Why is this important?
NHS patients' rights
Table of contents
- The NHS constitution
- Checking standards of healthcare services
- Right to a GP
- Choosing a GP
- Registering with a GP
- Treatment from a GP
- GP charges
- Changing a GP
- GP removes patient from register
- If you move out of GP’s area
- NHS 111 service and NHS Choices
- Maternity services
- Right to hospital treatment
- Seeing a consultant
- Hospital waiting lists
- Care in hospital
- Using mobile phones in NHS hospitals
- Hospital charges
- Paying for treatment not available on the NHS – 'top-up' payments
- Financial help for hospital patients
- Discharge from hospital
- Right to refuse treatment
- Right to die
- Removal of organs after death
- Access to medical reports and health records
- Direct payments
- Information about NHS services
- Information from your health care provider
- Local HealthWatch
Some of your rights as an NHS patient are set out in the NHS constitution. You can see a copy of the constitution on the GOV.UK website at www.gov.uk.
The Handbook to the NHS constitution at www.gov.uk gives a guide to patients' rights under the Constitution in England.
The Care Quality Commission
The Care Quality Commission checks all hospitals and providers of primary health services (for example, GPs and dentists) to see if they are meeting government standards. You can find out about what to expect from your health service provider by checking the Care Quality Commission's website at www.cqc.org.uk. You can also give feedback about the standard of care you received, but the Care Quality Commission cannot deal with individual complaints.
You can also compare the performance and customer ratings of your local health services on the MyNHS website at www.nhs.uk. The site is intended to help you choose where to go for your health services. For example, you can search standards for:
- food quality
- patient safety
- mental health.
You have the right to register with a GP if you live within the GP's catchment area even if you come from abroad. You can choose which GP you want to be registered with. If a GP refuses to accept you, they must have reasonable grounds for doing so, and must give you their reasons in writing – see under heading Registering with a GP.
For more information on NHS treatment for people from abroad, see NHS charges for people from abroad.
The list will contain the following information about each GP:
- surgery address and telephone number
- gender of the GP
- languages spoken by the GP, if the GP agrees this should be included
- particular health interests, if the GP agrees this should be included
- whether the GP does minor surgery
- whether the GP offers contraceptive and/or maternity services
- what the GP’s deputising arrangements are and whether a commercial deputising service is used.
The list may also contain information on whether any alternative therapies are available within the practice. It may also give details of surgery hours, whether there is an appointment system and whether there are any special clinics run at the surgery.
GP practice charters
Some GP practices have established their own practice charters which describe the standards of services a patient can expect and the arrangements for certain services, for example, repeat prescriptions. A practice charter may be displayed in the surgery premises.
If you are unable to find a GP
If you have been unable to find a GP yourself, you can ask your CCG to find you a GP.
To register with a GP you need to choose the surgery you want to register with and make sure that it covers your area. You can do this by searching online at: www.nhs.uk.
You should contact the surgery you want to register with, and ask if they will take you on. If they agree, they will ask you to fill in a registration form. Some GP practices also want to see proof of your identity, like a passport, and proof of your address, like a utility bill.
Some GP practices may also ask for your NHS medical card or your NHS number. But you don't need either of these to register with a GP or get NHS treatment.
The GP practice will then send your details to the Clinical Commissioning Group (CCG), who will write to you to confirm that you're registered with the new practice. Your medical records will be sent to the new practice.
Some CCGs also issue NHS medical cards. If they do, they will send you a new card when they write to you. But not all CCGs issue cards.
Children under 16 should be registered by their parent(s), but you don't have to register with the same GP as the rest of your family.
If you're staying somewhere in the UK for less than three months, you can ask to be registered with a GP on a temporary basis. You can also register temporarily if you move around the country and have no permanent address.
NHS numbers and NHS medical cards
NHS numbers help staff across the NHS get up-to-date information on patients' health. However, you don't need an NHS number or medical card to get NHS treatment.
A hospital should give your baby an NHS number shortly after birth. If the baby was not born in hospital, a number will be given once the hospital has been told about the birth. If your baby was born abroad and doesn't have an NHS number, you can get one by registering with a GP.
To get a medical card for your baby, you may need to get their NHS number to a chosen GP. However, procedures for getting medical cards vary from area to area. If in doubt, you should ask your GP.
If you don't have a medical card, or have lost it, you should contact your local Clinical Commissioning Group (CCG), giving your name, address and date of birth, and the name and address of your previous GP. If possible, you should also give your NHS number.
You can register with a GP without a medical card by completing a form supplied by the GP.
Problems with registering
Unless the GP’s register is full, or you live too far away for home visits, it is unlikely that the GP will refuse to accept you.
However, if the GP does refuse to accept you, then they must have reasonable grounds for doing so. These must not have anything to do with race, gender, social class, age, religion, pregnancy or maternity,sexual orientation, appearance, disability or medical condition. The GP must give you the reasons for their decision in writing. If a GP refuses to register you because of who you are, it could also be unlawful discrimination.
If you have been unable to register with a GP, you should contact the local Clinical Commissioning Group (CCG) or NHS England. You should send your medical card, with a letter giving the name of any GPs who have refused to register you, and of any GPs with whom you would prefer not to be registered.
The CCG will try to find a GP who is prepared to accept you. This will not necessarily be a GP of your choice. Once you have been allocated a GP, the GP must accept you and treat you, and can only remove you from their list under certain circumstances (see under heading GP removes patient from register). The CCG will then have to find you another doctor. The CCG cannot help you find another GP if you are already registered with a GP.
For more information on discrimination, see Discrimination when registering with a GP.
You are entitled to treatment from a GP at the surgery where you are registered. You have no automatic right, however, to see your own GP.
A GP must provide any treatment which is immediately necessary in an emergency, even if you are not registered with them.
Treatment outside surgery hours
All GPs must make sure that a service is provided for their patients when they are off duty. This service could be provided by, for example, other partners in a group practice, a rota between GPs, a commercial deputising service (a locum), or a telephone number which patients can use out of hours.
Out-of-hours services are regulated by the Care Quality Commission (CQC). Although the CQC does not deal with individual complaints, if you have a problem with an out-of-hours service, you can report your experience to the CQC. This could result in action being taken against the out-of-hours service provider. There is information about this on CQC website at www.cqc.org. Or you can contact your local HealthWatch for information about making a complaint.
You cannot insist that a GP visits you at home. A GP will only visit you at home if they think that your medical condition requires it. A GP can also decide how urgently a visit is needed.
If you were to become seriously ill after a GP had refused a home visit, the GP could be found to be in breach of their contract with the NHS, or could be found to have been negligent. You may therefore wish to make a complaint.
For information on making a complaint about a GP, see Complaints about GPs.
You can be visited at home by a community nurse if you are referred by your GP or by a hospital consultant. If you are not an urgent patient, you can make an appointment and should be visited on the day arranged.
You should also be visited at home by a health visitor if you have recently had a baby or if you are newly registered with a GP and have a child under five years.
If a GP decides you need medication, they will usually give you a prescription. In some cases, for example, if the surgery is in an isolated area, the GP may provide the medication themselves.
A GP must supply any drugs needed for immediate treatment in an emergency. There is no prescription charge for these.
Some GPs are qualified in alternative therapies and may offer these as part of their NHS treatment. In some areas GPs may be able to refer a client to alternative practitioners, but this will not always be available.
You can ask your GP to arrange a second opinion either from a specialist or another GP. However, the GP does not have to do this if they do not think it necessary. You have no right to a second opinion.
You do have the right to see a GP competent to deal with your particular case. If a GP refers you for a second opinion, you cannot insist on seeing a particular practitioner. However, you should not be referred to someone you do not wish to see.
If the GP refuses to arrange a second opinion, you may wish to change your GP (see under the heading Changing a GP).
If a GP is unsure about a diagnosis, they could be found negligent if they failed to refer you to a specialist and you suffered as a result of this. If you have not been referred for a second opinion and have suffered as a consequence, you may wish to complain.
For information on making a complaint, see Complaints about GPs.
There is no charge for basic GP treatment for NHS patients who live in the UK. There are charges for visitors from overseas, except in the case of an emergency. There may also be charges for certain services, for example, check-ups for employees and vaccinations for travelling abroad.
You can change your GP at any time you wish without having to give a reason. If you tell your local Clinical Commissioning Group (CCG) that you want to change your GP, they must give you details of how to do so and provide you with a list of alternative GPs.
You do not need the consent of your GP to change GPs. When you have found another GP willing to accept you, you should contact them and ask if they will take you on - see under the heading Registering with a GP. You can then make an appointment to see the new GP immediately.
Problems with changing a GP
If you wish to change your GP, but can't find a new GP who will accept you, you should contact your local Clinical Commissioning Group (CCG), who should find you an alternative - see under the heading Choosing a GP.
A GP may be able to remove you from the patient register in some situations, for example, because you move out of the practice area or are physically or verbally abusive to people at the practice. In most cases, the GP must have given you a warning, and provided you with the reasons for your removal from the register. The GP will inform the Clinical Commissioning Group (CCG) who then notifies you. The removal from the register takes effect from the eighth day after the CCG receives the GP’s notice, or from the date that you are included on another register if this is sooner. You are entitled to emergency treatment, or the continuation of treatment which is occurring more than once a week, until you are accepted by another GP.
If you have been violent, or have threatened to be violent, towards your GP or practice staff, and the police have been informed, you can be removed immediately from the GP’s list. You will only be accepted for emergency treatment by the GP who has removed you if the GP is satisfied that it is clinically necessary.
If you have been removed from a GP’s list you may wish to complain if you feel you have been treated unfairly, for example, if you feel discrimination was involved. You may be able to get help to do this from a Ctizens Advice Bureau. To find details of your nearest CAB, including those that can give advice by e-mail, click on nearest CAB.
For information on making a complaint, see Complaints about GPs.
If you are changing address, but are not moving too far, you may wish to stay with your current GP. You should ask the GP if they are willing to continue treating and visiting you at the new address. A GP can continue to treat you if you have moved out of their practice area, but they will have to assure the Clinical Commissioning Group (CCG) that they are willing to continue visiting and treating you.
NHS 111 service and NHS Choices
NHS 111 service is a confidential service offering advice and information about health problems and services. It provides 24-hour access to free health advice from experienced advisers. It can advise you on the next course of action, for example, whether to stay at home and what self-treatment to take, or whether to visit a GP or a hospital. The NHS 111 service is now available across England. Find more information about the NHS 111 service on the NHS Choices website at www.nhs.uk.
NHS Choices at www.nhs.uk is an online information service created by the Department of Health. You can find directories of GPs, dentists and pharmacists, information on common conditions and guides and tips on how to live a healthier lifestyle.
If you are pregnant, you will be able to receive services from one or more of the following:
- midwives, based either in a hospital or in a local health centre or clinic. Midwives are responsible for the care of all normal pregnancies and labours. You do not need to be referred to a midwife by your GP
- a GP. Not all GPs provide ante-natal care and arrange for delivery. If your GP does not provide this service, you may wish to register with another GP for your maternity care. Your Clinical Commissioning Group (CCG) or your local HealthWatch can provide details of GPs who offer maternity care
- an obstetrician based in a hospital. Generally, an obstetrician will only get involved if there are complications. However, you can request to see an obstetrician, even if the midwife or GP is providing all the care.
You may have a range of options to choose from on the type of ante-natal care you want and where you give birth. How much choice you have will depend on the area in which you live, but could include:
- full hospital care. This would only happen, in practice, if you require a high degree of medical intervention
- shared care between a GP and hospital staff. Normally, you would return home shortly after the birth
- a home birth, with the birth attended by, and ante-natal care provided by, a midwife and possibly a GP. You have the right to have your baby at home and may need to contact the supervisor of midwives to arrange for this. Alternatively, you could register with a different GP just for your maternity care.
You can get information on local maternity services from your CCG, a health visitor or GP. You can also contact your local HealthWatch.. They will give you details of, for example, the type of care offered, where the birth can take place, what pain relief is offered and what tests are available and what they are for. In some areas, there are maternity charters which set out the rights of pregnant women and new mothers, and the standards of service you can expect.
If you are having difficulty obtaining the type of care you want, or you require more information on how maternity services are organised in your area, you should contact the supervisor of midwives at your local maternity hospital or at the CCG.
You cannot receive NHS hospital treatment without being referred by your GP, unless you are attending a special clinic, for example, for the treatment of sexually transmitted diseases, or you need urgent medical attention in an emergency.
If you are referred for a first outpatient hospital appointment, you can choose to go to any NHS hospital that provides a service or a private hospital. This may not apply if you are referred for mental health or urgent services. You can find out more about choosing your hospital at www.nhs.uk.
If you are violent or abusive to NHS staff, you may be refused NHS hospital treatment, or given a verbal or written warning before treatment is withheld or withdrawn. Violent or abusive behaviour could include verbal abuse, threats, violence, drug or alcohol abuse in hospital, and destruction of property. Each NHS trust can decide which types of behaviour could lead to treatment being withheld or withdrawn and how such policies are implemented. However, treatment cannot be withdrawn for more than twelve months. If you are violent or abusive to NHS staff and have severe mental health problems or are suffering life-threatening conditions, you will not be denied treatment.
If you need urgent medical attention, you can go directly to the accident and emergency department of a hospital without needing a referral from your GP. Not all hospitals have accident and emergency departments.
If you need an ambulance to get to hospital in an emergency, it should arrive within a few minutes. The Handbook to the NHS Constitution gives target maximum times for ambulance arrival. If you need an ambulance, call 999.
It is the responsibility of the hospital providing the emergency treatment to meet the cost of treatment. If emergency admission as an in-patient is needed, the cost will be met by the Clinical Commissioning Group (CCG) where you live.
Treatment which may not be available on the NHS
Access to some forms of treatment, for example, in-vitro fertilisation, may be subject to the priorities of your Clinical Commissioning Group (CCG). Some treatment may not be provided in your area. Access to some treatment may depend on your need. However, the NHS Constitution says that local decisions about the funding of drugs and treatment must be made rationally, following proper consideration of the evidence. Information about local decisions must be made readily available to the public. You can get details of those services not provided, and any prioritising criteria, from your local CCG or your local HealthWatch.
Health care providers must not discriminate against you because of race, sex, disability, pregnancy or maternity, religion or belief, sexual orientation, age or gender reassignment when they decide what treatment to give you as a patient. For more information about discrimination, see under heading Discrimination.
An NHS clinic has refused to offer fertility services to us, because we are a lesbian couple. Can they do this?
No, they can't. If they are refusing to treat you just because you are a lesbian couple when the treatment would be offered to a straight couple, this is discrimination because of sexual orientation and it's against the law. You will need to get expert advice about how to take this further.
However, if they don't offer fertility treatment to any couples, regardless of their sexual orientation, you won't be able to complain about discrimination.
If you are unhappy because a certain form of treatment is not available, you should complain.
For information on making a complaint, see Dealing with NHS problems - where to start.
You have the right to choose a particular team headed by a named consultant for your first outpatient appointment, provided that the doctor referring you agrees that your choice is clinically appropriate. You can choose a team based at any hospital. However, you don't have the right to choose a particular consultant-led team for certain services, including accident and emergency, cancer, maternity and mental health services.
You may wish to get a second opinion after seeing a consultant, either as an out-patient or an in-patient. You will need to request this from the consultant, who may arrange for you to see someone else. If the consultant does not agree, you could ask your GP to help.
Choose and Book
You have the right to choose from any hospital when your GP refers you to see a specialist for further treatment. Your GP should discuss this with you.
You can book the appointment yourself. Your GP must give you an appointment request slip first. This must have a reference number and password which you use when you make your booking.
Choose and Book helps you to choose a hospital appointment at a convenient hospital and at a convenient time for you. It also means you can choose a hospital with a shorter waiting list.
You can find out more about Choose and Book by phoning the Choose and Book Appointments' Line on 0845 608 8888, or by going to the Choose and Book website at: www.chooseandbook.nhs.uk.
You may be unable to receive the hospital treatment you need immediately, and may have to go on a waiting list. Under the NHS Constitution, you have the right to use services within maximum waiting times. If this is not possible, your local Clinical Commissioning Group (CCG) must try to offer you a range of suitable alternative treatment providers if you ask it to do so. You can find out waiting times in the Handbook to the NHS Constitution.
Waiting lists do not operate on a last come, last served basis. Where you are on a waiting list depends on a range of circumstances and may change. If your condition deteriorates dramatically, your GP may recommend you be seen as a matter of greater urgency. How long you will have to wait for a date to see a specialist or have an operation, will therefore depend on the severity of your condition, how busy the specialist is and other demands on the hospital facilities.
To find out about waiting times at a hospital, go to the NHS Choices website at www.nhs.uk. Clinical Commissioning Groups (CCGs) and in England, your local HealthWatch can also provide information about local waiting lists. You can complain if you have been waiting longer than the maximum waiting times.
For information on making a complaint, see Dealing with NHS problems - where to start.
If you are waiting to be admitted to hospital, you should contact the hospital appointments’ department or the consultant on a regular basis, reminding the hospital staff that you are still waiting. If you are prepared to go into hospital at short notice you should say so, in case a cancellation occurs. You should also keep your GP informed of your condition, particularly if it deteriorates.
If you go into an accident and emergency department (A and E department), you should be assessed immediately.
Staff will try to make sure you do not wait more than four hours between attending the A and E department and admission, treatment or discharge. However, this time limit is only a guideline.
For information on making a complaint about a hospital, see Complaints about NHS hospitals.
If your operation is cancelled, you should be offered an alternative date.
If your operation is cancelled for non-medical reasons on or after the day you are admitted to hospital, you should be offered another treatment date within 28 days. If this is not possible, your treatment should be funded at the time and at the hospital of your choice.
Standards of care
The Care Quality Commission CQC) checks all hospitals, to see if they are meeting government standards. You can find out about what to expect from your local hospital by checking the CQC website at www.cqc.org.uk. You can also give feedback about the standard of care you received, but the CQC cannot deal with individual complaints.
If things go wrong
If something goes wrong during your treatment which leads to significant physical or psychological harm or death, the NHS provider must do the following:
- tell you or your representative in person about the incident, as soon as possible after it happened
- tell you what will be done to put things right
- apologise to you
- give you a written record of this information and keep records of further communication with you
- provide any other support you may reasonably need.
If this doesn’t happen, you can make a complaint.
Most hospitals have visiting hours during which visits to patients can be made. A person has no automatic right to visit you, and your doctor may decide that visits would be detrimental to your health. There is usually also a limit to the number of people who can visit at any one time. The restrictions on visits from children are the same as those for other visitors.
If someone wishes to visit you outside visiting hours, they should discuss this with the ward sister. If they cannot get permission from the ward sister, they should contact the hospital administrator if they wish to pursue the matter.
Financial help with visits
If you're getting Income Support, income-based Jobseeker’s Allowance, income-related Employment and Support Allowance or Pension Credit, you may be able to get a budgeting loan from the Social Fund for travel costs to visit a sick relative.
For more information, see Help for people on a low income – the Social Fund and other welfare schemes..
There may be a number of issues which you may wish to consider if your child is to go into hospital, for example, whether you can stay with your child, how much help you can give with feeding and looking after your child and what will happen to your child’s education. Action for Sick Children may be able to advise on all these issues. It also produces a leaflet for parents whose child is going into hospital for the first time. The address is:
Action for Sick Children
A child should usually be admitted to a children’s ward under the supervision of a consultant paediatrician. If your child is in an adult ward, you may wish to complain.
For information on making a complaint, see NHS and local authority social services complaints.
The Department of Health has strongly recommended to hospitals that they allow unrestricted visiting on children’s wards. Hospitals should also allow parents to be with their children as much as possible. This could include allowing you to stay overnight at the hospital. You should make enquiries before your child goes into hospital about what arrangements can be made.
If you are finding it difficult to visit a child in hospital, for example, if you have other children at home, you may wish to discuss this with the medical social worker at the hospital.
Single sex wards
You do not have the right to be cared for in a single sex ward. However, , all NHS hospitals are expected to get rid of mixed-sex wards, except where it is in your best interests or because you have chosen to be in a mixed-sex ward. For example, it might be in your best interests to be treated in a mixed-sex ward in a life-threatening emergency. A hospital can be fined for each day that you have to stay in a mixed-sex ward if there is no good reason why you have to be there.
Patients who die in hospital
If a patient dies in hospital, NHS staff should inform relatives and the patient’s GP as soon as possible, and advise the relatives of the arrangements that need to be made.
An NHS Trust may be responsible for the funeral arrangements if there are no relatives or the relatives are unable to afford the cost and do not qualify for a funeral payment from the social fund.
For information about funeral payments, see Help for people on a low income – the Social Fund.
You should be allowed to use your mobile phone in an NHS hospital. This includes using your phone on a ward, as long as it's not a risk to your safety or that of other patients and doesn't affect the operation of electronically sensitive medical equipment.
All NHS trusts should have a written policy on the use of mobile phones which you can ask your hospital to see. There should be signs up in all hospital areas which say clearly whether you can use a mobile phone there or not.
There is no charge for most hospital treatment for NHS patients who live in the United Kingdom. There are charges for visitors from overseas, except in the case of an emergency. However, there are charges for the emergency examination and treatment of people involved in road accidents. There are also charges for certain services, for example, beds with more privacy and alternative menus, patients' telephones and televisions.
For information about charges for overseas visitors, see NHS charges for people from abroad.
For information about charges for people involved in road accidents, see Traffic accidents.
There are some treatments used for certain illnesses, for example, cancer, which are very expensive and are not available on the NHS.
You can choose to pay for these treatments yourself without this affecting your other NHS care. This means that NHS care should not be withdrawn if you buy additional care privately.
If you do get private care, you should get this separately from the NHS care.
To find out what the government guidelines are for getting private and NHS care at the same time, go to the NHS website at www.nhs.uk.
Financial help for hospital patients
If you're getting certain social security benefits, your entitlement may be affected if you go into hospital.
If you are concerned about the effect of hospitalisation on benefits, you should consult an experienced adviser, for example, at a Citizens Advice Bureau. To search for details of your nearest CAB, including those that can give advice by email, click on nearest CAB.
If you are on a low income, you may be able to get help with travel costs to hospital and with the cost of prescriptions, wigs and fabric supports.
For more information about help with NHS costs, see Help with health costs.
Discharge from hospital
You should not be discharged from hospital until your care needs are assessed and arrangements made to ensure that you will receive any necessary services when you are discharged.
Any assessment should take into account your wishes, the wishes of your family and of any carer. You should be kept fully informed and involved, be given sufficient time to make decisions, and be told how to seek a review of any decisions made. You can ask for a reassessment of your needs if circumstances change in the future.
Unsatisfactory arrangements before or after discharge
You may not be satisfied with arrangements for your discharge from hospital because, for example:
- you feel that you need to remain in hospital for further in-patient treatment
- you are not satisfied with the community care services that have been arranged for you when you are to leave hospital
- you do not want to be sent to a care home.
Before discharge takes place, you, or your family, carer or representative, have the right to ask for a review of the decision which has been made about your eligibility for continuing NHS care. In England, you can also ask for a review after discharge.
If you are not satisfied with arrangements that have been made for you after you have been discharged, you can complain. If you are not satisfied with any medical services you are receiving from the NHS, you should use the NHS complaints procedure. If you are not satisfied with community care services which have been arranged or provided by the local authority, you should complain to the local authority using its complaints procedure.
For information on making a complaint to the local authority, see Dealing with complaints about adult social care - where to start
If you are unhappy with your discharge from hospital or with the arrangements made for you after discharge, you should consult an experienced adviser, for example, at a Citizens Advice Bureau. To search for details of your nearest CAB, including those that can give advice by email, click on nearest CAB.
For information on making a complaint, see Complaints about NHS hospitals.
Examination and treatment
You should not be examined or given any treatment or operation without your consent, unless:
- you have a notifiable disease or are a carrier of a notifiable disease
- you have been detained under the Mental Health Act, in certain circumstances
- your life is in danger, you are unconscious and you cannot indicate your wishes
- the patient is a child who is a ward of court and the court decides that a specific treatment is in the child’s interests
- a court or someone who has parental responsibility authorises treatment. A person whose treatment is authorised by a court must be given an opportunity to defend their case against treatment in court.
In some cases, it is good practice to ask you, the patient, to sign a consent form, but in other cases consent can be obtained orally. For example, it is good practice to obtain written consent for any procedure or treatment carrying substantial risk or side effects. If you are capable, it is good practice to obtain written consent for general anaesthesia, surgery and certain forms of drug therapy. Oral or written consent should be recorded in your notes with relevant details of health professionals’ explanations.
Even if you sign a consent form, the signature may not be a valid form of consent if you have not been given appropriate information to be able to give informed consent. Similarly, consent for one procedure does not imply consent for a further procedure or form of treatment.
The doctor must inform you of the nature, consequences, and any substantial risks involved in the treatment or operation, before you give your consent. It is for the doctor to decide exactly how much to tell you, the patient.
Capacity to consent to treatment
There may be situations where you lack capacity to consent to treatment. A person lacks capacity if their brain or mind is impaired and they do not have the ability to use and understand information to make a decision at the time. Examples could include dementia, brain damage, or intoxication through drugs or alcohol misuse. A capacity assessment should be carried out by a health professional. If it is felt that you do not have capacity, they will need to carefully consider what is in your best interests before making a decision.
Young people aged 16 or over but under 18 can give independent consent to their own treatment. It is not necessary to obtain the consent of a parent or guardian. A young person can be overruled by a court order.
However, if the young person is incapable of giving their own consent, for example, they are severely disabled, the parent’s or guardian’s consent must be obtained.
Children under 16 can give their own consent to treatment provided they are judged capable by a doctor, Clinical Commissioning Group (CCG) or NHS Trust, of understanding what is involved. There is no general test for assessing this capacity, and each case will be decided on its own merits.
If a child under 16 does not have sufficient understanding, parental consent (or a court order) will be required for any treatment, except in an emergency. If a child under 16 who does have sufficient understanding refuses treatment, treatment can still be given with their parent’s or guardian’s consent or by a court order.
Young people or children under 18 cannot give their own consent to experimental operations and blood donations, unless they have sufficient understanding of what is involved.
Experiments, medical research and teaching
In general, if a doctor wishes to carry out research on you, your consent has to be given. However, if a child under 16 is not competent to decide, a parent or court can consent to research on their behalf.
You should be given a full explanation of the procedures and risks involved. It should also be made clear to the patient that you can withdraw from the research at any time. Appropriate safeguards should always be in place to protect patient confidentiality.
It is possible to carry out research on people who are not able to make decisions for themselves – that is, people who lack mental capacity. Certain safeguards have to be met first.
For more information about mental capacity, see Managing affairs for someone else.
You have the right to refuse to participate in teaching without your treatment being affected. If you do not want to be involved in teaching, it is advisable to inform the hospital in advance.
Right to refuse treatment
You can refuse any treatment if you wish (but see under heading Consent). When you visit a doctor, this usually implies consent to examination and treatment. The doctor cannot act against specific instructions, so you should tell the doctor about any treatment you do not want.
If there are a number of alternative treatments which can be used to treat your condition, you should be given information on these. However, you cannot insist on a particular treatment if the doctor or consultant thinks this is not appropriate.
Forcing treatment on you against your will is assault. If you are assaulted, you should contact your Clinical Commissioning Group (CCG) or NHS Trust to make a complaint. Your local HealthWatch, local independent advocacy service or hospital-based PALS service may be able to help you take the complaint further. You may also wish to involve the police.
For information on making a complaint, see Dealing with NHS problems - where to start.
You refuse treatment for your child
If you, a guardian or child refuse to give consent for treatment which a doctor thinks is necessary, the doctor is still obliged to treat the child. The action the doctor takes will depend on how urgently the treatment is needed.
When a child’s life is in danger, the doctor has the right to do whatever is needed to save the child’s life. If you or a guardian either fail to provide medical help for a child, or unreasonably refuse to allow treatment, you can be prosecuted for neglect.
Right to die
The law concerning whether a person has the right to die is unclear. You have a right to refuse or stop treatment at any time, even if this means that you may die. However, it is normally illegal for a doctor to omit or carry out treatment with the specific intention of inducing or hastening death. If you believe you may become so ill that you could no longer make the decision about treatment, you should tell the doctor beforehand at what stage you would want treatment to stop.
In some cases, if you are unconscious or have very little consciousness, a doctor can stop some life support treatment if there is no chance of you getting better, or if it's not in your best interests. However, only a court can give a permission for this to happen.
In England, you can get more information about advance decisions on the NHS choices website at www.nhs.uk.
If you are thinking of making an advance decision you should consult an experienced adviser, for example, a solicitor or an adviser at a Citizens Advice Bureau. To search for details of your nearest CAB, including those that can give advice by email, click on nearest CAB.
If you are concerned about being treated against your wishes, you should ensure you make this clear at the time the treatment is proposed.
Removal of organs after death
Unless you have said you do not want parts of your body used for research or donated to others after your death, whoever is legally responsible for the body can allow organs to be donated. This will usually be your personal representative. Before organs can be removed from the body, medical staff must be certain that brain death has taken place, and a death certificate must be issued.
Access to medical reports and health records
You have the right to see most health records held about you, subject to certain safeguards. You are entitled to be informed of the uses of the information, who has access to them and how you can arrange to see your records. This information is provided in GP practices and NHS Trusts in the form of posters and leaflets. For more information on how the information is issued, you may wish to speak to the health professional in charge of your case. You may have to pay a fee to see your health records.
More about getting access to your health records In England
You have a right, subject to certain safeguards, to see any medical report written for an employer, prospective employer or insurer, by a medical practitioner who has responsibility for your ongoing care, for example, your GP or consultant and any medical practitioner who has treated you in the past.
For more information about access to personal records, see Using the law to protect your information.
Information about your medical history should be kept confidential, and should not be released to people who are not involved in your medical care without your consent. This includes your relatives, unless you are unable to give consent yourself. There are some exceptions to this rule. For example, medical information about you may be disclosed if it would prevent serious harm to others.
From 1 August 2013, CCGs are allowed to make direct payments to some NHS patients to allow them to buy their own healthcare. Direct payments could be used, for example, to pay for a carer, to buy medical equipment to use at home, or to pay for counselling.
A patient does not have to have direct payments if they don't want to, but some patients may want them, especially patients with a complex long-term condition. Before making a payment, the CCG must draw up a care plan with the patient setting out what the money can be used for and the money must not then be used for anything not included in the plan. In addition, the money cannot be used for GP services, including diagnostic tests, or for emergency treatment.
A patient who receives direct payments can either manage the money themselves or their representative can manage the money on their behalf. It is also possible for both patients or representatives to nominate someone else to manage the payments. If the patient is under 16 their parent or guardian can manage the money on their behalf.
CCGs must support patients receiving direct payments and must also warn them about the possible risks of payments being stolen or misused. The CCG can ask for any payment that has been misused to be repaid.
Information about NHS services
You have a right to detailed information on local health services, including quality standards and maximum waiting times. This information can be obtained from your GP, Clinical Commissioning Group (CCG)), local HealthWatch, NHS Trust or hospital-based Patient Advice Liaison Service (PALS).
The Department of Health has produced a Code of Practice on Openness in the NHS which states that patients should have access to available information about NHS services and policies, including information on standards under the NHS plan. A charge may be made for this information.
If you require any information from, for example, a CCG or a hospital Trust, you should, under the Code, receive a reply within 20 working days of your request.
The NHS must not discriminate against you when providing information about NHS services. For example, information must be available in formats which blind people can access. NHS Direct can provide interpreters in many different community languages.
You can compare the performance and customer ratings of your local health services on the MyNHS website at www.nhs.uk. The site is intended to help you choose where to go for your health services. For example, you can search standards for:
- food quality
- patient safety
- mental health.
Health Information Services
You can get information about NHS services from the NHS Choices website at: www.nhs.uk. The website gives you information about:
- local medical services, including how to find your nearest dentist, GP, hospital or pharmacist
- how to choose the best hospital or clinic for a particular treatment or procedure
- common diseases and conditions such as diabetes, and guides to common procedures, such as hip replacements
- how to make a complaint about an NHS service
- how to lead a healthier life.
You can also get advice and information about health problems and NHS services through the NHS 111 service (see under heading NHS 111 service and NHS Choices).
Health care providers such as doctors, nurses and other practitioners must try to make sure that things are explained to you in a way you understand. If they don't do this, it could be argued, for example, that you have not given proper consent to treatment – see under heading Consent.
If it's difficult for you to communicate for any reason, for example because you don't speak English or you have a disability which affects your communication, they should take steps to present the information in a way you will understand. This could mean, for example, providing a language interpreter or a sign language interpreter.
In some circumstances, if a health care provider doesn't take steps to communicate with you properly, you can complain that they have discriminated against you. It might be race discrimination if you can't understand what they are telling you because English isn't your first language. Or it might be disability discrimination if you can't understand what they are telling you because you have a disability, for example, if you're deaf.
If you need to talk about something of a personal medical nature which affects only women or men and you need an interpreter, you can complain about sex discrimination if the interpreter is not the same sex as you.
Local authorities must set up local HealthWatch services in their area. These cover primary healthcare and children and adult care services.
Services offered by your local HealthWatch will vary according to the local authority. But in general they have a responsibility for making sure that the views and feedback from patients and carers are taken into account when local services are planned.
Local HealthWatch also provide information about local health services and choices to be made about those services.
They also have the responsibility for helping with complaints about health. They can provide you with information about what to do when things go wrong. This could be signposting you to the relevant organisation with responsibility for complaints, or it could itself provide advocacy services if they are commissioned by the local authority to do this.
The NHS and other organisations or people providing health care services are not allowed to discriminate against you because of age, disability, gender reassignment, pregnancy or childbirth, race, religion, sex or sexual orientation.
If you're disabled, a health service provider must make reasonable adjustments to allow you to use their services, otherwise they will be discriminating against you. Examples of making reasonable adjustments include providing information on audiotape as well as in writing, or installing a ramp to allow wheelchair access.
I have hearing difficulties and it is embarrassing when I go to the dentist – I can never hear them when the receptionist calls out my name.
You could ask your dental surgery to keep a record of all their patients with hearing difficulties. Receptionists can then come over and let you know when the dentist is ready to see you, rather than calling out your name. The surgery should agree to this. If they don't agree and they don't have a very good reason, they are probably discriminating against you and you should make a complaint.
If you think that a doctor, dentist, nurse or other health care professional is discriminating against you, you can complain about this. Ask to see a copy of the equality policy of the organisation they work for and point out where they are failing to keep to it.
For more information about discrimination see our discrimination pages.
If you have experienced discrimination, you can get help from the EASS discrimination helpline.
You can also find out more information about discrimination in the NHS, on the website of the Equality and Human Rights Commission at: www.equalityhumanrights.com.