Working together, Brainkind and Healthwatch West Sussex have created a tool to support healthcare professionals through the process of making decisions in a person’s best interests.
The Consent to Treatment for Best Interests Decision Making Toolkit, can be used to record and evidence how you, as a healthcare professional, have worked in the best interests of your patients. It is there to support you to get the best outcome for your patients, whilst ensuring that you follow and document the process appropriately.
Why is this needed?
Roger (aged 30) is needle phobic and unable to give consent to any treatment. His consultant agreed through Best Interests to use a mask and not a needle for a medical procedure. Roger was given a mask to take home, so he could get used to the smell and having it on his face.
Roger arrived at the hospital on the day of his procedure to find there had been a change and the plan was now to use a needle. He was also told ‘we may have to hold you down to administer the injection.’ This option was refused, and Roger left without having the procedure. A few weeks later the medical procedure was completed using the mask. Obviously, these changes had financial costs for the NHS and were not good for Roger.
A few months later Roger’s GP recommended he needed medication to help reduce his symptoms. The GP telephoned Roger’s parents who would not give consent to the prescribing of this medication. Roger’s condition deteriorated over the next 18 months. Then a new GP followed the Best Interests process and prescribed the medication, which has since stabilised Roger’s condition.
What went wrong?
The original GP may have assumed Roger’s parents had the final say, which may have been due to gaps in understanding the Mental Capacity Act or simply a decision not to take responsibility for the prescribing of medication under ‘Best Interests for the patient.’
What we do know is that:
Roger did not have the correct support during this time and waited in pain too long to get the right medication.
Whatever the reason, a lack of evidence means we can only speculate and, in this example, has left the healthcare professional unable to justify what happened to Roger. These tools remove or reduce these risks when supporting people who lack the mental capacity to make specific health, care decisions, and improve patient care.