Do we care enough about consent?

This leaflet is widely available to patients in NHS Scotland including in the waiting room outside my consulting room:



Its first page defines consent as follows:



This is the front page of the current BMJ:



It is reporting on a legal ruling which has implications for consent as summarised by the editor:






Previously Sokol has said:



I have had a longstanding interest in consent:



Consideration of patient consent goes back to the earliest days of the NHS (and indeed before):


I have previously highlighted how this difficult area becomes even more complex when we are considering cognitive screening:



Scotland led the way with an incentivised target-based approach to the “early diagnosis” of dementia. The following is from one of the earliest expert meetings:

First Dementia Strategy Meeting

A few years later the Scottish Government were sharing widely league tables:



The Scottish Government commended its own approach to the Westminster Government:


How to improve




Geoff Huggins3


It was this robust approach that led me to consider whether the consent to assessment of the individual patient might be significantly affected by an external target. It was at this stage I contacted the National Clinical Leads for dementia, specifically highlighting my concerns about consent:

Dementia Leads1


The Scottish Lead for Dementia replied:

Dementia Leads2


I was delighted to attend this Conference in Glasgow which culminated in the signing of a rights-based approach to dementia:




At this Conference, the Chief Executive of the Mental Welfare Commission gave an address. Mr Colin McKay reminded us that for any individual deemed to lack capacity certain principles should apply. This includes having one’s own wishes listened to:



The previous Chief Executive of the Mental Welfare Commission offered his personal view on consent to examination. For many reasons I believe that cognitive screening is a very different activity to measuring blood pressure:



I have also been in conversation with parliamentarians regarding consent to cognitive screening. In my letter to Dr Simpson, MSP, I highlighted the following points:

  • my concerns are specifically about obtaining consent to cognitive screening
  • Cognitive screening does not fulfill World Health Organisation criteria (Wilson & Jungner)
  • the UK National Screening Committee do not advise screening for cognitive impairment


Richard Simpson2


This is the view of the former Cabinet Minister for Health & Wellbeing:

At liberty


I have also asked the UK’s leading Dementia charities about consent:



I have recently written to Alzheimer Scotland about their current campaign: “Lets talk about dementia”. Disappointingly this appears to have back-tracked from the Glasgow Declaration and is advocating early rather than timely diagnosis. The “difficult conversation” as suggested by Alzheimer Scotland appears to me to trivialize consent:



I have also had a number of “difficult conversations” when trying to raise issues of consent:

Dr Brian Robson


One of the many reasons why this matters is that cognitive screening is not risk-free.

046   047

Off-label anti-psychotic prescribing has increased year-on-year in the elderly across Scotland.

It is my view that those promoting improvement methodologies in NHS Scotland are currently not taking consent sufficiently seriously. It appears that I am not alone in having found these conversations “difficult”:


The following post was about improvement work in the elderly on the Ayrshire Health blog. The full post and all responses to it can be read here:

Flying without wings1

I submitted a reply which outlined my considerations about obtaining consent for cognitive screening. In response to my considerations, the Associate Nurse Director of Mental Health Services in NHS Ayrshire and Arran and Chair of the Mental Health Nursing Forum Scotland, appeared to remain unsure of the basis of my concerns:

Flying without wings2

Professor June Andrews, Director of the Dementia Services Development Centre offered the following advice:

June Andrews3


A service user shared my concerns about patient consent and raised the matter with the Ethics Committee of the Royal College of Psychiatrists:

John Sawkins


Over a decade ago, NHS Scotland published this Expert Group report:

Adding life to years, 2002 a

Adding life to years, 2002 c

Ageism in NHS Scotlandc

This blog post asks if we care enough about consent?
My view is that the principle of patient consent should be a fundamental right for all ages. It is the case that consent is a complex area but this is not a good enough reason for marginalising it. I would argue strongly that wider discussion particularly involving all of our elders is long overdue.

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