Capacity, children and representative authority at discharge

For a hospital-to-community discharge, establish separately who can decide care arrangements, what may be disclosed for continuing care, and who may access records as a representative. Capacity and representative powers concern the particular decision and differ nationally. A contact or proxy-account label is not sufficient authority. ^{241, 244, 245, 249}

The organisational implication is to record the relevant decision, any actual grant/order and the information needed for that role. Keep justified care-team handover separate from disputed representative access. This map supports the digital discharge example; it does not create an additional mandatory interoperability dataset.

Three decisions remain separate

Decision	What must be established	Consequence for digital exchange
Care and discharge arrangements	The person's decision-specific capacity and any relevant substitute decision-maker, court order or statutory route.	Record the decision and its scope; do not infer authority from a contact field.
Disclosure for continuing care	Confidentiality justification, appropriate recipient and necessary information, alongside data protection.	A care decision or representative appointment does not authorise every disclosure.
Representative record/portal access	Identity, validity and scope of the authority to act, with relevant restrictions and scheme rules.	Provide the justified access role; distinguish acting for the patient from providing their care.

These distinctions follow the national laws and guidance. Their digital consequences are implementation synthesis, rather than a universal statutory message-field list. ^{241, 244, 174, 172}

Four-nation legal map

England

The Mental Capacity Act 2005 (MCA), generally applicable from 16, requires capacity to be presumed and the person supported for the particular decision. Where capacity is lacking, the relevant best-interests and intervention rules apply. Family Law Reform Act 1969 section 8 gives effective treatment consent at 16/17. Treatment consent, care arrangements and information access still need their own legal analysis. ^{241, 242}

Under-16 competence requires individual assessment. Children Act 1989 section 3 defines parental responsibility; it does not remove a competent young person's confidentiality interests. Treatment refusal disputes cannot be resolved from age alone. ^{243, 254, 255}

A lasting power of attorney (LPA) donor must be at least 18. Inspect the registered instrument or court order for the relevant power, restrictions and activation conditions. A welfare attorney acts within scope when the person lacks relevant capacity; a deputy's powers depend on the order and the Act. Relevant information for that role differs from unrestricted record access. ^{241, 244}

Wales

The MCA, treatment-consent and parental-responsibility frameworks described above also apply in Wales. Use the Welsh social-services setting for discharge participation and advocacy rather than substituting English care legislation. The age-18 LPA donor rule and actual attorney/deputy powers remain material. ^{241, 242, 243, 244}

The Welsh Part 10 Code requires independent professional advocacy where its participation-barrier and no-appropriate-individual conditions are met. An advocate supports participation; that role does not itself confer general authority to consent or obtain every record. ²⁶³

Scotland

The Adults with Incapacity (Scotland) Act 2000 (AWI) defines an adult from 16. Its principles concern benefit, least restriction, the person's wishes and consultation. A section 47 certificate addresses medical treatment; it does not decide every residence or discharge arrangement. Section 50 has separate proxy and disagreement processes. ^{245, 246}

Inspect a welfare attorney's grant, guardianship or intervention order for the actual powers. Section 16 limits welfare powers to the relevant incapacity circumstances. Consultation with a relative differs from legal appointment. ^{245, 259}

General legal capacity begins at 16 under the Age of Legal Capacity (Scotland) Act 1991. Section 2(4) provides a specific under-16 treatment-consent route based on understanding. Most parental responsibilities/legal representation under Children (Scotland) Act 1995 section 1 concern under-16s; the responsibility to provide guidance continues to 18. ^{247, 248, 254}

Data Protection Act 2018 section 208 concerns the child's understanding for specified data-protection rights and consent, with a rebuttable presumption from 12. It is not a universal treatment-consent age or automatic parental portal entitlement. Read professional record-access guidance with that statute. ^{257, 256}

Northern Ireland

Ordinary treatment/care authority requires the applicable common-law and statutory analysis. The Mental Capacity Act (NI) 2016 is partly implemented; its LPA provisions in sections 97–99 and deputy provision in section 116 remain prospective. They cannot establish a current ordinary-care welfare appointment. Existing enduring powers of attorney concern property/affairs. ^{249, 250, 253, 258}

Age of Majority Act (NI) 1969 section 4 gives effective treatment consent at 16/17. For under-16s, competence and interests require assessment. Children Order 1995 Article 6 defines parental responsibility, without creating unlimited disclosure or portal access. Significant or disputed decisions may need court involvement. A nominated-person or proxy-account label does not supply otherwise missing powers. ^{251, 252, 254, 255}

Apply the rules to the patient in this discharge

Patient situation	Care and information consequence
Adult with relevant capacity	Support the person's own decision. An unwise choice alone does not establish incapacity. Address their confidentiality choices; assess any helper's access separately.
Adult lacks capacity for a relevant decision	Establish the national route and any representative's actual powers. Involve the person and relevant consultees. Assess care-team disclosure and representative information needs separately.
Person aged 16/17	Apply the national rules, including Scotland's adult threshold and NI's partial framework. A product age rule does not alone determine parental access or care authority.
Under-16 with sufficient competence	Assess the particular decision and national rules. Respect confidentiality and rights, with lawful exceptions considered separately.
Child lacks relevant competence	Establish appropriate parental/court authority and the child's interests; involve the child as far as possible. Disclose what is justified for care and the representative role.
No appropriate representative, conflict or urgency	Use the relevant advocacy, urgent-treatment or court route. Separate prompt justified clinical handover from disputed proxy access and review temporary arrangements.

The national provisions and professional guidance support these variants. Some disagreements require formal resolution; the map does not decide an individual dispute. ^{241, 245, 254, 255, 258, 174}

Representative roles and their limits

Role	Provider's authority check
Patient's authorised helper/proxy	Establish the patient's authority, its scope and any withdrawal. Helping use a service is different from making substitute care decisions.
Parent/person with parental responsibility	Establish actual legal status/orders and the child's competence, confidentiality and interests for the proposed access.
England/Wales attorney or deputy	Check registration/order, relevant powers, restrictions and activation conditions. A property/affairs role does not become a welfare decision-making power.
Scottish welfare attorney, guardian or intervener	Check the grant/order, relevant powers and incapacity conditions. Section 47 treatment authority and section 50 processes have separate scopes.
NI property/affairs attorney	Establish the actual authority and relevant information need. The existing enduring power does not become a general health/welfare appointment.
Advocate or informal carer	Establish the support function and any specific information entitlement. England/Wales Independent Mental Capacity Advocate (IMCA) duties and record-access powers have defined statutory conditions; advocacy does not automatically confer substitute decision-making power.

Sources distinguish the relevant information needed for a role from general record access. ^{244, 259, 253, 241, 263}

Digital access and the evidence boundary

An electronic subject-access request can trigger Article 15(3)'s electronic-copy duty. A care-team handover, a representative's request for relevant information and a subject-access request are different routes, each with its own identity, authority and scope requirements. ^{260, 244}

Permissions, acting-as attribution, review dates and access records are useful implementation consequences. Trace any claimed mandatory system field or protocol through the requirements catalogue. This map does not prescribe a UK-wide proxy-access message standard.

Individual grants/orders, placement, safeguarding, mental-health and liberty-authorisation questions retain their own legal routes. Restrictions on liberty and significant unresolved disagreements need separate assessment; the current professional guidance preserves that distinction. ²⁵⁸

Hospital discharge · SCR and equivalent records · Blood tests and results · Requirements catalogue

Where abuse or neglect is suspected, the protection worked examples add the separate referral, digital-system and controlled-access decisions.