Medical Consent for a Child in Kinship Care in England

The Basic Rule: Medical Treatment Requires Consent

Under English law, medical treatment requires valid consent. For a child, that consent normally comes from someone with parental responsibility — the birth mother, a parent married to or in a civil partnership with the mother at the time of birth, or a father jointly registered with the mother on or after 1 December 2003.

A grandparent, aunt, uncle or other kinship carer does not hold parental responsibility simply by caring for the child. So where does that leave a relative who needs to take the child to the doctor?

The answer depends on the type of treatment, the child's age, and whether the parent has delegated authority.

Routine Appointments and Delegated Consent

For everyday health care — a repeat prescription, a routine check-up, a course of antibiotics, a dental filling — a kinship carer can attend appointments and authorise treatment if the parent has signed a section 2(9) delegation letter covering routine health matters.

Routine immunisations fall into the same category. The Green Book on Immunisation (Chapter 2) confirms that a carer presenting with a child for scheduled vaccinations can proceed if the PR holder has consented in advance or arranged for the carer to bring the child. The PR holder's consent or arrangement is the authority; the child's personal health record (Red Book) is a record, not consent.

Without a delegation letter, section 3(5) of the Children Act 1989 allows a person with care of a child to take reasonable action to safeguard or promote the child's welfare. It is not blanket consent for medical treatment. For vaccinations and planned treatment, obtain the PR holder's consent or a section 2(9) delegation; section 3(5) cannot override an express objection.

Emergency Treatment: No Consent Needed

When a child needs immediately necessary treatment to save their life or prevent serious deterioration in health, healthcare professionals can provide emergency treatment without consent. Section 3(5) of the Children Act 1989 separately allows a person with care of a child to take reasonable steps to safeguard or promote the child's welfare; it is not a general treatment-consent authority for clinicians.

A kinship carer in this situation does not need to produce a delegation letter or prove their legal relationship to the child. The clinical team treats first and resolves consent questions later. The carer's role is to get the child to A&E or call 999, provide whatever medical history they know, and let the medical team do their job.

The Line Between Routine and Major Treatment

The distinction that matters most for kinship carers is between everyday health care and major medical interventions.

With a section 2(9) delegation, a kinship carer can handle routine matters such as:

• Routine GP appointments and prescribed medication
• Minor dental treatment
• Standard immunisations
• Routine dental checks and optometry appointments

Section 3(5) is a narrower backstop for reasonable welfare action when no delegation is available, such as urgent first aid. It does not provide blanket authority for these treatments.

Where the child cannot give valid consent, a PR holder or a court will normally be needed for:

• Elective surgery under general anaesthesia
• Complex psychiatric treatments
• Organ donation or experimental therapies

If a PR holder is uncontactable and the child needs a non-emergency but necessary procedure that falls in the grey area, the clinician will assess whether it counts as everyday care. If it is a major procedure and no PR holder can be reached, the NHS Trust's legal department may apply to the High Court for authorisation.

Gillick Competence: When the Child Can Consent

A child under 16 can consent to their own medical treatment if a healthcare professional assesses them as "Gillick competent" — meaning they have sufficient intelligence, maturity and understanding to fully appreciate what the treatment involves, its risks and its implications.

If a child is assessed as Gillick competent, their consent is legally valid on its own. Neither the kinship carer nor the parent needs to give additional consent.

Section 8 of the Family Law Reform Act 1969 makes a 16- or 17-year-old's consent to surgical, medical or dental treatment effective as if the young person were an adult. Under the Mental Capacity Act 2005, capacity is presumed from age 16 unless shown otherwise. If a 16-year-old gives informed consent, parental consent is not required.

For kinship carers, Gillick competence means that an older child or teenager can increasingly handle their own health decisions. It also means that if the child is Gillick competent, a healthcare provider may share medical information directly with the child rather than with the carer.

When the Parent Objects

A delegation letter only works while the parent consents to it. If a PR holder expressly refuses a specific treatment — even a routine one — section 3(5) cannot override that refusal and a delegation letter does not overrule the parent's direct instruction.

This creates a practical problem when parents and kinship carers disagree about the child's medical care. If the parent refuses necessary treatment and the child's health is at risk, the carer can contact the local authority's children's services or, in urgent cases, support the clinical team in seeking a court order.

Parental imprisonment, hospitalisation or substance misuse does not suspend or terminate their PR. A parent in prison still holds parental responsibility and must be consulted on major medical decisions unless a court order says otherwise.

The complete kinship consent guide for England includes a medical consent quick-reference card covering every level of treatment authority, from daily prescriptions to emergency surgery.

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