Experience Summary

In this experience, watch as the team perform a ward round of two patients. This ward round covers issues such as an Adults With Incapacity (AWI) form and discussion of sexually transmitted infections.

Adults With Incapacity

Within NHS Scotland, healthcare staff may encounter patients who are unable to make or communicate a decision about their healthcare. The Adults with Incapacity (Scotland) Act 2000 provides a legal framework for supporting these patients. The key principles are that any intervention should benefit the individual, take account of their wishes and feelings, and be the least restrictive option available. Staff should always presume capacity unless there is evidence that the patient cannot make the specific decision at the relevant time.

There are several AWI forms, depending on the legal action required. AWI 1–10 are used in applications for intervention or guardianship orders. Guardianship can provide authority for another person to make specific welfare or financial decisions on behalf of an adult who lacks capacity. Applications are made through the sheriff court and require appropriate supporting reports. AWI 11–13 relate to ending guardianship, while AWI 14–19 can be used in circumstances involving challenges or removal of welfare guardianship.

For NHS staff providing medical treatment, Section 47 of the AWI Act is particularly important. Where an adult lacks capacity to consent to non-emergency medical treatment, an authorised healthcare professional can complete a Section 47 certificate. Staff must assess capacity, consider the principles of the legislation and, where appropriate, consult with a welfare guardian, attorney or other relevant person before treatment.

Sexually Transmitted Infections

Confidentiality is also essential when managing sexually transmitted infections (STIs). NHS sexual health services provide confidential testing and treatment. A patient's GP is not normally informed without permission. Patients should be encouraged and supported to notify sexual partners following an STI diagnosis. If a patient does not wish to contact a partner themselves, they can provide partner details to the sexual health service, which may contact the partner anonymously without identifying the patient.

For NHS staff, the important principle is to maintain confidentiality while managing risks to public health. Information should only be disclosed without consent where there is an appropriate legal or public-interest justification, such as certain statutory notifications or a serious risk of harm. Any disclosure should be proportionate and limited to the information necessary.

In practice, NHS staff should assess capacity, obtain valid consent where possible, maintain confidentiality, document decisions clearly, follow local NHS policies, and seek advice from senior clinicians or appropriate specialist services when legal or safeguarding issues arise.

Learning Outcomes

1. Observe a ward round and note the issues that arise as part of the ward round.
2. Understand the legalities of patients receiving an STI diagnosis.
3. Understand the issues relating to confidentiality for a patient diagnosed with an STI.
4. Understand the legalities of a patient who does not have the capacity to consent to treatment.
5. Understand the components of a capacity assessment.

External Resources

• Adults with incapacity: code of practice for practitioners - NHS Scotland
• HIV and Sexually Transmitted Infections (STIs) - NHS England