Issues related to the consent process continue to represent a regular feature in claims experienced in NHS Wales. To support organisations in providing information to patients, the Welsh Risk Pool has funded the provision of a library of internationally authored and indemnified consent information for over ten years.
The Welsh Risk Pool supports organisations to comply with regulatory and best practice guidance through the Decision Making and Consent Programme - which recognises that effective dialogue between healthcare professionals and patients is crucial for safe and effective decisions making.
During 2023/24, the programme has undertaken a series of work streams with the implementation of a new e-learning package and consent webinar programme, along with the introduction of a peer review assessment - which underlines the importance of shared decision making, providing practical guidance to inform and improve clinical practice. Further training will be developed, and further resources will be put in place to increase understanding of the legal framework for decision-making provided by the Mental Capacity Act. Thematic concerns about end-of-life decision making raised by the Medical Examiners' Service and HM Coroners continue to highlight the need to improve clinical decision making.
All Wales Consent Group
The improvement programme is underpinned by the All-Wales Consent to Examination and Treatment Group, which has representation from all health bodies. This national group has been established to:
Library of Consent Information Leaflets
The Welsh Risk Pool funds access for all clinicians in Wales to a library of consent information, which is available via an electronic download centre. The library is maintained and updated by the provider EIDO Healthcare, who also provide indemnity in relation to the information contained in the leaflets. The WRP requires organisations to ensure that either EIDO procedure specific patient information leaflets (where available) or procedure-specific patient information leaflets produced by recognised professional bodies or other national bodies, are provided to patients receiving NHS care. Claims relating to consent issues where appropriate information has not been shared with patients may not be reimbursed.
Provision of consent information through the medium of Welsh is an important aspect of the programme. The EIDO download centre provides every available leaflet in a bilingual Welsh / English format and a wide range of other languages are available. Leaflets are available in other accessible formats, such as large print. A number of key leaflets are also provided in EasyRead format – specifically designed for service users with neurodiversity conditions.
During 2023/24, the Welsh Risk Pool has worked with the library provider and the Welsh Endoscopy Collaborative to review and update a number of consent information leaflets for endoscopic procedures. Key updates include an explanation of shared decision making, more detail on general anaesthesia and new complications. The Collaborative will continue to review the whole endoscopy library and introduce new documents where required. A new platform for the Decision Making and Consent library will shortly be introduced which will also enable organisations to submit locally-produced and approved consent information leaflets into the library – meaning that clinicians can access approved consent information from a single source.
Learning and Development in Consent
The Welsh Risk Pool has developed a bespoke e-learning package for NHS Wales healthcare professionals involved in the consent process. This was introduced into the main learning management systems used in Wales (ESR and Learn@Wales) and was launched by the Cabinet Secretary for Health and Social Services. The training has been very well received by the clinicians who have completed the e-learning package, who report that it is clinically relevant as it is delivered by Welsh clinicians and complements current national and regulatory guidance.
Webinars are now being held regularly on various topics in relation to consent. During 2023/24 these included the topics "Informed Consent - Getting it Right" and “Decision Making and Consent - No decision about me without me”. The webinars always generate considerable interest and discussion regarding the topic and facilitate participants to communicate with speakers during and after the session.