NHS patients' rights
This information applies to Scotland
Your rights and responsibilities
Right to a GP
People who are ordinarily resident in the UK, including people from other EEA countries and abroad, have the right to be registered with a General Practitioner (GP) if you live within the GP's catchment area. You can choose which GP you want to be registered with. The GP does not have to accept you. However, if they do refuse to accept you, they must have reasonable grounds for doing so, and must give you their reasons in writing – see under heading Registering with a GP.
For more information on NHS treatment for people from abroad, see NHS charges for people from abroad.
There is also a NHS fact sheet about 'Health care in Scotland for holidaymakers from overseas' on the NHS inform website at www.nhsinform.scot.
Choosing a GP
You can obtain a list of local GPs from your NHS Board. A list of NHS Boards can be found on the NHS inform website at www.nhsinform.scot. The list will contain the following information about each GP:
- surgery address and telephone number
- gender of the GP
- languages spoken by the GP, if the GP agrees this should be included
- particular health interests, if the GP agrees this should be included
- whether the GP does minor surgery
- whether the GP offers contraceptive and/or maternity services
- what the GP’s out of hours arrangements are.
The list may also contain information on whether any alternative therapies are available within the practice. It may also give details of surgery hours, whether there is an appointment system and whether there are any special clinics run at the surgery.
You can also find details of GP practices in Scotland from the national-service-directory on the NHS inform website.
GP practice charters
Some GP practices have established their own practice charters which describe the standards of services a patient can expect and the arrangements for certain services, for example, repeat prescriptions. A practice charter may be displayed in the surgery premises.
If you are unable to find a GP
If you have been unable to find a GP yourself, you can ask your NHS Board to find you a GP. You could also contact the Practitioner Services Department of the NHS National Services Scotland at www.psd.scot.nhs.uk which must help you find a GP.
Registering with a GP
To register with a GP, you will need to fill out an application form. This will be available from the GP practice or it can be completed online, printed off and taken to the GP. The form is available on the NHS Inform website at www.nhsinform.scot.
You don’t need to hold a medical card to register with a GP or receive services from the NHS in Scotland.
You can only register permanently with a GP practice if you are going to be staying in the area for more than 3 months. If not, you will have to register as a temporary resident.
There is detailed guidance about how to register with a GP Practice on the NHS Inform website.
Children under 16 should be registered by their parent(s), but don't have to register with the same GP as the rest of their family.
If you are staying somewhere in the UK for less than three months, you can ask to be registered with a GP on a temporary basis. You can also register temporarily if you move around the country and have no permanent address.
NHS numbers help staff across the NHS get up-to-date information on patients' health. However, if you do not have an NHS number, you can still get NHS treatment.
A hospital should give your baby an NHS number shortly after birth. If the baby was not born in hospital, a number will be given once the hospital has been told about the birth. If your baby was born abroad and does not have an NHS number, you can get one by registering with a GP.
NHS medical cards
An NHS medical card can be issued to confirm your registration with a GP but it is only issued if you request it. A medical card is not needed to receive NHS services in Scotland.
There is more information about medical cards on the NHS Inform website at www.inform.scot.
Problems with registering
Unless the GP’s register is full, or you live too far away for home visits, it is unlikely that the GP will refuse to register you.
However, if the GP does refuse to accept you, then they must have reasonable grounds for doing so. These must not have anything to do with race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition. The GP must give you the reasons for their decision in writing.
If you have been unable to register with a GP, you should contact the local NHS Board. You should give the name of any GPs who have refused to register you, and of any GPs with whom you would prefer not to be registered.
The NHS Board will try to find a GP who is prepared to accept you. This will not necessarily be a GP of your choice. Once you have been allocated a GP, the GP must accept you and treat you, and can only remove you from their list under certain circumstances (see under heading GP removes patient from register). The NHS Board will then have to find you another doctor. The NHS Board cannot help you find another GP if you are already registered with a GP.
Treatment from a GP
You are entitled to treatment from a GP at the surgery where you are registered. When you contact your GP surgery, you must be given access to a GP, nurse or other health professional within 48 hours if that is what you need. If this doesn’t happen you can make a complaint. You have no automatic right, however, to see your own GP.
A GP must provide any treatment which is immediately necessary in an emergency, even if you are not registered with them.
Treatment outside surgery hours
All GPs must make sure that a service is provided for their patients when they are off duty. This is known as out of hours service. To access this service you must phone NHS 24 on 111. All calls to NHS 24 are free. If you are unhappy about how your call is handled you may wish to make a complaint to NHS 24.
NHS Boards are responsible for ensuring that the standard of care provided by the out of hours service is satisfactory. If you are unhappy about the standard of treatment you have received, you may wish to make a complaint.
For more information about making a complaint about the NHS, see NHS complaints.
You cannot insist that a GP visits you at home. A GP will only visit you at home if they think that your medical condition requires it. A GP can also decide how urgently a visit is needed.
If you were to become seriously ill after a GP had refused a home visit, the GP could be found to be in breach of their contract with the NHS, or could be found to have been negligent. You may therefore wish to make a complaint.
For information on making a complaint about a GP in Scotland, see NHS complaints.
You can be visited at home by a community nurse if you are referred by your GP or by a hospital consultant. If you are not an urgent patient, you can make an appointment and should be visited on the day arranged.
You should also be visited at home by a health visitor if you have recently had a baby or if you are newly registered with a GP and have a child under five years.
If a GP decides you need medication, they will usually give you a prescription. In some cases the GP may provide the medication themselves, for example, if the surgery is in an isolated area.
A GP must supply any drugs needed for immediate treatment in an emergency.
Some GPs are qualified in alternative therapies and may offer these as part of their NHS treatment. In some areas GPs may be able to refer a client to alternative practitioners, but this will not always be available.
You can ask your GP to arrange a second opinion either from a specialist or another GP. However, the GP does not have to do this if they do not think it necessary. You have no right to a second opinion.
You do have the right to see a GP competent to deal with your particular case. If a GP refers you for a second opinion, you cannot insist on seeing a particular practitioner. However, you should not be referred to someone you do not wish to see.
If the GP refuses to arrange a second opinion, you may wish to change your GP (see under the heading Changing a GP).
If a GP is unsure about a diagnosis, they could be found negligent if they failed to refer you to a specialist and you suffered as a result of this. If you have not been referred for a second opinion and have suffered as a consequence, you may wish to complain.
For information on making a complaint in Scotland, see NHS complaints.
There is no charge for basic GP treatment for NHS patients who live in the UK. There are charges for visitors from overseas, except in the case of an emergency. There may also be charges for certain services, for example, check-ups for employees and vaccinations for travelling abroad.
For more information, see Help with health costs and Scottish Government guide on help with health costs.
Changing a GP
You can change your GP at any time you wish without having to give a reason. If you tell the NHS Board that you want to change your GP, they must give you details of how to do so and provide you with a list of alternative GPs.
You do not need the consent of your GP to change GPs. When you have found another GP willing to accept you, you should go to the new GP to be registered (see under the heading Registering with a GP). You can then make an appointment to see the new GP immediately.
Problems with changing a GP
If you wish to change your GP, but cannot find a new GP who will accept you, you should contact the NHS Board or NHS National Services Scotland, who should find you an alternative (see under the heading Choosing a GP).
GP removes patient from register
A GP may be able to remove you from the patient register in some situations, for example, because you move out of the practice area or are physically or verbally abusive to people at the practice. In most cases, the GP must have given you a warning, and provided you with the reasons for your removal from the register. The GP will inform the NHS Board who then notifies you. The removal from the register takes effect from the eighth day after the NHS Board receives the GP’s notice, or from the date that you are included on another register if this is sooner. You are entitled to emergency treatment, or the continuation of treatment which is occurring more than once a week, until you are accepted by another GP.
If you have been violent, or have threatened to be violent, towards your GP or practice staff, and the police have been informed, you can be removed immediately from the GP’s list. You will only be accepted for emergency treatment by the GP who has removed you if the GP is satisfied that it is clinically necessary. You will have to apply to the NHS Board to allocate you to another GP.
If you have been removed from a GP's register because of violence you may have difficulty registering with another GP. You may wish to complain if you feel you have been treated unfairly, for example, if you feel discrimination was involved. You may be able to get help to do this from a Citizens Advice Bureau - where to get advice.
For information on making a complaint see NHS complaints.
If you move out of GP’s area
If you are changing address, but are not moving too far, you may wish to stay with your current GP. You should ask the GP if they are willing to continue treating and visiting you at the new address.
Complaining about a GP
If you have a problem with your GP, you can try to speak to your GP or ask to speak to the practice manager. However, if you do not want to do this, you can contact the feedback and complaints team at your local NHS health board.
For information on making a complaint see NHS complaints.
In Scotland, advice about NHS services and treatment, as well as personal health advice and support is available from the NHS 24 website at www.nhs24.com or by phone on 111.
Health information, including local health information services across Scotland, is available from the NHS inform website at www.nhsinform.scot or by phone on 0800 22 44 88.
If you are pregnant, you will be able to receive services from one or more of the following:-
- midwives, based either in a hospital or in a local health centre or clinic. Midwives are responsible for the care of all normal pregnancies and labours. You do not need to be referred to a midwife by your GP
- a GP. Not all GPs provide ante-natal care and arrange for delivery. If your GP does not provide this service, you may wish to register with another GP for your maternity care. The NHS Board can provide details of GPs who offer maternity care
- an obstetrician based in a hospital. Generally, an obstetrician will only get involved if there are complications. However, you can request to see an obstetrician, even if the midwife or GP is providing all the care.
You may have a range of options to choose from on the type of ante-natal care you want and where you give birth. How much choice you have will depend on the area in which you live, but could include:-
- full hospital care. This would only happen, in practice, if you require a high degree of medical intervention
- shared care between a GP and hospital staff. Some areas offer a domino midwife scheme, where you are visited at home by a midwife who accompanies you to hospital and delivers the baby there, either with or without the hospital midwife’s help. Normally, you would return home shortly after the birth
- A short delivery system, where the baby is delivered by a core midwife in the hospital and then discharged to the care of the community midwife within six hours
- a home birth, with the birth attended by, and ante-natal care provided by, a midwife and possibly a GP. You have the right to have your baby at home and may need to contact the supervisor of midwives to arrange for this. Alternatively, you could register with an alternative GP just for your maternity care.
Information on local maternity services can be obtained from your NHS Board, a community midwife, a health visitor or GP. This information will include, for example, the type of care offered, where the birth can take place, what pain relief is offered and what tests are available and what they are for. In some areas, there are maternity charters which set out the rights of pregnant women and new mothers, and the standards of service you can expect.
If you are having difficulty obtaining the type of care you want, or you require more information on how maternity services are organised in your area, you should contact the supervisor of midwives at your local maternity hospital or at the NHS Board.
Right to hospital treatment
You cannot receive NHS hospital treatment without being referred by your GP, unless you are attending a special clinic, for example, for the treatment of sexually transmitted diseases, or you need urgent medical attention in an emergency.
If you are violent and/or abusive to NHS staff, you may be refused NHS hospital treatment, or given a verbal or written warning before treatment is withheld or withdrawn. Violent or abusive behaviour could include verbal abuse, threats, violence, drug or alcohol abuse in hospital, and destruction of property. Each NHS Board can decide which types of behaviour could lead to treatment being withheld or withdrawn and how such policies are implemented. However, treatment cannot be withdrawn for more than twelve months. If you are violent and/or abusive to NHS staff and have severe mental health problems or are suffering life-threatening conditions, you will not be denied treatment.
It is an offence to assault, hinder or obstruct an emergency worker (for example, a paramedic, doctor or nurse) while they are carrying out their duties. The penalty is a fine of up to £10,000 or imprisonment of up to 12 months.
If you need urgent medical attention, you can go directly to the accident and emergency department of a hospital without needing a referral from your GP. Not all hospitals have accident and emergency departments. Some hospitals have minor injuries units instead, where you can attend without a GP referral.
It is the responsibility of the hospital providing the emergency treatment to meet the cost of treatment. If emergency admission as an in-patient is needed, the cost will be met by the health authority where you live.
Inspection of NHS services
Healthcare Improvement Scotland (HIS) is part of NHS Scotland. There is more information about their work on their website at www.healthcareimprovementscotland.org. Healthcare Improvement Scotland:
- provides clinical standards and guidelines for NHS services
- inspects NHS Boards' hospitals and services and publishes reports on its website at www.healthcareimprovementscotland.org.
Treatment which may not be available on the NHS
Access to some forms of treatment, for example, in-vitro fertilisation (IVF), may be subject to the priorities of your NHS Board. Some treatment may not be provided in your area. Access to some treatment may depend on your need. You can get details of those services not provided, and any prioritising criteria, from the NHS Board.
Health care providers must not discriminate against you because of race, sex, disability, religion or belief or sexuality when they decide what treatment to give you as a patient. It is not against the law for them to discriminate against you because of your age. For more information about discrimination, see below at Discrimination.
An NHS clinic has refused to offer fertility services to us, because we are a lesbian couple. Can they do this?
No, they can't. If they are refusing to treat you just because you are a lesbian couple when the treatment would be offered to a straight couple, this is sexuality discrimination and it's against the law. You will need to get expert advice about how to take this further.
However, if they don't offer fertility treatment to any couples, regardless of their sexuality, you won't be able to complain about sexuality discrimination.
Licensing of new medicines
When a new medicine (or drug) is developed, it must be licensed before it can be made available for use in the UK. The Scottish Medicines Consortium (SMC) approves certain licensed medicines for general use by the NHS in Scotland.
Treatment for end of life or rare conditions
A patient may want to ask for treatment with a licensed medicine not approved for use by the NHS in Scotland, for example for an ‘end of life’ or rare condition. The Scottish Government recommends that a patient discusses treatment options with their clinician. The Scottish Medicines Consortium (SMC) uses Patient and Clinician Engagement (PACE) groups to gather detailed information for discussion on the benefits of a medicine, including how it can impact the quality of a patient’s life. There is a fact sheet about PACE on the SMC website at www.scottishmedicines.org.uk .
Paying for treatment not available on the NHS – 'top-up' payments
There are some treatments used for certain illnesses, for example, cancer, which are very expensive and are not available on the NHS. You can choose to pay for these treatments yourself without this affecting your other NHS care. This means that NHS care should not be withdrawn if you buy additional care privately.
Any private care should be provided separately from the NHS care.
There is guidance about getting private and NHS care at the same time on the Scottish Government website at www.gov.scot.
Complaining that treatment is not available on the NHS
If you are unhappy because a certain form of treatment is not available on the NHS, you can complain. There is a special process to request 'end of life' medicines and medicines to treat very rare conditions.
For information on making a complaint see NHS complaints.
If you are ordinarily resident in Scotland, you may be able to receive planned healthcare in another member state of the European Economic Area (EEA) or Switzerland that is paid for by the NHS, for example if you face undue delay under the NHS. You cannot claim reimbursement for any healthcare service provided outside the EEA or Switzerland.
A European Health Insurance Card (EHIC) does not cover planned treatment.
For information on the European Health Insurance Card (EHIC) see Travel insurance.
Whenever possible, you should get prior authorisation from your local NHS health board before seeking treatment abroad because you take on a substantial financial risk if you pay for the cost of treatment up front, and it may not be possible to get retrospective authorisation.
Long term health conditions: self management
Some people live with a long term health condition which is likely to have an impact on many aspects of daily life. Self management is a person-centred approach to better health and wellbeing. A Local Information System for Scotland (Aliss) gathers informal knowledge about self management, including links to local community support, in an online platform. There is more information about Aliss, including a facility to search the Aliss resources by local area, on the website www.aliss.org.
Specific health conditions
Age Scotland has produced leaflets on some specific health conditions. They are available on the Age Scotland website at www.ageuk.org.uk/scotland.
Seeing a consultant
You have no right to see a consultant or a particular doctor, although this can be requested. Your GP cannot insist that you see a particular consultant or doctor. You do have the right to see a doctor competent to deal with your case.
If you have special reasons for seeing a particular consultant, for example, if your child is the consultant’s patient, you could ask for an appointment, explaining your reasons for wanting to see them. If you still have difficulty in seeing the consultant, you could write to the hospital administrator asking for their help.
You may wish to get a second opinion after seeing a consultant, either as an out-patient or an in-patient. You will need to request this from the consultant, who may arrange for you to see someone else. If the consultant does not agree, you could ask your GP to help.
Hospital waiting lists
You may be unable to receive the hospital treatment you need immediately, and may have to go on a waiting list. There are maximum waiting times for in-patient treatment under the NHS plans. If necessary, treatment may be arranged in an alternative hospital to meet this guarantee.
There are also waiting time standards for a first appointment as an out-patient.
Waiting lists do not operate on a ‘last come, last served’ basis. Where you are on a waiting list depends on a range of circumstances and may change. If your condition deteriorates dramatically, your GP may recommend you be seen as a matter of greater urgency. How long you will have to wait for a date to see a specialist or have an operation, will therefore depend on the severity of your condition, how busy the specialist is and other demands on the hospital facilities.
You can telephone a freephone NHS helpline for information about waiting lists, the NHS waiting times information line on 0800 028 2836 (Monday to Friday from 8.00 am to 10.00 pm). GPs also have access to a national waiting times database. The Scottish Government Health Directorate and NHS Boards can also provide information about local waiting lists.
There is more information about waiting times on the NHS inform website at www.nhsinform.scot.
If you have been waiting longer than the Scottish Government’s target you can complain.
For information on making a complaint, see NHS complaints.
If you are waiting to be admitted to hospital, you should contact the hospital appointments’ department or the consultant on a regular basis, reminding the hospital staff that you are still waiting. If you are prepared to go into hospital at short notice you should say so, in case a cancellation occurs. You should also keep your GP informed of your condition, particularly if it deteriorates.
If you are on a hospital waiting list and fail to turn up for an appointment or admission, you may be put back to the bottom of the waiting list. If you aren’t available for a period of time for a good reason, for example, work commitments, illness or a pre-arranged holiday, you should let the hospital know and your position on the waiting list will be paused until you become available again.
Care in hospital
If you go into an accident and emergency department, you should be assessed immediately. You should not wait more than four hours before being admitted to a ward, sent home or transferred to another hospital.
If you have to wait for a longer period than that set out in the NHS plan, you may wish to complain.
For information on making a complaint, see NHS complaints.
Most hospitals have visiting hours during which visits to patients can be made. A person has no automatic right to visit you, and your doctor may decide that visits would be detrimental to your health. There is usually also a limit to the number of people who can visit at any one time. The restrictions on visits from children are the same as those for other visitors.
If someone wishes to visit you outside visiting hours, they should discuss this with the ward sister. If they cannot get permission from the ward sister, they should contact the hospital administrator if they wish to pursue the matter.
Financial help with visits
If you're getting Income Support, income-based Jobseeker’s Allowance, income-related Employment and Support Allowance or Pension Credit, you may be able to get help from your local authority for travel costs to visit a sick relative.
For more information, see Extra help if you're on benefits or your benefits have stopped.
There may be a number of issues which you may wish to consider if your child is to go into hospital, for example, whether you can stay with your child, how much help you can give with feeding and looking after your child and what will happen to your child’s education. Children's Health Scotland may be able to advise on all these issues. It also produces a leaflet for parents whose child is going into hospital for the first time. The address is:-
Children's Health Scotland
22 Laurie Street
A child should usually be admitted to a children’s ward under the supervision of a consultant paediatrician. If your child is in an adult ward, you may wish to complain.
For information on making a complaint, see NHS complaints.
The Scottish Government Health Department has strongly recommended to hospitals that they allow unrestricted visiting on children’s wards. Hospitals should also allow parents to be with their children as much as possible. This could include allowing you to stay overnight at the hospital. You should make enquiries before your child goes into hospital about what arrangements can be made.
If you are finding it difficult to visit a child in hospital, for example, if you have other children at home, you may wish to discuss this with the medical social worker at the hospital.
Single sex wards
You do not have the right to be cared for in a single sex ward. However, you do have the right to be informed before you go into hospital (unless it is an emergency or you are admitted to an intensive care unit) whether you will be in a mixed ward. You should have your privacy and dignity protected when in hospital with private washing areas and screens available where appropriate.
If you wish to be cared for in a single sex ward, you may have to delay your admission to hospital if this is not available immediately.
Patients who die in hospital
If a patient dies in hospital, NHS staff should inform relatives and the patient’s GP as soon as possible, and advise the relatives of the arrangements that need to be made.
An NHS Board may be responsible for the funeral arrangements if there are no relatives or the relatives are unable to afford the cost and do not qualify for a funeral payment from the social fund.
Using mobile phones in NHS hospitals
You should be allowed to use your mobile phone in hospital as long it does not interfere with medical equipment or cause a nuisance to patients. You will generally not be allowed to use your phone in ward areas.
You can ask to see the hospital's written policy on the use of mobile phones and there should be signs up in all hospital areas which state whether you can use a mobile phone. You can see a copy of NHS guidelines on using mobile phones on the Health Facilities Scotland website at www.hfs.scot.nhs.uk.
There is no charge for most hospital treatment for NHS patients who live in the United Kingdom. However, there can be charges for the emergency examination and treatment of people involved in road accidents. There are also charges for certain services, for example, beds with more privacy and alternative menus.
There are charges for visitors from overseas, except in the case of most emergencies.
For information about charges for overseas visitors, see NHS charges for people from abroad.
Financial help for hospital patients
If you're getting certain social security benefits, your entitlement may be affected if you go into hospital.
If you are concerned about the effect of hospitalisation on benefits, you should consult an experienced adviser, for example, at a Citizens Advice Bureau - where to get advice.
If you are on a low income, you may be able to get help with travel costs to hospital and with the cost of prescriptions, wigs and fabric supports.
For more information about help with NHS costs, see Help with health costs.
Transport for patients
If you have medical needs that mean you need help with transport to and from a hospital appointment or when you are being admitted to, or discharged from, hospital, you may be able to get help from the Patient Transport Service. The service is run by the Scottish Ambulance Service and you can find more on its website at www.scottishambulance.com.
If you don’t qualify for help from the Patient Transport Service, there may be a local scheme that you can apply to. Your GP or NHS Board should be able to give you more information about this.
Discharge from hospital
You should not be discharged from hospital until your care needs are assessed and arrangements made to ensure that you will receive any necessary services when you are discharged.
Any assessment should take into account your wishes, the wishes of your family and of any carer. You should be kept fully informed and involved, be given sufficient time to make decisions, and be told how to seek a review of any decisions made. You can ask for a reassessment of your needs if circumstances change in the future.
Unsatisfactory arrangements before or after discharge
You may not be satisfied with arrangements for your discharge from hospital because, for example:
- you feel that you need to remain in hospital for further in-patient treatment
- you are not satisfied with the community care services that have been arranged for you when you are to leave hospital
- you do not want to be sent to a care home.
Before discharge takes place, you, or your family, carer or representative, have the right to ask for a review of the decision which has been made about your eligibility for continuing NHS care.
If you are not satisfied with arrangements that have been made for you after you have been discharged, you can complain. If you are not satisfied with any medical services you are receiving from the NHS, you should use the NHS complaints procedure. If you are not satisfied with community care services which have been arranged or provided by the local authority, you should complain to the local authority using its complaints procedure.
If you are unhappy with your discharge from hospital or with the arrangements made for you after discharge, you should consult an experienced adviser, for example, at a Citizens Advice Bureau - where to get advice.
For information on making a complaint, see NHS complaints.
For information about community care, see Social care and support.
Examination and treatment
You should not be examined or given any treatment or operation without your consent, unless:-
- you have a notifiable disease that must, by law, be reported to the public health authority, or are a carrier of a notifiable disease
- you have been detained under mental health legislation and may lack capacity to give consent
- you lack capacity to provide consent because of an impairment caused by dementia, brain damage or intoxication through drink or drugs
- your life is in danger, you are unconscious and you cannot indicate your wishes
- a court or someone who has parental responsibility authorises treatment. A person whose treatment is authorised by a court must be given an opportunity to defend their case against treatment in court.
In some cases, it is good practice to ask you, the patient, to sign a consent form, but in other cases consent can be obtained orally. For example, it is good practice to obtain written consent for any procedure or treatment carrying substantial risk or side effects. If you are capable, it is good practice for the medical staff to obtain written consent for general anaesthesia, surgery and certain forms of drug therapy. Oral or written consent should be recorded in your notes with relevant details of health professionals’ explanations. If you are concerned about a specific type of treatment the doctor is obliged to describe other forms of treatment that are available.
When there is doubt about your capacity to provide consent an assessment has to be made by a health professional.
Even if you sign a consent form, the signature may not be a valid form of consent if you have not been given appropriate information to be able to give informed consent. Similarly, consent for one procedure does not imply consent for a further procedure or form of treatment.
The doctor must inform you of the nature, consequences, and any substantial risks involved in the treatment or operation, before you give your consent. It is for the doctor to decide exactly how much to tell you, the patient.
There is more about consent on the NHS inform website at www.nhsinform.scot.
In Scotland, a child under 16 can consent to, or refuse, any treatment if the qualified medical practitioner attending them believes they are capable of understanding the nature and possible consequences of the treatment. Parental consent should be obtained where a child under 16 does not have sufficient understanding, except in an emergency where there is not time to obtain it. If the local authority holds parental responsibility for a child under 16, consent from a parent or guardian does not need to be sought.
There is a useful NHS fact sheet for children and young people under 16 called 'Consent – your rights'. It is available on the NHS inform website at www.nhsinform.scot.
Experiments, medical research and teaching
In general, if a doctor wishes to carry out research on you, your consent has to be given. However, if a child under 16 is not competent to decide, a parent or court can consent to research on their behalf.
You should be given a full explanation of the procedures and risks involved. It should also be made clear to the patient that you can withdraw from the research at any time. Appropriate safeguards should always be in place to protect patient confidentiality.
You have the right to refuse to participate in teaching without your treatment being affected. If you do not want to be involved in teaching, it is advisable to inform the hospital in advance.
There is more information about consent on the NHS inform website at www.nhsinform.scot.
Right to refuse treatment
You can refuse any treatment if you wish (but see under heading Consent). Even if you are in the middle of a course of treatment that you provided consent for you can ask for the treatment to be stopped.
When you visit a doctor, this usually implies consent to examination and treatment. The doctor cannot act against specific instructions. You should tell the doctor about any treatment you do not want.
If there are a number of alternative treatments which can be used to treat your condition, you should be given information on these. However, you cannot insist on a particular treatment if the doctor or consultant thinks this is not appropriate.
Forcing treatment on you against your will is assault. If you are assaulted, you should contact your NHS Board to make a complaint. You may also wish to involve the police.
For information on making a complaint, see NHS complaints.
You refuse treatment for your child
If you, as a person with parental responsibilities or guardian of a child refuse to give consent for treatment which a doctor thinks is necessary, the action the doctor takes will depend on how urgently the treatment is needed.
When a child’s life is in danger, the doctor has the right to do whatever is needed to save the child’s life. However, the doctor may need to obtain a court order if you refuse to give consent for your child to be treated. If you or a guardian either fail to provide medical help for a child, or unreasonably refuse to allow treatment, you can be prosecuted for neglect.
Palliative care is care that is given when a cure is not possible. Palliative care aims to control pain and other symptoms, and also to meet the other needs of patients and carers facing progressive illness and bereavement, for example practical, social, emotional and spiritual needs. Palliative care can be delivered in any setting. Palliative care can be provided at any stage following the diagnosis of a life-limiting illness or condition, and not only in the last few days, weeks or months of life. There is information about palliative care, including specific conditions and sources of help, on the NHS inform website at www.nhsinform.scot
Right to die
The law concerning whether a person has the right to die is unclear. You have a right to refuse or stop treatment at any time, even if this means that you may die. However, it is illegal for a doctor to omit or carry out treatment with the specific intention of inducing or hastening death. If you believe you may become so ill that you could no longer make the decision about treatment, you should tell the doctor beforehand at what stage you would want treatment to stop.
You may wish to draw up a written document setting out what you would want to happen if you became too ill to give consent to medical treatment. Requests for specific treatments are called living wills and advance refusals of treatment are called advance directives, although these terms are often used interchangeably. An advance directive refusing treatment is legally binding on health care professionals.
In Scotland, you can get more information about advance directives from EXIT at www.euthanasia.cc.
If you are thinking of making an advance decision you should consult an experienced adviser, for example, a solicitor or an adviser at a Citizens Advice Bureau - where to get advice.
If you are concerned about being treated against your wishes, you should ensure you make this clear at the time the treatment is proposed.
Removal of organs after death
Adults and children over 12 can authorise in advance for their organs to be used for transplant or medical research after their death by carrying an organ donor card or registering on the NHS organ donor register, which you can access on the UK transplant website at www.uktransplant.org.uk.
If you don’t give any indication of your wishes, whoever is legally responsible for the body can allow organs to be donated. This will usually be your nearest relative. Before organs can be removed from the body, medical staff must be certain that brain death has taken place, and a death certificate must be issued.
Reporting problems with medicines and healthcare products
You can report suspected problems or incidents with medicines, medical devices and healthcare products, such as serious side effects that you were not informed about by your doctor, using the Yellow Card Scheme. There is more information on the Yellow Card Centre Scotland website at www.yccscotland.scot.nhs.uk, including the various ways to make a report.
Access to medical reports and health records
You have the right to see most health records held about you, subject to certain safeguards. You are entitled to be informed of the uses of the information, who has access to them and how you can arrange to see your records.
You have a right, subject to certain safeguards, to see any medical report written for an employer, prospective employer or insurer, by a medical practitioner who has responsibility for your ongoing care, for example, your GP or consultant and any medical practitioner who has treated you in the past.
There is more information about accessing your health records on the NHS inform website.
Information about your medical history should be kept confidential, and should not be released to people who are not involved in your medical care without your consent. This includes your relatives, unless you are unable to give consent yourself. There are some exceptions to this rule. For example, medical information about you may be disclosed if it would prevent serious harm to others.
There is more information about confidentiality on the NHS inform website.
Getting information from your health care provider
You have a right to ask for and receive information from a Scottish public health authority, including NHS boards, hospitals, GP’s, dentists, opticians, pharmacists and other health professionals. You might, for example, want to access information about services, decision making processes, the use of public funds and service standards. In most cases, the health authority must provide you with the information within 20 working days.
Health care providers such as doctors, nurses and other practitioners must try to make sure that things are explained to you in a way you understand. If they don't do this, it could be argued, for example, that you have not given proper consent to treatment – see under heading Consent.
If it's difficult for you to communicate for any reason, for example because you don't speak English or you have a disability which affects your communication, they should take steps to present the information in a way you will understand. This could mean, for example, providing a language interpreter or a sign language interpreter.
In some circumstances, if a health care provider doesn't take steps to communicate with you properly, you can complain that they have discriminated against you. It might be race discrimination if you can't understand what they are telling you because English isn't your first language. Or it might be disability discrimination if you can't understand what they are telling you because you have a disability, for example, if you're deaf.
If you need to talk about something of a personal medical nature which affects only women or men and you need an interpreter, you can complain about sex discrimination if the interpreter is not the same sex as you.
The Health in my language website at www.healthinmylanguage.com provides information about health and health-related services in Scotland, translated into a range of languages.
Further information about the NHS
The Scottish Government’s plan and targets for the NHS in Scotland are contained in the Better Health, Better Care: Action Plan, which is published on the Scottish Government’s website at www.gov.scot. You can find a summary of the plan and the key targets in a leaflet called Better Health, Better Care: What it means for you, which is also available on the Scottish Government website at www.gov.scot .
The Patient Advice and Support Service (PASS)
The Patient Advice and Support Service (PASS) is an independent service which provides free, accessible and confidential advice and support to patients, their carers and families about NHS healthcare. The service is provided by the Scottish CAB Service and you can access it from any Citizens Advice Bureau in Scotland. PASS promotes an awareness and understanding of the rights and responsibilities of patients and advises and supports people who wish to give feedback, make comments, raise concerns or make a complaint about treatment and care provided by the NHS in Scotland.
- helps you understand your rights and responsibilities as a patient
- provides information, advice and support for anyone who wishes to give feedback or comments, or raise concerns or complaints, about health care delivered by NHS Scotland
- provides practical help with making a complaint, including writing letters, making phone calls and supporting you in preparing for and attending meetings
- works with the NHS by using feedback to improve your healthcare and NHS service provision.
You can call PASS for advice and support on 0800 917 2127. Lines are open Monday to Friday from 9.00 am to 5.00 pm. You can find more information about PASS on the website at www.cas.org.uk/pass.
You can also get help from a Citizens Advice Bureau - where to get advice.
Organisations and people providing health services are not allowed to discriminate against you for example, because of your race, sex, disability, religion or belief, or sexuality. Your NHS Board might also have an equality policy which says it will not discriminate against you for other reasons, for example, if you have HIV.
If you're disabled, a health service provider must make 'reasonable adjustments' to allow you to use their services. If they don't do this, they must be able to show that their failure to do so is justified, otherwise they will be discriminating against you. Examples of making reasonable adjustments include providing information on audiotape as well as in writing, or installing a ramp to allow wheelchair access.
I have hearing difficulties and it is embarrassing when I go to the dentist – I can never hear them when the receptionist calls out my name.
You could ask your dental surgery to keep a record of all their patients with hearing difficulties. Receptionists can then come over and let you know when the dentist is ready to see you, rather than calling out your name. The surgery should agree to this. If they don't agree and they don't have a very good reason, they are probably discriminating against you and you should make a complaint.
If you think that a doctor, dentist, nurse or other health care professional is discriminating against you, you can complain about this. Ask to see a copy of the equality policy of the organisation they work for and point out where they are failing to keep to it.
For information on making a complaint in Scotland, see NHS complaints.
For more information about discrimination, see Discrimination in health and care services.
NHS services for the armed forces, family and veterans
The government has set out the entitlement to healthcare services that the armed forces, family and veterans can expect as part of the armed forces covenant. The armed forces covenant is available on the GOV.UK website at www.gov.uk. The NHS should give priority, based on clinical need, to all veterans whose injuries or ill-health, including mental health, result from their service even when the symptoms are not apparent for some time after leaving service.
For information and support for people in the Armed Forces community across Scotland, see www.adviceasap.org.uk.