Published May 2025
Overview
Decisions about taking people with cognitive impairments to hospital can be complex. They involve thinking about the person’s own ability to make decisions. For instance:
- Does the person understand the need for medical treatment?
- Can they weigh-up the risks of refusing admission or treatment?
- How can they be supported to access the medical treatment they need if their refusal is not based on an appreciation of how serious their condition is?
- If they do not have the ability to make their own decisions about medical treatment, when is it right to use force or sedate someone to ensure that they receive potentially life-saving medical care?
What this guide is about
This guide originated from evidence which demonstrates that practitioners struggle to make these decisions and focuses on issues of supporting people under the Mental Capacity Act (MCA), not the Mental Health Act – who are assessed as unable to make their own decision to be conveyed to hospital for physical treatment, and require a decision to be made, in their best interests.
The focus of this guide is to support both the individual when they are at the centre of decisions relating to conveyance to hospital, and the practitioner responsible for arranging, or undertaking, conveyance of the individual. It also looks to address potential health inequalities where individuals have been known to die from preventable conditions because professionals have not used the MCA, correctly.
While this guide discusses implementation of the MCA, we would always advise that you seek legal advice if you are unsure and experience complex situations that involve refusal to attend hospital, where possible.
How this guide was created
We created this guide with the Stop People Dying Too Young (the LeDeR programme) – Inclusion North group as it is important that the people affected shape best practice.
We also held wide-ranging discussions with social workers, paramedics, care providers, nurses, advocates and family members to identify the key areas addressed in this guide.
Who this guide is for
This guide is for individuals with a cognitive impairment and that may draw on care and support, their families and health and social care practitioners. It may be used to forward plan and help in situations when an individual may need conveyance to hospital.
Thanks and acknowledgements
We would like to thank the following, and everyone who attended our roundtable discussions. This guide could not have been created without your invaluable views and discussions.
Stop People Dying Too Young Group, Victoria Butler-Cole KC, Nicola Kohn, Alex Ruck Keene KC (Hon), Ian Brownhill, Edd Bartlett, Rachel Snow-Miller, Ben Troke, Yvonne Taylor, Chelle Farnan, Anneliese Hillyer-Thake, Larisa Wood, Julie Hall, Helen Edwards, Jamie Stone, Leanne Gelder, Pippa Johnson.