Effective · KLOE 4

Consent to care and treatment

Are people supported to understand and exercise their right to consent to care, support and treatment?

In brief

Consent to care and treatment is key line of enquiry 4 under the Effective key question in the Care Quality Commission (CQC) draft adult social care assessment framework (v9, 19 March 2026), currently published for consultation. It covers consent, advocacy and support, communicating rights, mental capacity act 2005. CQC describes performance against it at four rating levels: Outstanding, Good, Requires improvement and Inadequate. Each statement and rating characteristic quoted here is reproduced verbatim from CQC's draft; plain-English summaries are HLTH's own.

Key question: Effective
Line of enquiry: KLOE 4 of 4 under Effective
Rating levels: Outstanding, Good, Requires improvement, Inadequate
Source: Adult social care assessment framework, v9 (19 March 2026)
Status: Draft, published by CQC for consultation
Reference: pp. 29–32 of the CQC draft

Scope and topic areas

What this line of enquiry covers

Scope of this key line of enquiry and topic areas include:

Consent
Advocacy and support
Communicating rights
Mental Capacity Act 2005

Rating characteristics

How CQC describes each rating

The four characteristic sets for this KLOE, best to worst. Every point is CQC's wording, reproduced exactly.

Outstanding

In plain terms: Care is exceptional and consistently better than the Good standard.

Staff and leaders demonstrate exceptional skill and creativity in obtaining consent. Staff creatively overcome barriers where language, age, disability or other factors (including protected equality characteristics) make this challenging.
People experience consent as a collaborative and empowering process.
Consent practices are proactively monitored, reviewed, and improved. This process is informed by evidence, including learning from practice, relevant case law, good practice guidance and feedback from people.
Innovative approaches are used to involve people in decisions and communicate their rights. Tools and support for informed decision-making are co-developed with stakeholders, including people who use the service, those close to them and advocates.
The service goes above and beyond to maximise people’s decision-making capacity. Staff at all levels actively champion and advocate for the rights of people who lack capacity, so that their involvement in decision making is prioritised and decisions genuinely reflect what matters most to them.
The involvement of advocates is consistently promoted and positively welcomed. Gaps in advocacy are proactively anticipated. Where sources of information, advocacy and support are not readily available, the service works with appropriate partners to try to address this.

Good

In plain terms: The service meets the expected standard.

People are supported to understand their rights to consent to care, support and treatment, including the right to independent advocacy. They understand they have the right to change their mind and withdraw their consent and staff respect this.
Staff know the importance of consent and relevant legal requirements. They make sure people understand what they are consenting to before they deliver care, support or treatment. People are given the appropriate information, support and time they need to make an informed decision.
People’s rights are communicated in a way that meets their communication needs. This includes their human rights, rights under the Mental Capacity Act 2005 -, their rights under the Equality Act 2010 and any other relevant legislation. These rights are promoted and protected.
There is a clear understanding of the requirements of the Mental Capacity Act 2005 and guidance relating to capacity and consent, and staff demonstrate how they put these into practice effectively. People are supported to understand information, communicate and make decisions about their life, care, support and treatment in line with the Mental Capacity Act 2005, involving their representatives and advocates when needed.
Staff actively consider whether people have the mental capacity to give consent. If there is a reason to doubt the person has capacity, assessments are completed in line with legal requirements and recorded.
The service makes lawful decisions in people’s best interests when required. People are involved and their feelings, beliefs and values are considered. Those close to the person and their advocates are involved and kept informed of any changes as appropriate.
People are supported to access independent advocacy, including statutory or non-statutory when available, and advocates are appropriately involved by the service.
The service identifies gaps where people who lack capacity don’t have the required support and staff escalate this to the relevant agencies.
The service is clear and transparent with people about the cost of their care, support and treatment. People know how much they are expected to pay and what the service provides for this.

Requires improvement

In plain terms: The service is not yet Good and has areas that must improve.

People are not always made aware of their rights around consent or are not fully supported to understand what they are consenting to. People are not consistently supported and enabled to give consent.
Staff do not always seek consent to deliver care, support and treatment when required; staff do not fully understand the importance of consent or relevant requirements.
People’s rights are not communicated consistently or in formats that meet their communication needs, which means some people do not fully understand their rights.
The service does not always assess people’s mental capacity to make specific decisions when appropriate, or practice and assessments do not meet legal requirements. Understanding of the requirements of the Mental Capacity Act 2005 is inconsistent.
Best interests decision making processes do not always meaningfully involve people or consider their feelings, beliefs and values. People’s representatives, others close to them and advocates are not always appropriately involved or informed.
People are not consistently supported to access independent advocacy, or the service involves advocates inconsistently or superficially.
The service does not consistently give people clear or accurate information about the cost of their care or other terms and conditions.

Inadequate

In plain terms: Performance is well below the expected standard; enforcement may follow.

The service does not ensure that it obtains people’s consent to care, support and treatment, or it does not appropriately support people to give valid consent. Staff are unclear about the requirements relating to consent.
Consent to care, support and treatment is not obtained in line with legislation and guidance, including the Mental Capacity Act 2005. Staff do not understand existing legal requirements.
People’s rights are not communicated to them or are communicated in ways they cannot understand.
The service does not ensure that people’s mental capacity is assessed when appropriate. Best interests decisions are not made in line with legal requirements.
Staff do not know what advocacy support is available to people, or if they do, they do not support people in accessing advocacy. The service engages with advocates in a defensive or obstructive way.
The service does not give people transparent information about the costs of their care or other terms and conditions. There can be hidden or unexpected costs for people.

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