Covert administration of medication - what social care staff need to know
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Giving someone medicine without their knowledge—such as hiding it in food or drink—is called covert administration. It’s an option of last resort, but in social care settings it sometimes becomes necessary when a person refuses essential treatment and lacks the mental capacity to make that decision themselves.
In January 2025, the Specialist Pharmacy Service (SPS) published updated national guidance, clarifying the legal framework and good practice for health and social care professionals.
Key Points from the Guidance
1. Last Resort Only
o Covert administration should never be routine or convenient.
o It is only considered when all other options—such as offering medication in a different form or explaining benefits—have been tried and failed.
2. Capacity First
o A mental capacity assessment must be carried out for each decision.
o If the person has capacity, they must make their own choice—even if it means refusing medication.
3. Best Interests Decision
o If the person lacks capacity, a best interests meeting should be held, involving family, carers, and professionals.
o The decision must balance risks and benefits, always considering the person’s dignity, rights, and previously expressed wishes.
4. Clear Process & Documentation
o Any covert administration must be recorded, with a care plan in place.
o It should be regularly reviewed to check if it’s still necessary.
5. Legal & Ethical Framework
o The practice must comply with the Mental Capacity Act 2005 and relevant case law.
o It must also align with professional standards for nurses, pharmacists, and care staff.
Why this is Important for Social Care
Covert medication decisions are complex and risky - done wrongly, they could amount to assault or a breach of human rights.
The SPS guidance reassures staff that there is a safe, lawful pathway, but only if the right steps are followed: capacity assessment, best interests meeting, careful documentation, and ongoing review.
It places dignity, rights, and person-centred care at the heart of medication decisions.
Closing Thought
The updated guidance is clear: covert administration isn’t about hiding medicine—it’s about protecting health while upholding rights. By following the right legal and ethical steps, social care staff can make sure that when covert medication is used, it’s done with compassion, transparency, and the person’s best interests at heart.
Five golden rules of covert medication administration infographic