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BPS practice guidelines - define good practice for all psychologists whether registered, chartered or in training and offer guidance for decision making.

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Practice Guidelines | BPS - British Psychological Society

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BPS Explore is our easy-to-access central location for you to read and download a wide range of psychological content from practitioners, researchers and working groups.

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*Please note, another key piece of legislation relevant to your role is the Equality Act (2010). This will be covered in more detail in your ‘Promoting Inclusion’ teaching (Day 8)!

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Afternoon - Ethical Scenario Activity / Resources / Optional further reading

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Afternoon - Ethical Scenario Activity / Resources / Optional further reading

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7d. For reference only: UK GDPR Guidelines (2018) - full document

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7d. For reference only: UK GDPR Guidelines (2018) - full document

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The UK GDPR guidelines (2018)

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7c. For reference only: Data Protection Act (2018) - full document

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7c. For reference only: Data Protection Act (2018) - full document

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The Data Protection Act (2018)

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As an EMHP you will handle personal and sensitive data. Your service will have policies relating to information governance and GDPR that you will need to follow to adhere the Data Protection Act (2018). This should be covered by training your service provides. The training should help you understand how to share information with others (e.g., schools, social care) in accordance with both data protection and child protection legislation.

You will also be gaining written and verbal consent to record sessions with children and young people for use in supervision and university assignments. This will be covered in your Module 2 and Module 3 assignment support sessions in more detail, or you can see the relevant pages in your course handbook (pages 67-80).

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7a. Data Protection - Individual Rights 

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7a. Data Protection - Individual Rights 

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Everyone has rights in terms of their personal data including the right to be informed about how personal data is being used, the right to access personal data stored by an organisation, and the right to have data erased if requested.

It is important that consent is sought and recorded when collecting and storing a person's personal data.

UK GDPR Guidelines (2018) state that children and young people need particular protection regarding their personal data because they may be less able to understand their rights and the risks involved. Helping children and young people to understand why and how their data their data is used, and their rights regarding this data, is key to implementing these guidelines.

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Everyone working or volunteering with children and young people in the UK has a statutory duty for safeguarding.

Child protection responsibilities differ according to the sector and role a person is working in.

You will receive safeguarding training from your service to meet the requirements set out in statutory guidance.

This training should include how to recognise safeguarding concerns, responding to disclosures and the safeguarding pathways and policies in your service and local authority.

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4d. For reference only: The Children Act (1989) - full document

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4d. For reference only: The Children Act (1989) - full document

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The Children Act (1989)

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4a. The Children Act (1989) introductory video 

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4a. The Children Act (1989) introductory video 

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5f. Optional further reading: Mental Health Act UK Reform

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5f. Optional further reading: Mental Health Act UK Reform

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The Mental Health Act UK reform is a step towards modernising mental health law in England and Wales. The new Mental Health Bill 2025 aims to create a system that is more modern, respectful of people's rights, and better equipped to deliver therapeutic care.

The government introduced a draft Bill in 2022 and a final version in 2024. That Bill is now progressing through Parliament and is expected to become law in 2025.

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Better care for mental health patients under major reforms

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Mental Health Act reformed to improve treatment of patients and address disparities.

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5d. For reference only: The Mental Capacity Act (2005) - full document

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5d. For reference only: The Mental Capacity Act (2005) - full document

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The Mental Capacity Act (2005)

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5c. Optional further reading: Summary from Social Care Institute for Excellence 

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5c. Optional further reading: Summary from Social Care Institute for Excellence 

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SCIE At a glance 5

First published: June 2009
Last updated: July 2020; October 2022

This at a glance summary presents an overview of the Mental Capacity Act (MCA) 2005, which is important to health and social care practice.

The MCA has been in force since 2007 and applies to England and Wales. The primary purpose of the MCA is to promote and safeguard decision-making within a legal framework. It does this in two ways:

By empowering people to make decisions for themselves wherever possible, and by protecting people who lack capacity by providing a flexible framework that places individuals at the heart of the decision-making process

By allowing people to plan ahead for a time in the future when they might lack the capacity.

Key messages

The Mental Capacity Act (MCA) 2005 applies to everyone involved in the care, treatment and support of people aged 16 and over living in England and Wales who are unable to make all or some decisions for themselves.

The MCA is designed to protect and restore power to those vulnerable people who lack capacity.

The MCA also supports those who have capacity and choose to plan for their future - this is everyone in the general population who is over the age of 18.

All professionals have a duty to comply with the Code of Practice. It also provides support and guidance for less formal carers.

The Act's five statutory principles are the benchmark and must underpin all acts carried out and decisions taken in relation to the Act.

Anyone caring for or supporting a person who may lack capacity could be involved in assessing capacity - follow the two-stage test.

The MCA is designed to empower those in health and social care to assess capacity themselves, rather than rely on expert testing - good professional training is key

Understanding and using the MCA supports practice - for example, application of the Deprivation of Liberty Safeguards

Reach

About two million people in England and Wales are thought to lack capacity to make decisions for themselves. They are cared for by around six million people, including a broad range of health and social care staff, plus unpaid carers. Those working in health and social care include: doctors, nurses, dentists, psychologists, occupational therapy, speech and language therapists, social workers, residential and care home managers, care staff (including domiciliary care workers), and support workers (including people who work in supported housing).

Someone's Mental Capacity, or ability to make a certain decision, may be impacted by:

a stroke or brain injury

a mental health problem

dementia

a learning disability

confusion, drowsiness or unconsciousness because of an illness of the treatment for it

substance misuse.

Five key principles

The Act is underpinned by five key principles (Section 1, MCA). It is useful to consider the principles chronologically: principles 1 to 3 will support the process before or at the point of determining whether someone lacks capacity. Once you've decided that capacity is lacking, use principles 4 and 5 to support the decision-making process.

Assessment of capacity and best interests decision-making (Sections 2-4, MCA)

What is mental capacity and when might you need to assess capacity?

Having mental capacity means that a person is able to make their own decisions. You should always start from the assumption that the person has the capacity to make the decision in question (principle 1). You should also be able to show that you have made every effort to encourage and support the person to make the decision themselves (principle 2). You must also remember that if a person makes a decision which you consider eccentric or unwise, this does not necessarily mean that the person lacks the capacity to make the decision (principle 3). Under the MCA, you are required to make an assessment of capacity before carrying out any care or treatment - the more serious the decision, the more formal the assessment of capacity needs to be.

When should capacity be assessed?

You might need to assess capacity where a person is unable to make a particular decision at a particular time because their mind or brain is affected by illness of disability. People's situations may change and the capacity determination may need to be reviewed. You cannot decide that someone lacks capacity based upon age, appearance, condition or behaviour alone.

The test to assess capacity

Two-stage functional test of capacity

The Supreme Court in the case of A Local Authority v JB [2021] UKSC 52 supported the following approach to undertaking and an assessment and making a determination of someone's capacity to make a specific decision (this was also included in the Draft Codes of Practice):

1. Is the person able to make the decision (with support if required)?

2. If they cannot, is there an impairment or disturbance in the functioning of their mind or brain?

3. Is the person's inability to make the decision because of the impairment or disturbance?

The person is determined as unable to make the relevant decision if they are unable to:

1. understand information given to them

2. retain that information long enough to be able to make the decision

3. weigh up the information available to make the decision

4. communicate their decision - this could be by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand.

The determination of a person's capacity is made on the balance of probabilities - is it more likely than not that the person lacks capacity? You should be able to show in your records why you have come to your conclusion that capacity is lacking for the particular decision.

Best interests decision-making

If a person has been assessed as lacking capacity then any action taken, or any decision made for or on behalf of that person, must be made in their best interests (principle 4). The person who has to make the decision is known as the 'decision-maker' and normally will be the carer responsible for the day-to-day care, or a professional such as a doctor, nurse or social worker where decisions about treatment, care arrangements or accommodation need to be made.

What is 'best interests'?

The Act provides a non-exhaustive checklist of factors that decision-makers must work through in deciding what is in a person's best interests. A person can put their wishes and feelings into a written statement if they so wish, which the person determining capacity must consider. In addition, people involved in caring for the person lacking capacity have to be consulted concerning a person's best interests.

For more detailed information you should refer to the Code of Practice.

If a person has been assessed as lacking capacity then any action taken, or any decision made for or on behalf of that person, must be made in their best interests.

Case example: Assessing capacity

Anna Southcott (the patient's name has been changed), 76, has dementia and lives in a care home. She has asthma. Her capacity fluctuates. The district nurse attends to administer flu vaccinations. Ms Southcott is able to communicate.

Principle

The decision relates to administering a flu vaccination. The district nurse should start from the position of assuming that Ms Southcott has the capacity to decide whether to receive a flu vaccination, unless there is evidence to show that she lacks the capacity to do so (principle 1). Even if the nurse has to help Ms Southcott to make the decision, this does not mean she lacks the capacity to make it.

The nurse should not treat Ms Southcott as being unable to make the decision herself until all practicable steps to help and support her to make it have been taken, without success (principle 2). Only if this is the case should the nurse assess Ms Southcott's capacity to make the decision using the two-stage test.

As Ms Southcott's capacity fluctuates, the nurse should consider whether the decision can be postponed until she may have capacity to make the decision. The nurse will speak to Ms Southcott's carers about this, as well as asking about her condition and whether there are any contraindications for a flu vaccination - the following assumes this not to be the case.

Practice

The nurse must disregard Ms Southcott's ability to make decisions in general. The impairment or disturbance must affect her ability to make a specific decision at a specific time. The nurse will give her some simple information about why she needs a flu vaccine (her age and asthma), then will ask her to repeat that information. It may be that Ms Southcott has previously expressed preferences about having a flu vaccination, and this might provide a useful steer for the nurse.

In relation to the decision that needs to be made, the district nurse should decide on the balance of probabilities (more likely than not) whether Ms Southcott is able to:

understand relevant information about the decision

retain that information in her mind long enough to make the decision herself

use or weigh up (evaluate) that information as part of the decision-making process.

If Ms Southcott cannot do any of these three things, she is treated as being unable to make the decision.

The District nurse must then decide: does Ms Southcott have an impairment of, or a disturbance in, mind or brain function? There must be an impairment of her mind or some disturbance that affects the way her brain works. She has dementia, so this part of the test is fulfilled to the balance of probabilities (more likely than not).

Does the impairment or disturbance mean that she is unable to make a specific decision, at the specific time she needs to?

The decision about Ms Southcott's capacity must not be based merely on her age, appearance, assumptions about her condition or any aspect of her behaviour.

The nurse decides that Ms Southcott lacks capacity to make a decision about receiving a flu vaccination and clearly records her assessment with reasons. Using best interests decisionmaking (principle 4) the decision is taken that in view of her age and asthma, it would be in her best interests to receive the vaccination.

Thanks to Andrew Alonzi of Nottingham Law School for his contribution to this case study (updated by Claire Webster to reflect the Supreme Court ruling in A Local Authority v JB [2021] UKSC 52).

The new roles, bodies and powers supporting the MCA

Attorneys appointed under Lasting Powers of Attorney (LPAs) - the Act introduces a new form of Power of Attorney which allows people over the age of 18 to formally appoint one or more people to look after their health, welfare and/or financial decisions, if at some time in the future they lack capacity to make those decisions for themselves.

Court of Protection and Deputies - the MCA created a new court and a new public official to protect people who lack capacity and to supervise those making decisions on their behalf. The Court is able to appoint a Deputy, for example, because a person has an ongoing lack of capacity. The Court will tailor the powers of the deputy according to the circumstances of the individual.

The Public Guardian - the role of the Public Guardian is to protect people who lack capacity from abuse. The Public Guardian is supported by the Office of the Public Guardian (OPG). The OPG maintains a register of LPAs and EPAs. It also maintains a register of the Court-appointed Deputies and is responsible for supervising them.

Independent Mental Capacity Advocate (IMCA) - IMCAs are a statutory safeguard for people who lack capacity to make some important decisions. This includes decisions about where the person lives and serious medical treatment when the person does not have family of friends who can represent them. IMCAs can also represent individuals who are the focus of adult protection proceedings. The Deprivation of Liberty Safeguards introduced further roles for IMCAs.

Advance decisions to refuse treatment - the Act creates statutory rules with clear safeguards so that people may make a decision in advance to refuse treatment if they should lack capacity in the future.

A criminal offence - the Act introduces a new criminal offence of ill treatment or wilful neglect of a person who lacks capacity.

Code of Practice

The Code explains how the MCA works on a day-to-day basis and provides guidance to those working with people who may lack capacity. The Code explains the key features of the MCA in more detail, as well as some of the practical steps that people using and interpreting the law need to take into consideration. If you work with people who lack capacity and you are a professional and/or you are paid for the work you do then you have a legal duty to have regard to the Code. It is also relevant to unpaid carers who will be helped and guided by it. The current code of practice requires updating, as case law continues to provide updated guidance for practice. The new Mental Capacity Amendment Act, and Liberty Protection Safeguards will also be followed by an updated Code of Practice to include updated case studies and findings from case law.

Interface with the MHA

It will be important for health and social care staff who support some client groups (for example, those with mental health problems, particularly those with severe and enduring mental ill health, or older people) to have an understanding of the interface issues between the MCA and the Mental Health Act 1983 (as amended by the 2007 Act). This will also include the need to have an awareness of the Deprivation of Liberty Safeguards. Health and social care staff who support people should have an understanding that there are still requirements to follow the MCA even when a person is detained under the Mental Health Act, and an understanding which legal framework should be used at the relevant time, to deprive a person of their liberty.

Liberty Protection Safeguards

In July 2018, the government published a Mental Capacity (Amendment) Bill which will see DoLS replaced by the Liberty Protection Safeguards (LPS). This passed into law in May 2019. Under LPS, there will be a streamlined process to authorise deprivations of liberty. Read more here: Liberty Protection Safeguards.

Keep up to date

We hope this at a glance about MCA has been helpful. Some aspects of the MCA are complex, and it is important that they are fully understood. SCIE offers e-learning, bespoke training, and consultancy support, to make sure that you and your organisation are aware of good practice and legal duties in this area. Or if you would like to talk to our team about how we can help, please complete our enquiry form.

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Mental Capacity Act 2005 at a glance - SCIE

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Skip to content SCIE At a glance 5 First published: June 2009Last updated: July 2020; October 2022 This at a glance summary presents an overview of the Mental Capacity Act (MCA) 2005, which is important to health and social care practice. The MCA has been in force since 2007 and applies to England and Wales.

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5a. Mental Capacity Act (2005) introductory video

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5a. Mental Capacity Act (2005) introductory video

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The Mental Capacity Act: an animated guide by Infodeo.

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6a. Gillick Competency introductory video

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6a. Gillick Competency introductory video

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Guide to Gillick Competency Guidelines for Young People

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The pdf above is an illustrated overview of the most recent report the UK Government submitted to the UNCRC in 2022, made by the Department for Education.

It is important to note that different organisations have different viewpoints on how well the UK is doing in implementing children's rights for all.

For example, the Children's Rights Alliance for England raised key issues to the UNCRC in an alternative report in 2022 (optional further reading).

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6. Gillick Competency & ​Fraser Guidelines

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6. Gillick Competency & ​Fraser Guidelines

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In addition to the Mental Capacity Act (2005), Gillick Competency is a legal standard that determines when a child under the age of 16 can consent to their own medical treatment without the need for caregiver permission or knowledge.

This has relevance to several key areas of your role, for example when navigating consent for treatment, information sharing and caregiver involvement.

The Fraser Guidelines are similar to Gillick Competency, but apply specifically to advice and treatment about contraception and sexual health.

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2c. Optional further reading: Summary from Mind

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2c. Optional further reading: Summary from Mind

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In the UK, human rights are protected by the Human Rights Act 1998. Public authorities, like a local authority or the NHS, must follow the Act. If a public authority has breached your human rights, you may be able to take action under the Act.

Read this page to find out more about the Human Rights Act.

What's the Human Rights Act 1998?

The Human Rights Act gives effect to the human rights set out in the European Convention on Human Rights. These rights are called Convention rights.

Examples of Convention or human rights include:

the right to life

the right to respect for private and family life

the right to freedom of religion and belief.

The Human Rights Act means you can take action in the UK courts if your human rights have been breached.

What's the European Convention on Human Rights?

The European Convention on Human Rights protects the human rights of people in countries that belong to the Council of Europe. This includes the UK. The Council of Europe is different from the European Union.

Who does the Human Rights Act protect?

The Human Rights Act protects everyone in the UK. It doesn't matter if - for example, you're a British citizen, a foreigner or an asylum seeker.

Who must follow the Human Rights Act?

Public authorities must follow the Human Rights Act.

They must respect and protect your human rights, unless there's a law which prevents it. The Human Rights Act says they must act in a way which is compatible your human rights.

What's a public authority?

A public authority is an organisation which provides public functions. This can be a public sector organisation, like a hospital, government department or the courts. Private organisations or charities which carry out public functions are also public authorities - for example, private prisons.

When must public authorities follow the Human Rights Act?

Public authorities must follow the Human Rights Act in everything they do. They must respect and protect your human rights when they make individual decisions about you. They must also follow the Human Rights Act when they plan services and make policies.

Taking positive steps to protect your human rights

Public authorities must not interfere with your human rights. Sometimes they must also take positive steps to protect your rights when your life is in danger or you're threatened by other people.

For example, the police have a positive duty to protect you if they know your life is in danger from someone. If they don't act to protect you they may breach article 2 which protects your right to life.

What can you do if a public authority has breached your human rights?

If a public authority has breached your human rights you can take action under the Human Rights Act. You can complain to the public authority or you may be able to take legal action in the courts.

What if a private organisation or person has breached your human rights?

Only public authorities have obligations under the Human Rights Act. You can't take action against other people or private organisations because they've breached your human rights.

But if you take court action against someone for some other reason - for example, a claim for unfair dismissal against your employer, the courts can look at whether your human rights have also been breached. This is because courts are also public authorities and they must take account of human rights in all cases they hear.

Next steps

Other useful information

The European Convention on Human Rights

You can access the European Convention on Human Rights on the European Court of Human Rights website at

Equality Advisory Support Service (EASS)

The EASS helpline can provide advice and information on human rights and discrimination issues.

Equality and Human Rights Commission (EHRC)

You can find useful information about discrimination on the EHRC website at

Liberty

For more information and advice on the different rights protected under the Human Rights Act go to Liberty's website at

British Institute of Human Rights

You can also find more information about human rights in Your human rights guides from the British Institute of Human Rights (BIHR) at

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In the UK, human rights are protected by the Human Rights Act 1998. Public authorities, like a local authority or the NHS, must follow the Act. If a public authority has breached your human rights, you may be able to take action under the Act.

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3d. For reference only: UNCRC (1989) - full document

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3d. For reference only: UNCRC (1989) - full document

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3c. Optional further reading: UNCRC Summary 

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3c. Optional further reading: UNCRC Summary 

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2a. Human Rights Act (1998) - introductory video

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2a. Human Rights Act (1998) - introductory video

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Our Human Rights Act explained in 2 minutes

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The aim of this morning is for you to gain an overview of the legal frameworks that are relevant to your role.

In this section are 5 key pieces of legislation. For each piece of legislation we have linked key information including:

summary information

an introductory video

links to other relevant legislation / information (optional further reading)

the full documents for each legislation (for reference only, you do not need to read these!)

There is no need to read/watch every post - resources titled 'optional further reading' or 'for reference only' can be revisited at a later date if helpful.

Please use the question box below if there is anything you want to ask!

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The Data Protection Act (2018) legislates how organisations can use personal information and aligns with the UK's General Data Protection Regulation (GDPR) guidelines (2018).

It sets out the data protection principles for handling personal data (information that can be linked to an individual).

Follow the link above for a short overview of the act.

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The Data Protection Act 2018 controls how your personal information is used by organisations, businesses or the government.

The Data Protection Act 2018 is the UK's implementation of the General Data Protection Regulation (GDPR).

Everyone responsible for using personal data has to follow strict rules called 'data protection principles'. They must make sure the information is:

used fairly, lawfully and transparently

used for specified, explicit purposes

used in a way that is adequate, relevant and limited to only what is necessary

accurate and, where necessary, kept up to date

kept for no longer than is necessary

handled in a way that ensures appropriate security, including protection against unlawful or unauthorised processing, access, loss, destruction or damage

There is stronger legal protection for more sensitive information, such as:

race

ethnic background

political opinions

religious beliefs

trade union membership

genetics

biometrics (where used for identification)

health

sex life or orientation

There are separate safeguards for personal data relating to criminal convictions and offences.

Your rights

Under the Data Protection Act 2018, you have the right to find out what information the government and other organisations store about you. These include the right to:

be informed about how your data is being used

access personal data

have incorrect data updated

have data erased

stop or restrict the processing of your data

data portability (allowing you to get and reuse your data for different services)

object to how your data is processed in certain circumstances

You also have rights when an organisation is using your personal data for:

automated decision-making processes (without human involvement)

profiling, for example to predict your behaviour or interests

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The Data Protection Act (DPA) controls how personal information can be used and your rights to ask for information about yourself

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The Mental Capacity Act (2005) is a key piece of legislation in the UK that governs the decision-making process for individuals who may lack the mental capacity to make certain decisions.

It applies to people aged 16 and over and aims to protect and empower those who may lack the mental capacity to make their own decisions about their care and treatment.

Although you will not be responsible for assessing mental capacity within your role, it is important to be aware of - particularly Gillick Competence (see box to the right).

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The Human Rights Act (1998) requires all public bodies (like courts, police, local authorities, hospitals and publicly funded schools), and other bodies carrying out public functions, to respect and protect human rights.

There are 16 rights which protect anybody living in the UK. This includes people who are foreign nationals, detained in hospital or in prison.

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3. United Nations Convention on the Rights of the Child (UNCRC, 1989)

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3. United Nations Convention on the Rights of the Child (UNCRC, 1989)

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The United Nations Convention on the Rights of the Child (UNCRC) is an important, legally binding agreement signed by 196 countries (including the UK) which outlines the fundamental rights of every child.

The Convention has 54 articles, each outlining a fundamental right that applies to every child, for example the right to an education (Article 28).

The UNCRC explains how adults and governments must work together to make sure all children can enjoy all their rights.

The convention aims to strike a balance between respecting caregiver responsibilities and children and young people's rights and best interests.

Article 12 states that whilst all children who are able to form their own views should have the right to express these in matters that affect them, the views should be given due with according to the child's evolving capacity (development, growth and maturity).

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What is the UN Convention?

The UN Convention on the Rights of the Child (UNCRC) is the basis of all of our work. It is the most complete statement of children's rights ever produced and is the most widely-ratified international human rights treaty in history.

What makes the UN Convention so special?

The Convention has 54 articles that cover all aspects of a child's life and set out the civil, political, economic, social and cultural rights that all children everywhere are entitled to. It also explains how adults and governments must work together to make sure all children can enjoy all their rights.

Every child has rights "without discrimination of any kind, irrespective of the child's or his or her parent's or legal guardian's race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status" (Article 2).

The Convention must be seen as a whole: all the rights are linked and no right is more important than another. The right to relax and play (Article 31) and the right to freedom of expression (Article 13) have equal importance as the right to be safe from violence (Article 19) and the right to education (Article 28).

We are the only organisation working for children recognised by the Convention.

The Convention is also the most widely ratified human rights treaty in the world. All UN member states except for the United States have ratified the Convention. The Convention came into force in the UK in 1992.

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UN Convention on the Rights of the Child - UNICEF UK

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The United Nations Convention on the Rights of the Child (UNCRC) is the basis for all of UNICEF's work and upholds children's rights all over the world.

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The Children Act (1989) was created to consolidate earlier laws governing a child's upbringing. The act positions the welfare of the child as paramount.

The act established the legislative framework for the current child protection system in England and Wales. It sets out the "paramountcy principle" – that the welfare of the child should be the court’s main consideration.

The act developed centred the rights of children and young people as autonomous individuals who should be protected by effective interventions if they are in danger and be informed and included in decisions about their care and future.

The act also developed the concept of parental responsibility and states that where possible children should be brought up and cared for within their own families,

The Children Act (2004) built on the previous act and developed the infrastructure in place to support children's safety with the creation of directors for children's services in local authorities and Local Safeguarding Children's Boards (LSCB's).

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Morning - Individual learning - Key legislation 

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Morning - Individual learning - Key legislation 

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BPS Code of Ethics and Conduct

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Instructions: in your groups you will have one hour to discuss the four scenarios using the discussion questions provided. We will then join back together as a wider group to share our reflections.

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4c. For reference only: The Children Act (2004) - full document

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4c. For reference only: The Children Act (2004) - full document

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The Children Act (2004)

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5e. For reference only: The Mental Health Act (2007) - full document

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5e. For reference only: The Mental Health Act (2007) - full document

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In addition to The Mental Capacity Act (2005), there is The Mental Health Act (2007) - this documents the conditions under which someone may be admitted to hospital involuntarily, also know as 'being detained under the Mental Health Act'.

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5b. NHS summary of Mental Capacity Act (2005)

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5b. NHS summary of Mental Capacity Act (2005)

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The Mental Capacity Act (MCA) is designed to protect and empower people who may lack the mental capacity to make their own decisions about their care and treatment. It applies to people aged 16 and over.

It covers decisions about day-to-day things like what to wear or what to buy for the weekly shop, or serious life-changing decisions like whether to move into a care home or have major surgery.

Examples of people who may lack capacity include those with:

But just because a person has one of these health conditions does not necessarily mean they lack the capacity to make a specific decision.

Someone can lack capacity to make some decisions (for example, to decide on complex financial issues) but still have the capacity to make other decisions (for example, to decide what items to buy at the local shop).

The MCA says:

assume a person has the capacity to make a decision themselves, unless it's proved otherwise

wherever possible, help people to make their own decisions

do not treat a person as lacking the capacity to make a decision just because they make an unwise decision

if you make a decision for someone who does not have capacity, it must be in their best interests

treatment and care provided to someone who lacks capacity should be the least restrictive of their basic rights and freedoms

The MCA also allows people to express their preferences for care and treatment, and to appoint a trusted person to make a decision on their behalf should they lack capacity in the future.

People should also be provided with an independent advocate, who will support them to make decisions in certain situations, such as serious treatment or where the individual might have significant restrictions placed on their freedom and rights in their best interests.

How is mental capacity assessed?

The MCA sets out a 2-stage test of capacity:

1) Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use?

2) Does the impairment mean the person is unable to make a specific decision when they need to? People can lack capacity to make some decisions, but have capacity to make others. Mental capacity can also fluctuate with time - someone may lack capacity at one point in time, but may be able to make the same decision at a later point in time.

Where appropriate, people should be allowed the time to make a decision themselves.

The MCA says a person is unable to make a decision if they cannot:

understand the information relevant to the decision

retain that information

use or weigh up that information as part of the process of making the decision

Helping people make their own decisions

Before deciding a person lacks capacity, it's important to take steps to enable them to try to make the decision themselves.

For example:

does the person have all the relevant information they need?

have they been given information on any alternatives?

could information be explained or presented in a way that's easier for them to understand (for example, by using simple language or visual aids)?

have different methods of communication been explored, such as non-verbal communication?

could anyone else help with communication, such as a family member, carer or advocate?

are there particular times of day when the person's understanding is better?

are there particular locations where the person may feel more at ease?

could the decision be delayed until they might be better able to make the decision?

Is the decision in their best interests?

If someone lacks the capacity to make a decision and the decision needs to be made for them, the MCA states the decision must be made in their best interests.

The MCA sets out a checklist to consider when deciding what's in a person's best interests.

It says you should:

encourage participation - do whatever's possible to permit or encourage the person to take part

identify all relevant circumstances - try to identify the things the individual lacking capacity would take into account if they were making the decision themselves

find out the person's views - including their past and present wishes and feelings, and any beliefs or values

avoid discrimination - do not make assumptions on the basis of age, appearance, condition or behaviour

assess whether the person might regain capacity - if they might, could the decision be postponed?

It's vital to consult with others for their views about the person's best interests.

In particular, try to consult:

anyone previously named by the individual

anyone engaged in caring for them

close relatives and friends

any attorney appointed under a Lasting Power of Attorney or Enduring Power of Attorney

any deputy appointed by the Court of Protection to make decisions for the person

Finding the least restrictive option

Before you make a decision or act on behalf of someone who lacks capacity, always question if you can do something else that would interfere less with their basic rights and freedoms.

This is called finding the "least restrictive alternative". It includes considering whether there's a need to act or make a decision at all.

Where there's more than one option, it's important to explore ways that would be less restrictive or allow the most freedom for a person who lacks capacity.

But the final decision must always allow the original purpose of the decision or act to be achieved.

Any decision or action must still be in the best interests of the person who lacks capacity.

So sometimes it may be necessary to choose an option that is not the least restrictive alternative if that option is in the person's best interests.

Deprivation of liberty

In certain cases, the restrictions placed upon a person who lacks capacity may amount to "deprivation of liberty". This must be judged on a case-by-case basis.

Where it appears a deprivation of liberty might happen, the provider of care (usually a hospital or a care home) has to apply to their local authority.

They'll then arrange an assessment of the person's care and treatment to decide if the deprivation of liberty is in the best interests of the individual concerned.

If it is, the local authority will grant a legal authorisation. If it is not, the care and treatment package must be changed - otherwise, an unlawful deprivation of liberty will occur. This system is known as the Deprivation of Liberty Safeguards.

If you suspect a deprivation of liberty may happen, talk to the care provider and then possibly the local authority.

Advance statements and decisions

An advance statement is a written statement that sets down a person's preferences, wishes, beliefs and values regarding their future care. It's not legally binding.

The aim is to provide a guide for anyone who might have to make decisions in a person's best interests if that person has lost the capacity to make decisions or communicate their decision.

An advance statement can cover any aspect of a person's future health or social care.

This could include:

how they want any religious or spiritual beliefs they hold to be reflected in their care

where they would like to be cared for - for example, at home or in a hospital, nursing home or hospice

how they like to do things - for example, if they prefer a shower instead of a bath, or like to sleep with the light on

concerns about practical issues - for example, who will look after their pet if they become ill

Find out more about making advance statements
An advance decision (sometimes known as an advance decision to refuse treatment, an ADRT, or a living will) is a legally binding decision that allows someone aged 18 or over, while still capable, to refuse specified medical treatment for a time in the future when they may lack capacity to consent to or refuse that treatment.

An advance decision must be valid and applicable to current circumstances. If it is, it has the same effect as a decision made by a person with capacity - healthcare professionals must follow the decision.

If the advance decision refuses life-sustaining treatment, it must:

be in writing, signed and witnessed

state clearly that the decision applies even if life is at risk

People who make an advance decision may wish to consider letting their family, friends and carers know about it.
Find out more about advance decisions
Lasting Powers of Attorney

You can grant a Lasting Power of Attorney (LPA) to another person (or people) to enable them to make decisions about your health and welfare, or decisions about your property and financial affairs.

Separate legal documents are made for each of these decisions, appointing one or more attorneys for each.

An Enduring Power of Attorney (EPA) under the previous law was restricted to making decisions over property and affairs, which includes financial affairs and accessing the person's information.

An EPA made before the Mental Capacity Act came into force on 1 October 2007 remains valid.

Powers of attorney can be made at any time when the person making it has the mental capacity to do so, provided they're 18 or over.

Both an EPA and LPA must be registered. An LPA can be registered at any time, but a personal welfare LPA will only be effective once the person has lost the capacity to make their own decisions.

When acting under an LPA, an attorney (the appointed person) must:

make sure the MCA's statutory principles are followed

check whether the person has the capacity to make that particular decision for themselves - if they do, a personal welfare LPA cannot be used and the person must make the decision

In addition, the Court of Protection will be able to appoint deputies who can also take decisions on health and welfare and financial matters if the person concerned lacks the capacity to make a decision.

They'll come into action when the court needs to delegate an ongoing series of decisions rather than one decision.

If the person concerned already has an LPA appointed, they will not normally need a deputy as well.

The Office of the Public Guardian registers LPAs and EPAs, and supervises court-appointed deputies.

It provides evidence to the Court of Protection and information and guidance to the public.

The Public Guardian works with a range of agencies, such as the financial sector, police and social services, to investigate concerns.

The Court of Protection

The Court of Protection oversees the operation of the Mental Capacity Act and deals with all issues, including financial and serious healthcare matters, concerning people who lack the mental capacity to make their own decisions.

The court also tries to resolve all disputes when the person's carer, healthcare worker or social worker disagree about what's in the person's best interests, or when the views of the attorneys conflict in relation to property and welfare.

The court hears important cases, such as whether the NHS should withdraw treatment, whether a serious medical treatment decision is in a person's best interests, or whether it's in a person's best interests to be deprived of their liberty.

Cases can be brought to the court by family members, as well as advocates and professionals involved in decisions.

Professionals' duties under the Mental Capacity Act

The Mental Capacity Act applies to all professions - doctors, nurses, social workers, occupational therapists, healthcare assistants, and support staff.

These staff and their employers have a duty to ensure they know how to use it.

Most trusts and local authorities will have a Mental Capacity Act lead who provides specialist advice on how the Act works.

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Mental Capacity Act - Social care and support guide

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What is the Mental Capacity Act and what does it mean for you?

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6b. Gillick competency and Fraser Guidelines factsheet

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6b. Gillick competency and Fraser Guidelines factsheet

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Introduction

Gillick competency and Fraser guidelines help people who work with children to balance the need to listen to children's wishes with the responsibility to keep them safe.

When practitioners are trying to decide whether a child is mature enough to make decisions about things that affect them, they often talk about whether the child is 'Gillick competent' or whether they meet the 'Fraser guidelines'.

Although the two terms are frequently used together and originate from the same legal case, there are distinct differences between them.

Both Gillick competency and Fraser guidelines refer to a legal case from the 1980s which looked at whether doctors should be able to give contraceptive advice or treatment to young people under 16-years-old without parental consent.

Applying Gillick competence and Fraser guidelines

The Fraser guidelines still apply to advice and treatment relating to contraception and sexual health. But Gillick competency is often used in a wider context to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.

You should always encourage a child to tell their parents or carers about the decisions they are making. If they don't want to do this, you should explore why and, if appropriate, discuss ways you could help them inform their parents or carers. For example, you could talk to the young person's parents or carers on their behalf.

If the young person still wants to go ahead without their parents' or carers' knowledge or consent, you should consider the Gillick and Fraser guidelines. The following information looks at how this can be applied in practice.

Gillick competence

Gillick competence

Gillick competency applies mainly to medical advice but it is also used by practitioners in other settings. For example, if a child or young person:

would like to have therapeutic support but doesn't want their parents or carers to know about it

is seeking confidential support for substance misuse

has strong wishes about their future living arrangements which may conflict with their parents' or carers' views.

Medical professionals need to consider Gillick competency if a young person under the age of 16 wishes to receive treatment without their parents' or carers' consent or, in some cases, knowledge.

If the young person has informed their parents of the treatment they wish to receive but their parents do not agree with their decision, treatment can still proceed if the child has been assessed as Gillick competent.

There is specific guidance for medical professionals on using Gillick competence - see case history and legislation.

Assessing Gillick competence

There is no set of defined questions to assess Gillick competency. Professionals need to consider several things when assessing a child's capacity to consent, including:

the child's age, maturity and mental capacity

their understanding of the issue and what it involves - including advantages, disadvantages and potential long-term impact

their understanding of the risks, implications and consequences that may arise from their decision

how well they understand any advice or information they have been given

their understanding of any alternative options, if available

their ability to explain a rationale around their reasoning and decision making.

Remember that consent is not valid if a young person is being pressured or influenced by someone else.

Children's capacity to consent may be affected by different factors, for example stress, mental health conditions and the complexities of the decision they are making. The same child may be considered Gillick competent to make one decision but not competent to make a different decision.

If you don't think a child is Gillick competent or there are inconsistencies in their understanding, you should seek consent from their parents or carers before proceeding.

In complex medical cases, such as those involving disagreements about treatment, you may wish to seek the opinion of a colleague about a child's capacity to consent (Care Quality Commission, 2019).

Young people also have the right to seek a second opinion from another medical professional (General Medical Council, 2020).

Refusal of medical treatment

Gillick competency can be used when young people wish to refuse medical treatment.

However, if a young person refuses treatment which may lead to their death or severe permanent harm, their decision can be overruled. More information about this is available in the guidance for medical professionals in each UK nation - see case history and legislation.

Child protection concerns

The child's safety and wellbeing is paramount.

When you are assessing Gillick competency if you have any concerns about the safety of the young person you should check whether previous child protection concerns have been raised, and explore any factors that could put them at risk of abuse.

You must always share child protection concerns with the relevant agencies, even if this goes against a child's wishes.
> Find out more about recognising and responding to abuse

Fraser guidelines

Fraser guidelines

The Fraser guidelines apply specifically to advice and treatment about contraception and sexual health. They may be used by a range of healthcare professionals working with under 16-year-olds, including doctors and nurse practitioners.

Following a legal ruling in 2006, Fraser guidelines can also be applied to advice and treatment for sexually transmitted infections and the termination of pregnancy (Axton v The Secretary of State for Health, 2006).

Using the Fraser guidelines

Practitioners using the Fraser guidelines should be satisfied of the following:

the young person cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment (or to allow the practitioner to inform their parents or carers).

the young person understands the advice being given.

the young person's physical or mental health or both are likely to suffer unless they receive the advice or treatment.

it is in the young person's best interests to receive the advice, treatment or both without their parents' or carers' consent.

the young person is very likely to continue having sex with or without contraceptive treatment.

(Gillick v West Norfolk, 1985)

Child protection concerns

When using Fraser guidelines for issues relating to sexual health, you should always consider any potential child protection concerns:

Underage sexual activity is a possible indicator of child sexual exploitation and children who have been groomed may not realise they are being abused.

Sexual activity with a child under 13 should always result in a child protection referral.

If a young person presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be an indicator of child sexual abuse or exploitation.

You should always consider any previous concerns that may have been raised about the young person and explore whether there are any factors that may present a risk to their safety and wellbeing.

You must always share child protection concerns with the relevant agencies, even if a child or young person asks you not to.

> Find out more about recognising and responding to abuse

Case history, legislation and guidance

Gillick v West Norfolk and Wisbech Area Health Authority 1986

In 1982 Victoria Gillick took her local health authority (West Norfolk and Wisbech Area Health Authority) and the Department of Health and Social Security to court in an attempt to stop doctors from giving contraceptive advice or treatment to under 16-year-olds without parental consent.

The case went to the High Court in 1984 where Mr Justice Woolf dismissed Mrs Gillick's claims. The Court of Appeal reversed this decision, but in 1985 it went to the House of Lords and the Law Lords (Lord Scarman, Lord Fraser and Lord Bridge) ruled in favour of the original judgment delivered by Mr Justice Woolf:

"...whether or not a child is capable of giving the necessary consent will depend on the child's maturity and understanding and the nature of the consent required. The child must be capable of making a reasonable assessment of the advantages and disadvantages of the treatment proposed, so the consent, if given, can be properly and fairly described as true consent" (Gillick v West Norfolk, 1984).

What are the Fraser guidelines?

The Fraser guidelines refer to the guidelines set out by Lord Fraser in his judgment of the Gillick case in the House of Lords (Gillick v West Norfolk, 1985), which apply specifically to contraceptive advice.

Lord Fraser stated that a doctor should always encourage a girl aged under 16 to inform her parents or carers that she is seeking contraceptive advice (or allow the doctor to inform the parents or carers on her behalf). But if she cannot be persuaded to do so they can proceed to give contraceptive advice and treatment as long as certain conditions are met. This includes making sure it's in the girl's best interests for advice to be given and that she understands the advice.
> Find out more about using the Fraser guidelines
What is Gillick competence?

Lord Scarman's comments in his judgment of the Gillick case in the House of Lords (Gillick v West Norfolk, 1985) are often referred to as the test of "Gillick competency". He said:

"...it is not enough that she should understand the nature of the advice which is being given: she must also have a sufficient maturity to understand what is involved."

He also commented more generally on parents' versus children's rights:

"parental right yields to the child's right to make his own decisions when he reaches a sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring decision."
> Find out more about assessing Gillick competency
Legislation and guidance

Gillick v West Norfolk and Wisbech Area Health Authority went to the House of Lords and is often used as a legal precedent across the UK.

In Scotland, the Age of Legal Capacity (Scotland) Act 1991 sets out when children have the legal capacity to make decisions. Section 2 sets out when a child under the age of 16 can consent to medical treatment or procedures.

Medical guidance

In England, the Department of Health and Social Care provides guidance for medical professionals on the legal framework they need to consider when obtaining valid consent to examination, treatment or care (Department of Health and Social Care, 2009).

In Northern Ireland the Department of Health provides consent guides for healthcare professionals (Department of Health, 2003).

In Scotland the NHS has provided a good practice guide on consent for health professionals (PDF) (Scottish Executive Health Department, 2006).

References and resources

References and resources

Axton v The Secretary of State for Health (The Family Planning Association: intervening) (2006) EWHC 37. As cited in Family Law Week.

Care Quality Commission (2019). Brief guide: capacity and competence to consent in under 18s (PDF). Care Quality Commission.

Department of Health (2003). Consent guides for healthcare professionals. [Accessed 02/02/2020].

Department of Health and Social Care (2009) Reference guide to consent for examination or treatment (second edition). London: Department of Health and Social Care.

Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security [1984] Q.B. 581. As cited in Children's Legal Centre (1985) Landmark decision for children's rights. Childright, 22: 11-18.

Gillick v West Norfolk & Wisbech Area Health Authority, UKHL 7 (17 October 1985) Available via (BAILII) in The law reports (appeal cases) [1986] AC 112.

Scottish Executive Health Department (2006). A good practice guide on consent for health professionals in NHS Scotland (PDF). Edinburgh: Scottish Executive

Childline

If a child or young person needs confidential help and advice direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online or read about children's rights on the Childline website.

You can also download or order Childline posters and wallet cards.

Elearning

Our online and face-to-face training courses can help develop your understanding of how to protect children from abuse and safely recruit staff and volunteers to work with children:

Further reading

For further reading about Gillick competency and Fraser guidelines, search the NSPCC Library catalogue using the keywords "Gillick competency" and "Fraser guidelines".
> Find out more about the Library and Information Service

Introduction

Gillick competency and Fraser guidelines help people who work with children to balance the need to listen to children's wishes with the responsibility to keep them safe.

When practitioners are trying to decide whether a child is mature enough to make decisions about things that affect them, they often talk about whether the child is 'Gillick competent' or whether they meet the 'Fraser guidelines'.

Although the two terms are frequently used together and originate from the same legal case, there are distinct differences between them.

Both Gillick competency and Fraser guidelines refer to a legal case from the 1980s which looked at whether doctors should be able to give contraceptive advice or treatment to young people under 16-years-old without parental consent.

Applying Gillick competence and Fraser guidelines

The Fraser guidelines still apply to advice and treatment relating to contraception and sexual health. But Gillick competency is often used in a wider context to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.

You should always encourage a child to tell their parents or carers about the decisions they are making. If they don't want to do this, you should explore why and, if appropriate, discuss ways you could help them inform their parents or carers. For example, you could talk to the young person's parents or carers on their behalf.

If the young person still wants to go ahead without their parents' or carers' knowledge or consent, you should consider the Gillick and Fraser guidelines. The following information looks at how this can be applied in practice.

Gillick competence

Gillick competence

Gillick competency applies mainly to medical advice but it is also used by practitioners in other settings. For example, if a child or young person:

would like to have therapeutic support but doesn't want their parents or carers to know about it

is seeking confidential support for substance misuse

has strong wishes about their future living arrangements which may conflict with their parents' or carers' views.

Medical professionals need to consider Gillick competency if a young person under the age of 16 wishes to receive treatment without their parents' or carers' consent or, in some cases, knowledge.

If the young person has informed their parents of the treatment they wish to receive but their parents do not agree with their decision, treatment can still proceed if the child has been assessed as Gillick competent.

There is specific guidance for medical professionals on using Gillick competence - see case history and legislation.

Assessing Gillick competence

There is no set of defined questions to assess Gillick competency. Professionals need to consider several things when assessing a child's capacity to consent, including:

the child's age, maturity and mental capacity

their understanding of the issue and what it involves - including advantages, disadvantages and potential long-term impact

their understanding of the risks, implications and consequences that may arise from their decision

how well they understand any advice or information they have been given

their understanding of any alternative options, if available

their ability to explain a rationale around their reasoning and decision making.

Remember that consent is not valid if a young person is being pressured or influenced by someone else.

Children's capacity to consent may be affected by different factors, for example stress, mental health conditions and the complexities of the decision they are making. The same child may be considered Gillick competent to make one decision but not competent to make a different decision.

If you don't think a child is Gillick competent or there are inconsistencies in their understanding, you should seek consent from their parents or carers before proceeding.

In complex medical cases, such as those involving disagreements about treatment, you may wish to seek the opinion of a colleague about a child's capacity to consent (Care Quality Commission, 2019).

Young people also have the right to seek a second opinion from another medical professional (General Medical Council, 2020).

Refusal of medical treatment

Gillick competency can be used when young people wish to refuse medical treatment.

However, if a young person refuses treatment which may lead to their death or severe permanent harm, their decision can be overruled. More information about this is available in the guidance for medical professionals in each UK nation - see case history and legislation.

Child protection concerns

The child's safety and wellbeing is paramount.

When you are assessing Gillick competency if you have any concerns about the safety of the young person you should check whether previous child protection concerns have been raised, and explore any factors that could put them at risk of abuse.

You must always share child protection concerns with the relevant agencies, even if this goes against a child's wishes.
> Find out more about recognising and responding to abuse

Fraser guidelines

Fraser guidelines

The Fraser guidelines apply specifically to advice and treatment about contraception and sexual health. They may be used by a range of healthcare professionals working with under 16-year-olds, including doctors and nurse practitioners.

Following a legal ruling in 2006, Fraser guidelines can also be applied to advice and treatment for sexually transmitted infections and the termination of pregnancy (Axton v The Secretary of State for Health, 2006).

Using the Fraser guidelines

Practitioners using the Fraser guidelines should be satisfied of the following:

the young person cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment (or to allow the practitioner to inform their parents or carers).

the young person understands the advice being given.

the young person's physical or mental health or both are likely to suffer unless they receive the advice or treatment.

it is in the young person's best interests to receive the advice, treatment or both without their parents' or carers' consent.

the young person is very likely to continue having sex with or without contraceptive treatment.

(Gillick v West Norfolk, 1985)

Child protection concerns

When using Fraser guidelines for issues relating to sexual health, you should always consider any potential child protection concerns:

Underage sexual activity is a possible indicator of child sexual exploitation and children who have been groomed may not realise they are being abused.

Sexual activity with a child under 13 should always result in a child protection referral.

If a young person presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be an indicator of child sexual abuse or exploitation.

You should always consider any previous concerns that may have been raised about the young person and explore whether there are any factors that may present a risk to their safety and wellbeing.

You must always share child protection concerns with the relevant agencies, even if a child or young person asks you not to.

> Find out more about recognising and responding to abuse

Case history, legislation and guidance

Gillick v West Norfolk and Wisbech Area Health Authority 1986

In 1982 Victoria Gillick took her local health authority (West Norfolk and Wisbech Area Health Authority) and the Department of Health and Social Security to court in an attempt to stop doctors from giving contraceptive advice or treatment to under 16-year-olds without parental consent.

The case went to the High Court in 1984 where Mr Justice Woolf dismissed Mrs Gillick's claims. The Court of Appeal reversed this decision, but in 1985 it went to the House of Lords and the Law Lords (Lord Scarman, Lord Fraser and Lord Bridge) ruled in favour of the original judgment delivered by Mr Justice Woolf:

"...whether or not a child is capable of giving the necessary consent will depend on the child's maturity and understanding and the nature of the consent required. The child must be capable of making a reasonable assessment of the advantages and disadvantages of the treatment proposed, so the consent, if given, can be properly and fairly described as true consent" (Gillick v West Norfolk, 1984).

What are the Fraser guidelines?

The Fraser guidelines refer to the guidelines set out by Lord Fraser in his judgment of the Gillick case in the House of Lords (Gillick v West Norfolk, 1985), which apply specifically to contraceptive advice.

Lord Fraser stated that a doctor should always encourage a girl aged under 16 to inform her parents or carers that she is seeking contraceptive advice (or allow the doctor to inform the parents or carers on her behalf). But if she cannot be persuaded to do so they can proceed to give contraceptive advice and treatment as long as certain conditions are met. This includes making sure it's in the girl's best interests for advice to be given and that she understands the advice.
> Find out more about using the Fraser guidelines
What is Gillick competence?

Lord Scarman's comments in his judgment of the Gillick case in the House of Lords (Gillick v West Norfolk, 1985) are often referred to as the test of "Gillick competency". He said:

"...it is not enough that she should understand the nature of the advice which is being given: she must also have a sufficient maturity to understand what is involved."

He also commented more generally on parents' versus children's rights:

"parental right yields to the child's right to make his own decisions when he reaches a sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring decision."
> Find out more about assessing Gillick competency
Legislation and guidance

Gillick v West Norfolk and Wisbech Area Health Authority went to the House of Lords and is often used as a legal precedent across the UK.

In Scotland, the Age of Legal Capacity (Scotland) Act 1991 sets out when children have the legal capacity to make decisions. Section 2 sets out when a child under the age of 16 can consent to medical treatment or procedures.

Medical guidance

In England, the Department of Health and Social Care provides guidance for medical professionals on the legal framework they need to consider when obtaining valid consent to examination, treatment or care (Department of Health and Social Care, 2009).

In Northern Ireland the Department of Health provides consent guides for healthcare professionals (Department of Health, 2003).

In Scotland the NHS has provided a good practice guide on consent for health professionals (PDF) (Scottish Executive Health Department, 2006).

References and resources

References and resources

Axton v The Secretary of State for Health (The Family Planning Association: intervening) (2006) EWHC 37. As cited in Family Law Week.

Care Quality Commission (2019). Brief guide: capacity and competence to consent in under 18s (PDF). Care Quality Commission.

Department of Health (2003). Consent guides for healthcare professionals. [Accessed 02/02/2020].

Department of Health and Social Care (2009) Reference guide to consent for examination or treatment (second edition). London: Department of Health and Social Care.

Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security [1984] Q.B. 581. As cited in Children's Legal Centre (1985) Landmark decision for children's rights. Childright, 22: 11-18.

Gillick v West Norfolk & Wisbech Area Health Authority, UKHL 7 (17 October 1985) Available via (BAILII) in The law reports (appeal cases) [1986] AC 112.

Scottish Executive Health Department (2006). A good practice guide on consent for health professionals in NHS Scotland (PDF). Edinburgh: Scottish Executive

Childline

If a child or young person needs confidential help and advice direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online or read about children's rights on the Childline website.

You can also download or order Childline posters and wallet cards.

Elearning

Our online and face-to-face training courses can help develop your understanding of how to protect children from abuse and safely recruit staff and volunteers to work with children:

Further reading

For further reading about Gillick competency and Fraser guidelines, search the NSPCC Library catalogue using the keywords "Gillick competency" and "Fraser guidelines".
> Find out more about the Library and Information Service

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Gillick competence and Fraser guidelines | NSPCC Learning

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Gillick competency is often used to assess whether a child is mature enough to consent to treatment. Fraser guidelines are used for issues relating to sexual health.

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2d. For reference only: The Human Rights Act (1998) - full document

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2d. For reference only: The Human Rights Act (1998) - full document

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The Act has three main effects:

1. You can seek justice in a British court

It incorporates the rights set out in the European Convention on Human Rights (ECHR) into domestic British law. This means that if your human rights have been breached, you can take your case to a British court rather than having to seek justice from the European Court of Human Rights in Strasbourg, France.

2. Public bodies must respect your rights

It requires all public bodies (like courts, police, local authorities, hospitals and publicly funded schools) and other bodies carrying out public functions to respect and protect your human rights.

3. New laws are compatible with Convention rights

In practice it means that Parliament will nearly always make sure that new laws are compatible with the rights set out in the European Convention on Human Rights (although ultimately Parliament is sovereign and can pass laws which are incompatible). The courts will also, where possible, interpret laws in a way which is compatible with Convention rights.

Find out more about human rights and how they play a part in our everyday lives: what are human rights?

Download a full copy of the Human Rights Act.

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The Human Rights Act allows you to defend your rights in UK courts and ensures that public organisations respect and protect your human rights.

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This is a free MindEd e-learning session.  It is aimed at a universal audience and introduces the key concepts in legal and ethical discussion on good practice in mental health work with children and young people including:

Ethical frameworks

Capacity

Consent

Confidentiality

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BABCP Standards of Conduct, Performance and Ethics

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BABCP Standards of Conduct, Performance and Ethics

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Standards of Conduct, Performance & Ethics – BABCP

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As a member of BABCP you are required to make sure that you are familiar with the standards and that you keep to them. If you are applying for membership or Accreditation as a CBT practitioner, trainer or supervisor, or Evidence Based Parent Trainer or a Registered Wellbeing Practitioner you will be asked to sign a declaration to confirm that you have read and will keep to the standards. We use the term ‘Registrant’ to cover all people registered on the CBT Register UK and Ireland.

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Attendance:

Please note, attendance must be registered via the My Exeter app. See the following link for further guidance: MyExeter App | Current Students | University of Exeter.

If you have any issues logging into the app, please email emhp@exeter.ac.uk.

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Why have you built a new app?

We are building a new app based on insight from students around how to improve their student experience at UoE. We want to reduce the number of places where you can get information at the University, so MyExeter is now the one essential tool to navigating your life at UoE. Our goal, in line with the University's Strategy, is to deliver you a unique, personalised digital experience.

Why should I use MyExeter?

The MyExeter app is now an essential tool to your life at University. Use it to view your class timetable, find and book study spaces on your campus, discover the latest University updates and events and much more.

You'll notice the app being updated and improved regularly. We're continuously gathering insight and feedback to ensure the app is valuable to you in your life at UoE. You can help to make it even better by providing feedback in the feedback form within the app.

How do I leave feedback on the app?

We'd love to hear your feedback and ideas, whether its small improvements or ideas for big new features! Let us know by completing the form within the app: Within the app, go to the 'Account' tab and select 'Leave feedback' to complete the form.

We would also like to invite all students to register your interest in taking part in user testing and feedback sessions to help improve our services. Complete this form to register.

I have an idea for a feature for MyExeter, who can I share it with?

Share your idea with us by leaving feedback in the 'Account' section of the app. See 'How do I leave feedback on the app?' for more info on how to do this.

Is my information safe on MyExeter?

Your data is safe with us. The app uses data from your University records to deliver personalised services based on your discipline, campus, or year of study.

For more detailed information please visit 'Terms of Use' in the Account section of the app menu.

Do I need to pay for MyExeter?

No, the app and all of its features are free to all students.

How do I access MyExeter? Can I use the app on mobile and desktop?

The MyExeter app works best on a mobile device.
Download MyExeter for free from the Apple App Store or Google Play Store.
If you don't have a smartphone you can use the MyExeter web app. This web app isn't as developed as the app that you will find on the app stores, but it has all the essential features Students will need.

What is the Check-In feature?

Check-in is the feature within the MyExeter app that is used to record attendance of required students. If this applies to you, you will see a green 'check-in' button in the app at the time of the teaching session you are required to check-in to. If you are not required to register your attendance in classes, you will not see the green Check-in button. Learn more about how to record your attendance in MyExeter.

For support with using MyExeter, contact the IT Helpdesk by phone (01392 725050) or by raising an incident. If you're on campus, visit the Digital Hub for face-to-face support in or

I'm a University of Exeter colleague, can I access MyExeter?

Right now MyExeter is only designed for UoE Students. University colleagues do have access to MyExeter, however the content isn't yet tailored for staff. If you're a University of Exeter colleague and would like to get involved with research into creating a staff profile in MyExeter, sign up here.

If you have any questions about MyExeter, attend our fortnightly Digital Demo sessions to learn more & ask us anything.

10/07/2024 Release

Online Check-in
Required students can now check in to online and hybrid teaching sessions directly in the app.

Check-in experience
Improved check-in UI design.

PWA update
The web version of the app has been brought up to date to keep consistency with the mobile version, improving user experience.

Event time fixes
Fixed issues affecting how event times are displayed.

Timetable updates
Improved experience when no timetable data is present.

Accessibility improvements
We've made the app easier for everyone to use.

General improvements
Includes performance enhancements and various bug fixes to keep things running smoothly.

05/06/2025 Release

Events
The events page will now load on the current or next upcoming date, not a past one. Events now appear in chronological order, and the page loads faster for a smoother experience.

Accessing MyExeter
We've resolved an issue that was preventing some iOS devices from progressing past the initial loading screen.

Timetable
The "My Timetable" link in the App Information page now correctly directs to the mobile version.

General improvements
Includes performance enhancements and various bug fixes to keep things running smoothly.

Location service issue fix
Location service issue experienced in Release 7 preventing some international visa holders from checking in.

Performance improvements
Various front end performance improvements to speed up the app.

Events updates
We have resolved an issue that was preventing some events from appearing. All scheduled events should now display correctly & we've made it easier to understand event pricing with a clearer cost display. Additional fix to ensure events are shown on the correct date/time.

MyDay updates
You will now only see current and upcoming timetable events, past events are filtered out to help you stay focused.

Check-In button fix
We have fixed an issue that was preventing some international students from seeing the check-in button. It should now be visible and functioning as expected.

Accessing MyExeter
We have improved the startup flow and you'll now only be asked to accept the terms and conditions on first log in or when they've been updated.

Timetable updates
The calendar now starts on Monday to better align with the academic week and we have added a preview map of where your timetable session is located so you can see where you need to be at a glance.

Various bug fixes
To improve the overall user experience.

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MyExeter App | Current Students | University of Exeter

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MyExeter is the app for Exeter University students. View your timetable, book study spaces, register your attendance, and discover what's on.

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Hello all,

Welcome to today's teaching on legal, ethical and professional issues that may arise as part of your role as an EMHP.