be allowed to develop at common law so as to encompass murder in certain cases of euthanasia

Supreme court - held that the court does have the constitutional authority to make a declaration of incompatibility as regards the general prohibition of assisted suicide; majority felt that the question is one that Parliament is in a much better position than the courts to assess

European court of Human Rights - the court decided that the question of assisted suicide falls within a state's margin of appreciation; as such Nicklinson's application was "manifestly ill-founded" and therefore declared inadmissible

Assisted Dying Bill; the bill failed to pass the second reading debate on 11 September 2015 as 118 MPs voted for the bill progressing while 330 voted against

Tony Nicklinson diesleft000

Article 3: Prohibition of Torture and inhuman or degrading treatment

There is no definitive definition but inhuman or degrading treatment or punishment has to be very serious to be in breach of Article 3.

Torture is defined as: the most serious kind of ill treatment. It consists of deliberate inhuman treatment, causing very serious and cruel suffering. The suffering can be either mental or physical or both. (Department of Constitutional Affairs, 2006)

When analysing whether or not treatment or punishment is contrary to Article 3, the evolving nature of the Convention and the rights contained therein should always be taken into account. The European Court has noted that treatment that may not have been considered torture in the past, may be so nowadays and also vice verse.

This is an absolute right. Most if not all punishment is degrading, but the European Court and domestic Courts have drawn a distinction between ordinary prison conditions and those that fall below an acceptable standard. Successfully justifying treatment contrary to Article 3, however, is rare.

Article 5: Right to Liberty and Security

Article 5 limits the circumstances in which someone can be detained. This covers detention for both long periods (for example, if you are in prison or are forced to stay as a patient in a mental hospital) and short periods (for example, if you are arrested). There may even be a detention when the police stop someone on the street and search them.

For any detention to comply with Article 5 it must come within one of six sets of circumstances;A. Detention after conviction

B. Detention for non-compliance with a court order or legal obligation

C. Detention on remand

D. Detention of a minor

E. Detention for medical or social reasons

F. Detention of a foreigner

(European Court of Human Right 2020)

The detention must also have a clear legal basis and it must be proportionate, that is, there must be an adequate reason for the detention and the detention should not be for an unreasonably long time. Where someone is detained it is up to the Government to justify the detention rather than for the person detained to show why they should be released.

Article 8: Right to respect for private and family life

Guarantees respect for four things:

private life

family life

home

correspondence

In medicine we are mostly concerned with Private life, which has a large scope, and the ECHR has stressed that it is not possible to limit or define what comes within its scope. Thing that clearly do come within it's scope are;

Bodily integrity Article 8 will come into play if someone is forced to have medical treatment or if he or she is forcibly restrained.

Personal autonomy this means the right to make decisions about how you lead your life. People have tried to argue that the right to smoke cannabis is an issue of personal autonomy and should therefore be protected by Article 8 but the courts have not been prepared to accept this.

Sexuality there have been a number of cases in which the ECHR has made it clear that laws which prohibit gay men having sex breach Article 8.

Personal identity the ECHR decided in 2002 that British laws failure to fully recognise the new gender of transgendered people breached Article 8.

Personal information the holding, use or disclosure of personal information about someone is covered by Article 8. The article may also give someone the right to access personal information held about them.

Surveillance

A qualified right

Article 8 is qualified right. This means that an interference with the right can be justified. Where the interference is justified, there will be no breach of the article. Any circumstances where an interference with the right can be justified are set out in the second part of the article.

For an interference to be justified it must be in accordance with the law;has to be clear legal basis for the interference

the law should be readily accessible

pursue a legitimate aim e.g. the prevention of disorder or crime

be necessary in a democratic society

Article 8 and the other qualified articles are largely concerned with preventing the Government, the police or other state bodies interfering with peoples rights

In reality, cases frequently involve claims to breaches of more than one article;Case -

Dianne Pretty was suffering from motor neurone disease and wanted a declaration from the department of public prosecutions (DPP) that her husband would not be prosecuted if he assisted her to die. Mrs Pretty claimed that the DPPs refusal was a breach of articles 2 - right to life, 3 - freedom from inhuman and degrading treatment, 8 - right to respect for private life and 14 - freedom from discrimination, of the European Convention.

The court considered her argument in terms of the European Convention;

Week 1 Consent

What is consent?

You have the right to accept or refuse treatment that is offered to you, and not to be given any physical examination or treatment unless you have given valid consent. (p. 52, NHS Constitution)

Discuss.

When issues with consent arise the options for the claimant are to bring about a claim for battery (for unlawful touching) or negligence

Battery = patient did not consent

If one person touches another without consent this is considered battery. Damages may be awarded under civil law or, in more extreme cases, criminal charges can be bought. There is no need to prove that harm has been inflicted but where it is, damages awarded will likely be higher.

Liver surgeon, Simon Bramhall, marked his initials on the livers of two transplant patients. It is not believed to have been harmful to the liver and the marks normally disappear however the branding was discovered by another surgeon who was operating on one of the patients after their liver failed to heal properly for other reasons. He was fined 10,000 and sentenced to a community order. (mr-simon-bramhall-18-december-2020.pdf (mpts-uk.org). (Links to an external site.)Negligence = failure to properly inform the patient of risks

More legal cases are focused on negligence because the issue is frequently about the amount of information given. There is an obligation to inform the patient about nature of the procedure, the material risks and alternative forms of treatment. In these cases it MUST be shown that the patient suffered harm. The claimant also has to persuade the court that if they were to have been provided with more information they would not have agreed to the procedure.

What would our junior doctor in the case above have been guilty of?

GMC guidance recommends that those undertaking the procedure may delegate the consent process to someone who is suitably trained and has relevant knowledge of the procedure, understanding the risks involved.

Case Appleton v Garrett [1995] - The claimants were patients of the defendant dentist, who had carried out unnecessary treatment upon them for financial gain. The defendant had deliberately withheld information about the necessity of the treatment in the knowledge that they would not have consented to the treatment had he made them aware of the facts. The claimants sought aggravated damages from the defendant on the basis that they had suffered trespass to the person. The dentists was found liable for battery and struck off the dental register. In eight of the cases the defendant admitted negligence and the claimants recovered damages for negligence.

Types of consent

As a general rule, medical treatment, even of a minor nature, should not proceed unless the doctor has first obtained the patients consent (Mason and McCall Smiths Law and Medical Ethics)

Written consent

routine in surgery

ensures consent obtained and communicated with whole team

provides evidence of consent

can be withdrawn at any time

Implied consent

implied by behaviour

not implied by simply attending hospital or GP practice

Informed Consent

The nature of the procedure; i.e. for a hemicolectomy for diverticulitis the patient would have to be informed that the operation involved an abdominal incision followed by removal of part of the colon with re-joining of the remaining two ends of the colon.

Risks and benefits; this does not require the disclosure of every single possible risk ever, only the significant risks.

Alternative options

Valid Consent

Necessary to show that:

The person is competent (link to Mental Capacity Act)

The person is not subject to coercion

The person is sufficiently informed

Autonomy

"Free will; self-governing, ability of a person or a group to choose a course of action. Autonomy is a basic human right and is one of the principles of bioethics" (Oxford reference)

Autonomy forms the basis of patient centred medicine and was behind the development of informed consent.