Parental Responsibility Policy

Children must be accompanied to appointments by someone with Parental Responsibility

We require a parent or someone with parental responsibility to be present with a child in any appointment unless they are over 13 and have maturity and capacity to be able to attend and understand a consultation on their own.

Without a court order parental responsibility cannot be transferred to others, including nannies, grandparents, siblings, aunts, personal assistants. They are welcome to attend with the person who has parental responsibility.

Gillick Competency and Fraser Guidelines

The reasons we require a person with parental responsibility to be present are:

1. A child under 13 cannot legally consent to any treatment including examination and prescribing as this requires parental consent. This means we cannot do anything unless a parent/ someone with parental consent is present.
2. To help with providing the medical history.
3. To help support managing any condition including when to come back or seek alternative help.
4. To provide reassurance to the parent.

Please do not book any appointments for children unless the person with parental responsibility is able to attend. Anyone else involved in your child’s care is also welcome to attend if desired.

Please only book an appointment for a child if you have assessed them and deem it necessary, ie not at the request of school/nursery, without having seen the child yourself.

Appointments for children should be in person as they will usually need to be examined, ie for a fever or sore throat. If your child has a rash that is likely to be an infection (ie not eczema) you may be asked to wait apart from other patients.

We would be concerned if a child who does not meet the consent requirements attends alone.

Children and consent

• All children 11 and under must be accompanied by a parent/someone with parental responsibility
• Children between 12 and 16 may attend alone if they are deemed by the parent to be mature and responsible enough to understand and retain information from a consultation and to consent to any procedures and treatment.

When is consent required?

For any assessment and treatment including any examination or procedure (except certain emergencies). Please see the NHS website for further information

What is valid consent?

For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.

The meaning of these terms are:

• voluntary: the decision to either consent or not to consent to treatment must be made by the person, and must not be influenced by pressure from medical staff, friends or family
• informed: the person must be given all of the information about what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment does not go ahead
• capacity: the person must be capable of giving consent, which means they understand the information given to them and can use it to make an informed decision

If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected.

This is still the case even if refusing treatment would result in their death, or the death of their unborn child.

If a person does not have the capacity to make a decision about their treatment and they have not appointed a lasting power of attorney (LPA), the healthcare professionals treating them can go ahead and give treatment if they believe it's in the person's best interests.

But clinicians must take reasonable steps to discuss the situation with the person's friends or relatives before making these decisions.

Further information is available on the NHS website

Who has consent?

All adults are assumed to have consent unless they are unable to provide it for medical or psychological or cognitive rare reasons.

Children under the age of 16 can consent to their own treatment if they're believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment. This is known as being Gillick competent.

Otherwise, someone with parental responsibility can consent for them.

This could be:

• the child's Parent (as below)
• the child's legally appointed guardian
• a person with a residence order concerning the child
• a local authority designated to care for the child
• a local authority or person with an emergency protection order for the child

Consent cannot be transferred otherwise to anyone else ie nannies, grandparents, siblings, aunts.

Further information can be found on the NHS website

Which Parent(s) have Parental responsibility?

A mother automatically has parental responsibility for her child from birth.

Unless they did not give birth to the child, then they must apply for a parental order or adoption if you want to become the legal parent of the child.

A father usually has parental responsibility if he’s either:

• married to the child’s mother
• listed on the birth certificate (after a certain date, depending on which part of the UK the child was born in)

You can apply for parental responsibility if you do not automatically have it

Further information can be found on the government's website

For the above reasons the person with parental needs to be present at the time of the assessment to be able to provide valid consent on behalf of the child.