4.2 Establish a basis for access
For simplicity of implementation, this standard defines the following bases for proxy access.
Patient is under 16
Clinical professionals must assess the child’s Gillick competence to consent to proxy access.
Parental responsibility
Where a child is deemed to not be Gillick competent in relation to proxy access, clinical professionals can grant proxy access to the child's parents on the basis of parental responsibility.
Guardians and carers who are not the child’s parents
Where a child is deemed to not be Gillick competent in relation to proxy access, clinical professionals can make a decision in the child's best interests to grant proxy access to someone who is not the child's parent, provided any appropriate consultation with those with parental responsibility has occurred.
The child's consent
If assessed as Gillick competent in relation to proxy access, a child must provide informed consent to proxy access as per section 4.3. Refer to proxy access: advice and guidance for further detail on when consent is likely to be a relevant basis for proxy access.
Where there are digital services available for the child to access, clinical professionals and staff should promote self-access above proxy access, where appropriate.
All decisions about granting proxy access must be made in the child's best interests.
Patient is 16 or over
Clinical professionals should always consider the patient's capacity, but may presume capacity to consent to proxy access unless they have evidence to the contrary, as per the Mental Capacity Act (2005).
Where the patient has capacity, self-access should be promoted above proxy access.
Where the patient has a temporary less of capacity, an end date should be set in line with when they may regain capacity.
The patient’s consent
If the patient has capacity at the point of deciding on proxy access, clinical professionals must get the patient’s informed consent before granting access as per section 4.3.3.
Health and welfare power of attorney
If the patient does not have capacity at the point of deciding on proxy access and is aged 18 or over, clinical professionals can rely on a valid and applicable lasting power of attorney (LPA) being in place to grant proxy access to a health and welfare attorney.
Court-appointed personal welfare deputy
If the patient does not have capacity at the point of deciding on proxy access and is aged 18 or over, clinical professionals can rely on a court order being in place naming someone as the patient’s personal welfare deputy.
Note: Being a health and welfare attorney or personal welfare deputy does not automatically give someone the right to be a proxy. A patient must lack capacity for the LPA or deputyship to be treated as valid and applicable. It may be necessary for the clinical professional to undertake a capacity assessment.
Carers without power of attorney or deputyship
If the patient does not have capacity at the point of deciding on proxy access, clinical professionals may make a decision in the patient's best interests to grant proxy access to an appropriate proxy who does not have power of attorney or deputyship.
All decisions about granting proxy access must be made in the patient's best interests.
Last edited: 6 May 2026 1:57 pm