Effective · KLOE 4
Consent to care and treatment
Are people supported to understand and exercise their right to consent to care, support and treatment?
CQC wording, draft v9, pages 29 to 32.
Draft, not the current assessment framework
CQC's adult social care draft v9, dated 19 March 2026. The current quality statements remain in use.
CQC draft scope
What this proposed KLOE covers
Scope of this key line of enquiry and topic areas include:
- Consent
- Advocacy and support
- Communicating rights
- Mental Capacity Act 2005
How would this apply to your service?
The draft applies one framework across adult social care, but useful evidence depends on your service and people.
Source: Adult social care assessment framework, draft v9, 19 March 2026, pages 29 to 32.
HLTH analysis
What this could mean in practice
People should understand and exercise their rights to consent, withdraw consent and participate in decisions about their care.
Information, time, communication support and advocacy should enable informed decisions wherever possible. When capacity is in question, decision-specific assessment and best-interests processes should involve the person and consider their wishes, beliefs and values.
Evidence and conversations to explore
- Consent conversations and communication support
- Capacity assessments and decision records
- Access to advocacy and decision-making support
Questions worth asking
- How does the service confirm that consent is informed and freely given?
- How are communication barriers addressed before decisions are made?
- How are people involved when capacity assessment or best-interests decision-making is needed?
HLTH's interpretation of CQC's 19 March 2026 draft. This is not current CQC guidance, an official interpretation, a checklist or a rating prediction. Reviewed 17 September 2026.
CQC draft rating characteristics
How the draft describes each rating
These are CQC's draft characteristics. CQC says rating characteristics guide judgements, they are not a mechanical checklist.
Outstanding
- 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
- 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
- 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
- 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.
Want to know how your service would fare?
Book a mock inspection run against the draft KLOEs, or call 020 8090 5346 to speak to one of our experts.