Tayside Breast Cancer Independent Advisory Group: final report

Patient centred consent

27. Informed consent was discussed at some length in the Group, both in relation to the 2015 Supreme Court Judgement on Montgomery, and in relation to the extant 2008 GMC guidance on patient consent (see Annex C for references). The Group fully recognises that CMGs are only guidance, and that clinicians are free to deviate from standard practice as defined in the CMG, so long as they are able to justify their decision, follow the due medicines governance process where this is required and record that justification appropriately. The key point in relation to the NHS Tayside breast cancer issue was not that certain medicines were routinely prescribed at lower doses, but that deviation from the practice of other clinicians across the country was not discussed with patients at an individual level. Rather, a "blanket" prescribing policy was applied on a population basis. The Group therefore recommends that, for informed consent to take place, patients must be explicitly informed of any variance from generally accepted standard SACT clinical practice. The risks of treatment should also be discussed and this discussion recorded in the patient's record. (Recommendation 17).

28. The Group noted that a national review of SACT consent is currently underway, aiming to standardise the various documentation currently in use, develop guidance on SACT consent and move to a "Once for Scotland" approach. The Group recommends that all Boards must adopt the standardised approach to SACT consent once guidance is available, to ensure national consistency in documentation of informed consent across Scotland. (Recommendation 18).

29. The Group also feel it is important to acknowledge the work underway in NHS Tayside to support both patients and their family members. This is through a new offer of continued support for their wellbeing, and extended health monitoring, including the offer of independent medical advice from outside NHS Tayside which emerged during the course of the work of this Group. We recommend that NHS Tayside should continue to pursue and prioritise the actions to deliver this (Recommendation 19).