Consent and reflection policy (termination of pregnancy)

1. What the regulation says

Care and treatment of service users must only be provided with the consent of the relevant person. (Regulation 11(1))

The full text of Regulation 11 is at https://www.legislation.gov.uk/uksi/2014/2936/regulation/11. Where this policy and the regulation diverge, the regulation wins.

The provider's separate statutory termination obligations sit in the Abortion Act 1967, the Abortion Regulations 1991 (HSA1/HSA4 certification and the register of terminations) and the Care Quality Commission (Registration) Regulations 2009, Regulation 20, which requires that, unless two certificates of opinion have been received in respect of the service user, no termination of pregnancy is carried out and no fee is demanded or accepted from a service user (Reg 20(2)). Recent legislative changes may affect the criminal-law position for women in England and Wales who end their own pregnancies. Providers must verify the current primary legislation before publishing any patient-facing wording. This does not alter the provider's obligations under the Abortion Act 1967, the Abortion Regulations 1991, the HSA1/HSA4 process or the CQC Registration Regulations unless primary legislation says so.

2. Plain-English summary

You can only provide care or treatment with the consent of the relevant person. If the service user is 16 or over and lacks capacity, follow the Mental Capacity Act 2005. If Parts 4 or 4A of the Mental Health Act 1983 apply, follow that instead. Section 5 of the MCA (acts done in connection with care or treatment) still applies underneath.

For termination of pregnancy, consent is held to a higher communication standard than most clinical procedures because of the gestational-age dependency, the statutory framework, and the particular sensitivity around coercion and capacity.

3. Purpose

This policy sets out how the Service obtains valid, voluntary, informed consent for termination of pregnancy and how it manages reflection time and capacity assessment.

Termination consent is held to a higher communication standard than most clinical procedures because of the gestational-age dependency, the statutory framework, and the particular sensitivity around coercion and capacity.

4. Scope

This policy applies to:

• All patients presenting for a termination consultation, whether medical or surgical pathway.
• Patients aged 16 and over (presumed competent to consent).
• Patients aged under 16 (Gillick-competence assessment required, see section 10).
• Patients where capacity is in question for any reason (cognitive, mental health, intoxication, language).
• Consent for the termination itself plus consent for any incidental procedures (anaesthesia, follow-up imaging, blood testing, contraceptive provision, tissue retention).

Before adoption, the Service must insert its current treatment pathways, approved patient information, consent and HSA1 forms, named safeguarding route, interpreter arrangements, record location and staff authorisation process. Remove any pathway or role the Service does not provide.

5. Roles and responsibilities

• Registered Manager: owns the consent system, makes sure the approved pathway is followed and ensures audit actions are completed.
• Clinical lead: approves patient information, confirms who is competent to take consent, reviews complex capacity or coercion cases and leads clinical audit.
• Clinician taking consent: gives current pathway-specific information, checks understanding and voluntariness, assesses capacity where indicated and completes the consent record.
• Safeguarding lead: advises on suspected coercion, exploitation or abuse and records the safeguarding decision and referral route.
• Administrative staff: may arrange appointments and provide approved information, but must not answer clinical consent questions or present booking attendance as agreement to treatment.
• All staff: must stop and escalate if consent is unclear, withdrawn or appears to have been obtained under pressure.

6. Operational consent procedure

1. Confirm the person and proposed pathway. Use the Service's identity checks, confirm gestational age and establish which treatment and incidental procedures are being considered.
2. Give current information. Explain what will happen, material risks, expected effects, alternatives, aftercare and how to obtain urgent help, using communication support where needed.
3. Check understanding and capacity. Invite questions, ask the patient to explain the decision in their own words and complete a decision-specific capacity or Gillick-competence assessment where indicated.
4. Check that the decision is voluntary. Give the patient an opportunity to speak without an accompanying person and follow the safeguarding route if coercion or exploitation is suspected.
5. Offer reflection without imposing delay. Record the time offered, whether the patient wants more time and any later conversation. No mandatory cooling-off period is created by this policy.
6. Record consent and complete the statutory pathway. Complete the consent record and any separate HSA1 certification steps required for the pathway. A signed form does not replace the conversation.
7. Reconfirm before treatment. Immediately before treatment, check that the patient still agrees and that the planned procedure matches the consent record. Stop if consent is withdrawn or becomes unclear.

7. The consent conversation

A trained clinician conducts the consent conversation. The discussion covers:

• The patient's gestational age, confirmed by ultrasound where clinically indicated.
• The available treatment pathways at the patient's gestational age (medical, surgical, or both).
• The procedure for each pathway: what happens, where, by whom, how long.
• Material risks of each pathway, including the risk of incomplete termination and continuing pregnancy.
• Likely physical experience during and after the procedure.
• Alternatives, including continuing the pregnancy and the support routes for each alternative.
• Aftercare, follow-up, and how to access urgent help if complications arise.
• Contraception options for the future.

The clinician answers the patient's questions. The Service does not impose a minimum number of conversations; one conversation is sufficient if the patient is clear, but the patient may take additional reflection time at their request (section 8).

8. Reflection time

The Abortion Act 1967 does NOT impose a statutory cooling-off period. The Service's policy is to:

• Offer the patient as much reflection time as they want, including overnight or longer.
• Never pressure a patient to confirm a decision in the consultation.
• Document the reflection offered and the patient's choice on the consent record.

Where the patient explicitly states they have already reflected and want to proceed, the Service does not require an artificial delay. Adding a delay against the patient's wishes is itself a violation of patient autonomy.

9. Capacity assessment

Capacity is assumed in adults aged 16 and over unless there is reason to believe otherwise (Mental Capacity Act 2005, sections 1 to 3).

Where capacity is in doubt, the assessing clinician documents:

• The specific decision being assessed (capacity is decision-specific, not blanket).
• The information given to the patient.
• Whether the patient can understand, retain, weigh, and communicate the decision.
• The conclusion (capacity / no capacity for this decision).

If the patient is assessed as lacking capacity for this decision, the termination cannot proceed on the basis of their consent. The Service follows the best-interests pathway under the Mental Capacity Act 2005 and consults with the patient's representatives or seeks judicial input where appropriate. The Service's clinical lead is involved in every such case.

10. Patients under 18

10.1 Patients aged 16 and 17

Presumed competent to consent. Parental involvement is encouraged but not required. The Service applies the same consent standard as for adults. Safeguarding considerations may still apply (see safeguarding policy).

10.2 Patients aged under 16

For under-16s, the clinician must assess Gillick competence for the specific decision. Fraser principles may be relevant where contraception or sexual-health advice is involved, but they must not be applied mechanically as a substitute for a full Gillick competence assessment, safeguarding assessment and termination-specific consent process. The assessing clinician documents:

• whether the patient understands the information, the proposed treatment, the alternatives and the consequences, and can retain, weigh and communicate that decision (Gillick competence for this specific decision)
• the safeguarding assessment, including any indication of coercion, exploitation or abuse
• whether the patient has been encouraged to involve a parent or another trusted adult, and their response
• the termination-specific consent discussion and the reflection opportunity offered
• the outcome and any onward referral or support

Where Gillick competence is not established, or a safeguarding concern arises, the Service does NOT proceed on the patient's sole consent and follows the safeguarding pathway under Working Together to Safeguard Children 2026 and local safeguarding children procedures.

10.3 Patients under 13

Patients under 13 are not legally able to consent to sexual activity. Any patient presenting under 13 is referred under the child-safeguarding pathway in the safeguarding policy. The clinical question is then secondary to the safeguarding response.

11. Coercion screening

Every consent conversation includes screening for coercion or pressure from a partner, family member, or third party. The Service's clinicians are trained to:

• Ask the question directly when there is any cue.
• Provide an opportunity for the patient to be seen alone if accompanied.
• Recognise non-verbal cues of pressure (eye contact, body posture, who answers questions).

Where coercion is disclosed or suspected, the safeguarding policy applies.

12. Information provision

The Service provides written information to the patient covering:

• The treatment pathways available at the patient's gestational age.
• Material risks of each pathway, with comparative figures where reliable data exists.
• Aftercare and follow-up.
• Contraception options.
• Patient confidentiality and data protection (see separate policy).
• How to access urgent help if complications arise after discharge.

Patient-facing written information is reviewed annually by the Service's clinical lead and is updated whenever clinical evidence or regulatory guidance changes.

13. Documenting consent

The consent record includes:

• The clinician who took consent and their professional registration number.
• The gestational age confirmed.
• The pathway consented to.
• The risks discussed, in summary.
• The reflection time offered and chosen.
• The capacity assessment outcome.
• The Gillick competence assessment outcome (where applicable).
• Any coercion screening result.
• The patient's signature.

Consent records are retained per the Service's records retention policy and the Abortion Regulations 1991 retention requirements.

14. Training

All clinicians taking consent for termination complete:

• Induction training on Abortion Act statutory grounds.
• Annual refresher on Mental Capacity Act 2005 plus Gillick competence and consent for under-18s.
• Coercion screening communication training (initial plus biennial refresher).

15. Audit and monitoring

The clinical lead audits consent records monthly. The sample includes every case involving a patient under 16, a capacity concern, suspected coercion or withdrawn consent, plus 10 other completed pathways or all completed pathways if fewer than 10 occurred.

The audit checks that information matched the pathway, material risks and alternatives were discussed, reflection was offered, voluntariness and capacity were considered, consent was reconfirmed and the clinician was authorised. It identifies the staff member responsible for each correction and sets a due date. Findings are reviewed by the Registered Manager and recorded in the governance action plan. Overdue actions, repeated omissions or a concern that consent was not valid are escalated immediately. Closure requires evidence that the change was made and a follow-up sample showing that it worked.

After three consecutive monthly audits meet the Service's agreed standard, the routine-record sample may move to quarterly. Exception cases remain subject to monthly review.

16. Review

This policy is reviewed at least annually and whenever GMC consent guidance, RCOG best-practice guidance, or the Abortion Act 1967 materially changes.

17. Related policies in this pack

• Patient confidentiality and data protection policy
• Statutory notification policy for HSA1 and HSA4
• Medication safety policy for termination care
• Safeguarding children policy
• Mental Capacity Act policy

18. Sources and further reading

This template is based on CQC's guidance for providers and managers, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and other topic-specific legislation and guidance listed below. It is a starting point for adaptation, not a substitute for legal, clinical, HR, safeguarding or specialist professional advice.

• CQC Regulation 11: Need for consent
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (https://www.legislation.gov.uk/uksi/2014/2936/regulation/11)
• Abortion Act 1967: https://www.legislation.gov.uk/ukpga/1967/87
• Abortion Regulations 1991 (HSA1/HSA4 certification and the register of terminations)
• Care Quality Commission (Registration) Regulations 2009, Regulation 20 (requirements relating to termination of pregnancies; certificates of opinion, register and notifications)
• Recent changes to the criminal law on ending one's own pregnancy in England and Wales (verify against current primary legislation before publishing patient-facing wording; provider obligations under the Abortion Act 1967, the Abortion Regulations 1991, HSA1/HSA4 and the CQC Registration Regulations are unchanged unless primary legislation says otherwise)
• GMC, Good Medical Practice 2024: https://www.gmc-uk.org/professional-standards/good-medical-practice-2024
• GMC, Decision making and consent: https://www.gmc-uk.org/professional-standards/the-professional-standards/decision-making-and-consent
• GMC, 0-18 years: guidance for all doctors: https://www.gmc-uk.org/professional-standards/the-professional-standards/0-18-years
• Royal College of Obstetricians and Gynaecologists, Best practice in abortion care: https://www.rcog.org.uk/guidance/browse-all-guidance/other-guidelines-and-reports/best-practice-in-abortion-care/
• Mental Capacity Act 2005: https://www.legislation.gov.uk/ukpga/2005/9
• MCA Code of Practice (2007, update in consultation)
• Montgomery v Lanarkshire Health Board [2015] UKSC 11: https://www.supremecourt.uk/cases/uksc-2013-0136.html
• Gillick competence (and Fraser guidelines, where contraception or sexual-health advice is involved)
• Human Rights Act 1998, Article 8 (respect for private and family life) where relevant
• Working Together to Safeguard Children 2026; local safeguarding children procedures (for patients under 18)
• NHS, "Consent to treatment: children and young people": https://www.nhs.uk/conditions/consent-to-treatment/children/

19. When to seek further advice

Seek specialist advice where the issue involves serious harm, safeguarding, deprivation of liberty, restraint, children, professional misconduct, controlled drugs, radiation, termination of pregnancy, infection outbreak, water safety, employment dismissal, DBS barring referral, or regulatory enforcement.

20. Document control

This sample policy template was issued by Verivius. It is a template, not a substitute for legal advice or the provider's own policy-development process. Where this template and live law or regulator guidance diverge, the live source wins.