Your news focus on Alder Hey ('The age of consent' pages 1213, 8 February) prompts the question: what exactly is informed consent?

For anyone to give informed consent they must be informed about what it is they are consenting to and the likely outcome. Regardless of the type and nature of the procedure, patients who are being asked to give consent must be told about the procedure, the inherent risks and the likely outcomes.

Imagine a lone patient presented with the stark fact that they have cancer. The next step may well be to outline the proposed treatment, and then they are asked to give their consent. But even if the staff member takes time and trouble to go through everything painstakingly, it is unlikely they will have heard much more than the word 'cancer'.

In many cases they are unlikely to have taken on board anything about the proposed treatment or be in a position intellectually or emotionally to make a judgement about whether or not to give their 'consent' at that stage.

Even in cases where diagnosis, a full explanation to the patient, and the seeking of informed consent may be separated by days, weeks or months; where the information may be reiterated several times, professionals should still ensure the patient is aware and has sufficient knowledge and understanding of all the relevant facts to be able to make an informed decision.

How can professionals be sure?

There are no simple answers.

While it may be time-consuming to check with the patient what they have heard and understood, it is vital if the professional is to assure themselves they have achieved the desired outcome - namely informed consent. Using techniques which include seeking feedback from patients at regular intervals can be helpful.

In that way the professional will be able to ascertain how much the patient has understood.

More care, more time, better training and certain clear monitoring and audit processes are likely to be essential if the previous pitfalls are to be avoided.

David Rogers Deputy chief executive West Birmingham CHC