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Table 1 Obtaining third-party consent for residents without capacity in the three devolved home countries

From: Protocol for a cluster randomised controlled trial to determine the effectiveness and cost-effectiveness of independent pharmacist prescribing in care homes: the CHIPPS study

England and Northern Ireland
A letter will be sent to the supporting relative/friend/potential consultee from the GP, enclosing the Information Sheet and Advice Form for signature. The Information Sheet explains the study and asks if, in their opinion, their friend/relative would have wanted to participate, if they had been able to decide this for themselves, and, if they felt that their friend/relative would have participated, would they be willing to act as consultee and give permission on their friend/relative’s behalf? The potential consultee is asked to complete an Advice Form and send it back within 2 weeks. If there is no response within 2 weeks, another similar letter is sent, asking for return of the completed Advice Form within 1 week, stating that, if this not returned the care home will assume that the friend/relative cannot be a consultee and will then identify someone for this role from within the care home; this person will not be the care home manager and will be completely independent of the study.
Capacity to consent is described in the Mental Capacity Act 2005 [24] and involves using personal and nominated consultees. The assent process is consistent with Alzheimer Europe Ethics of Dementia Research [25] and has the support of Alzheimer’s UK. In Northern Ireland there is currently no primary legislation on capacity (according to the General Medical Council) and so decisions about medical treatment and care when people lack capacity must be made in accordance with the common law, which requires decisions to be made in a person’s best interests. Therefore, in Northern Ireland, the procedures used in England will be used.
The letter requesting permission, on behalf of the resident, will be sent to the resident’s Welfare Power of Attorney (WPoA), along with the Information Sheet and Consent Form. If there is no response within 2 weeks, another similar letter is sent. If the WPoA returns the signed Consent Form, then the resident will be recruited into the study. If the WPoA does not return the Form, the resident will not be recruited.
In Scotland, capacity to consent is described in the Adults with Incapacity Act (Scotland) 2000 [26] and involves a WPoA who is able to give consent.