Choice and Control
Scope of this chapter
Choice: The act of choosing between two or more options
Control: The power to influence or decide things
As adults, we all have choice and control over our lives. From what time we get up, what we wear, what and when we eat, where we go and who we see right through to where we live and how we spend our money.
The people we support are also entitled to the same levels of choice and control, and part of our role is to support and encourage them to realise this.
Empowering the people we support to make their own choices and have as much control as possible in all areas of their lives is a core value and principle. This means it applies to everyone and is always relevant when planning for or providing care and support.
Relevant Regulations
Related Chapters and Guidance
- Consent
- Communicating Effectively
- Culturally Appropriate Care and Support
- Dignity and Respect
- Mental Capacity
- Participation and Advocacy
- Promoting Individual Wellbeing
- Providing Care and Support
- Department of Health: Voice, choice and control
Amendment
In May 2024, information about Regulation 9A: Visiting and accompanying in care homes, hospitals and hospices was added to Section 3, Day-to-day choice and control.
Options offered should be appropriate to the person’s preferences and needs.
Petra does not like custard. For dessert, she is offered a choice of ice cream or apple pie with custard. This is not a choice, because one of the options given to her, she does not like.
Options should always be options that are actually available.
Stuart is going to the park after lunch. He needs to decide how to get there. Staff ask whether he would like to go on the bus, get a taxi or walk. Stuart has no money, so walking is the only realistic option. Therefore, he does not have a choice. Furthermore, if Stuart were to choose an option that was not available this could cause him to become angry or upset.
Information about options should be provided in the best way for the person, considering their preferred method of communication, the length of time they normally need to make a choice and any other relevant factors.
Care must also be taken not to unduly influence the person towards making a particular choice. Staff should be able to talk to the person about the pros and cons of each option but should remain impartial.
An important part of person-centred care or support planning is to give the person as much choice and control as possible about how they are supported.
Some of the key things to find out are listed in the table below:
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How do you like to be supported? |
What do you need support with and exactly how do you like this support to be provided? What do you not like? |
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What can you do independently? |
When can support be ‘hands off’? |
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Who do you like supporting you? |
Would you like to be supported by someone with similar interests/same age/same gender etc.? |
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What routines or activities are important? |
Do you need any private time? Are there places you always go at certain times? Are there things you always do at certain times? |
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What support do you need with relationships? |
Who is important to you? How would you like to keep in touch, how often, specific times etc. Do you need, support charging mobiles phones or tablets? Is there anyone you do not want to see? |
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How will we know if you want us to do things differently? |
How will you communicate it? Are there any non-verbal signs to be aware of? |
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Do you have any goals or ambitions? |
Are these realistic? What support is needed to achieve them? |
If the person is unable to provide this information themselves, you can gather it from those that know them well. This could be family, friends or another provider. When providing support, you should look out for any signs that the person does not like how they are being supported and be open to trying new things in response to this.
The person should be given regular opportunities to say if they are happy with how support is being provided to them. Staff should also be proactive if there are signs or indicators that the person may not be happy, even if they do not say anything.
Their individual care or support plan should be updated accordingly.
Examples of day-to-day choices include:
- When to get up;
- When/whether to shower;
- What to wear;
- What to eat/drink and when;
- Whether to take medication;
- What to watch on the television;
- Where to go and how to get there;
- What to buy;
- Who to see, when and where;
- Who to telephone and when;
- When to go to bed.
Even though the person’s preferences may be recorded in the individual care or support plan, you should not assume that the person would make the same choice all the time. Options should still be given on each occasion.
If the person lives in a care home, Regulation 9A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires that, unless there are exceptional circumstances, the person must be able to receive visits from anyone they wish to see.
Examples of bigger decisions include:
- Where to live;
- Whether to have medical treatment;
- Whether to make a will;
- Whether to get married or have children;
- Whether to invest or borrow money.
These decisions will likely require expert advice. For example, from a social worker, health professional or financial advisor. Staff should support people to access the advice they need to understand available options and make a choice.
Choosing whether to do something (or not) is an important part of exercising control.
Consent should be sought before doing any action to the person or on behalf of the person. If consent is not provided, the action should not normally take place.
For further information and guidance see: Consent
The first 3 principles of the Mental Capacity Act 2005 should always be applied:
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1. A person must be assumed to have capacity unless it is established that they lack capacity. |
Every person from the age of 16 has a right to make their own decisions if they have the capacity to do so. Staff must assume that a person has capacity to make a particular decision at a point in time unless it can be established that they do not. |
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2. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success. |
People should be supported to help them make their own decisions. No conclusion should be made that a person lacks capacity to make a decision unless all practicable steps have been taken to try and help them make a decision for themselves. |
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3. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. |
A person who makes a decision that others think is unwise should not automatically be labelled as lacking the capacity to make a decision. |
For information about applying these principles in practice see: Mental Capacity
It is highly unlikely that a person will lack the capacity to have any choice or control over their life. People that lack capacity to make bigger decisions will often still be able to exercise choice and control over daily life.
If a person does lack the capacity to make a particular choice, it should be made in accordance with the preferences set out in their individual care or support plan. If this is not clear, or the choice relates to a big decision it will need to be made in their best interests in line with the Mental Capacity Act 2005.
See: Mental Capacity
Last Updated: April 16, 2024
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