Gillick Competence and Kinship Carers in England

If you are caring for a relative's child in England and a healthcare professional mentions "Gillick competence," it can feel like one more legal concept added to an already confusing situation. But Gillick competence actually simplifies things — it is the principle that says a child mature enough to understand a medical decision can consent to it themselves, regardless of who else has authority.

What Gillick Competence Means

The principle comes from the 1985 House of Lords decision in Gillick v West Norfolk and Wisbech Area Health Authority. The ruling established that a child under 16 can consent to medical treatment without parental involvement if a healthcare professional judges that the child has sufficient intelligence, maturity, and understanding to fully comprehend the nature, purpose, and risks of the proposed treatment.

This is not about a fixed age. A 12-year-old might be assessed as Gillick competent for a routine vaccination but not for a complex surgical procedure. The assessment is specific to the treatment in question and is made by the treating clinician, not by the carer or the parent.

Why It Matters for Kinship Carers

When you are caring for a child without Parental Responsibility, the consent question comes up frequently. Who signs the form for an immunisation? Who gives the go-ahead for a course of antibiotics? For non-Gillick competent children, you rely on a delegation letter from the parent (Section 2(9) of the Children Act 1989) or the reasonable-steps provision in Section 3(5).

But if the child is Gillick competent for the treatment in question, their own consent is legally sufficient. The healthcare professional does not need consent from you, the parent, or anyone else. This removes one of the consent hurdles that kinship carers often face — particularly with older children and teenagers.

Young People Aged 16 and 17

For young people aged 16 and 17, section 8 of the Family Law Reform Act 1969 makes their consent to surgical, medical or dental treatment effective as if they were adults. The Mental Capacity Act 2005 presumes that a person aged 16 or over has capacity to make a decision unless it is established otherwise.

In practice, this means that if you are caring for a 16- or 17-year-old relative, they can consent to most of their own medical treatment. You may still be involved — attending appointments, providing context to the clinician — but the legal consent sits with the young person.

The Limits of Gillick Competence

A child who is Gillick competent can consent to treatment. What they cannot do — at least not in every case — is refuse it. English case law has established that while a Gillick competent child's consent is legally valid, their refusal of treatment can be overridden by a parent with Parental Responsibility or by the court, particularly where refusal would put the child's life at risk.

For kinship carers, this edge case rarely arises in practice. The more common scenario is straightforward: the clinician assesses the child, determines they are competent, the child consents, and the treatment proceeds.

What This Means Day to Day

If the child in your care is old enough to understand their own health decisions — typically from around age 11 or 12, depending on the individual — the consent process at the GP surgery or hospital may be simpler than you expect. The clinician speaks directly with the child, assesses their understanding, and proceeds with their consent.

Where the child is not yet mature enough for a particular decision, you will still need either a delegation letter from the parent or reliance on Section 3(5) for routine matters. The England kinship consent guide covers both routes, so you know which applies in each situation.

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