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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Communication passports and accessible consent

Psychiatry · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Urgency does not erase communication

Life-threatening illness may require rapid treatment, but failure to use available signs, symbols, interpreters, hearing aids, familiar supporters or a current passport can create avoidable incapacity, distress and error.

Action: Presume a conscious patient has capacity and seek consent using the fastest effective communication support while stabilising immediate threats. If, despite practicable support, there is a reasonable belief that the person lacks capacity, give only immediately necessary treatment reasonably believed to be in their best interests, check any applicable advance decision or authorised attorney as far as practicable, involve the person as much as possible and record the legal basis.

Synopsis

Use a co-produced communication passport to make needs visible while preserving the person's own voice, support valid consent and capacity assessment, and carry precise adjustments safely across care boundaries.

  • A communication passport is a concise, person-owned account of how someone understands, expresses choices, shows pain or distress, and what practical approaches help care succeed.
  • Co-produce it with the person, record the source and review date, distinguish the person's preferences from supporter interpretation, and avoid turning it into a behavioural control plan.
  • The Accessible Information Standard requires services to identify, record, flag, share, meet and review disability-related information and communication needs.
  • Consent requires accessible information about the nature, purpose, material benefits, risks and alternatives, plus a genuine opportunity to ask questions and decide voluntarily.
  • Under the Mental Capacity Act 2005, presume capacity, take all practicable supportive steps, and never infer incapacity merely from disability or an unwise decision.
  • Assess capacity for the specific decision and time: can the person understand, retain, use or weigh relevant information and communicate a choice by any means?
  • If capacity is absent, comply with any valid and applicable advance decision and verify an attorney's or deputy's scope. Otherwise make and record the overall best-interests decision; before acting, consider whether the purpose can be achieved as effectively in a way less restrictive of the person's rights and freedom.

Key red flags

A patient who usually communicates choices becomes unable to do so after illness, sedation or removal of aids; treat this as a change and restore access before concluding incapacity where time allows.

An outdated passport that instructs staff to defer automatically to a carer may conflict with the adult's present wishes, confidentiality and decision-specific capacity.

Apparent agreement obtained through acquiescence, repeated leading questions or inaccessible risk information is not reliable evidence of informed consent.

A supporter who appears coercive, blocks private communication, changes the person's answers or controls medication and money raises a safeguarding concern.

Investigation priorities

01
Communication-needs assessmentFirst step

Identify how the person receives information, expresses choices and signals pain, distress or disagreement.

Management branches

Prepare communicationBuild an actionable passport

A person has communication needs that unfamiliar teams may not reliably meet.

  1. Ask the person how they want information delivered, how they show choices and distress, who may support them and what approaches should be avoided.
  2. Combine direct preferences with clearly attributed observations, recording concrete examples, essential aids, sensory needs and a review date.
  3. Flag and share the passport through approved systems with the person's involvement, then ensure receiving staff can access and use it before care begins.
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Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NHS England Accessible Information Standard implementationIdentifying, recording, flagging, sharing, meeting and reviewing communication needs.
  • NICE NG108 decision-making and mental capacitySupported decision-making, capacity assessment, best interests and advocacy.
  • Mental Capacity Act 2005 section 1Statutory principles of presumption, practicable support, unwise decisions, best interests and least restriction.
  • Mental Capacity Act Code of PracticeOperational guidance for capacity, consent, best interests and authorised decision-makers.
  • GMC decision making and consentCurrent professional guidance on supported consent, emergencies and treatment where capacity is absent.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom