Accessible Information and Informed Consent in Adult Social Care
Informed consent is a legal and ethical requirement, yet in practice it is often undermined by inaccessible communication. Within communication, accessible information and total communication, consent is only valid when people can genuinely understand, weigh up and express decisions. This expectation sits at the heart of the core principles and values that underpin person-centred care.
When information is presented in formats people cannot process, consent becomes procedural rather than meaningful. This exposes providers to safeguarding risk, capacity challenges and regulatory scrutiny.
Why accessible information is essential for valid consent
Accessible information ensures that consent is:
- Informed, not assumed
- Specific to the decision being made
- Revisitable and reviewable over time
- Clearly evidenced in records
Consent must be seen as a process, not a signature.
Operational example 1: consent for personal care routines
Context: A provider relied on generic consent statements within care plans. Staff assumed consent remained constant, even when routines caused distress.
Support approach: The service introduced accessible explanations of personal care tasks using images, simple language and demonstration.
Day-to-day delivery detail: Before support, staff explained what would happen using visuals and checked understanding through response and behaviour. Consent or refusal was recorded daily, not assumed.
Evidencing effectiveness: Reduced distress during care, clearer records of consent, and fewer complaints from families about feeling excluded from decision-making.
Operational example 2: medication and health decisions
Context: Consent for medication was documented once, despite changes in medication type and side effects.
Support approach: Accessible medication information was developed using pictures, simplified explanations and supported discussion.
Day-to-day delivery detail: Staff explained changes in medication using accessible formats and observed understanding. Where understanding fluctuated, best interest processes were triggered appropriately.
Evidencing effectiveness: Improved compliance, clearer mental capacity assessments, and stronger links between consent, capacity and best interest decisions.
Operational example 3: consent during periods of distress
Context: During distress, staff struggled to distinguish refusal from lack of understanding.
Support approach: Individual communication indicators for refusal and assent were identified and recorded.
Day-to-day delivery detail: Staff paused interventions, used simplified communication and revisited decisions once distress reduced. Supervision reinforced that consent could be withdrawn.
Evidencing effectiveness: Reduced use of restrictive practices and improved safeguarding outcomes.
Commissioner expectation
Commissioner expectation: Commissioners expect providers to evidence how consent is gained, reviewed and re-confirmed using accessible communication, particularly where capacity fluctuates or risk is involved.
Regulator expectation (CQC)
Regulator / Inspector expectation (CQC): The CQC expects consent processes to be person-centred and accessible. Inspectors will test whether people understand decisions and whether staff can explain how consent is obtained and reviewed.
Governance controls that protect consent
- Accessible consent records linked to specific decisions
- Capacity assessments informed by communication needs
- Audits that test understanding, not just signatures
- Supervision that challenges assumptions about consent
Accessible information transforms consent from a compliance exercise into a genuine expression of choice and autonomy.