Gillick competence, young people's consent and healthcare boundaries

In England and Wales, Gillick competence describes whether a child under 16 has sufficient understanding and intelligence to make a specific decision about their care. It applies to the particular choice being made, not as a blanket label. NHS guidance also explains that many 16 and 17 year olds can usually consent to their own treatment. In practice, homes staff should not assume a parent automatically decides every health issue for an older child, or for a younger child who does understand the matter.

Homes staff are rarely the clinicians who make final decisions about treatment. This is why role boundaries matter. Staff should understand the principle, help the young person have their views heard, record the discussion clearly and escalate to the appropriate health professional, manager or social worker when needed.

Serious refusal or disputes about treatment are not matters to resolve on shift. If a young person's refusal, a parent's refusal or disagreement between adults could lead to serious harm, obtain urgent clinical, social work or legal advice. In an emergency, health professionals may act to protect life and prevent serious harm.

Frontline points to remember

• Under 16 decisions may still depend on the child's competence and understanding.
• Many 16 and 17 year olds can make their own treatment decisions.
• Homes staff should not dismiss a child's view because of age alone.
• High-stakes refusal or disagreement requires urgent escalation.
• Disputed or complex health decisions should follow the correct professional route.
• Privacy around health conversations remains important.

Manager focus: staff should not overreach

Knowing about Gillick competence should make staff more cautious and respectful, not more confident about making complex decisions alone.