By Dr Sarah Jarvis 1 0 Comments. On your marks for the SJT Autumn 9 of Vulnerable patients, consent and confidentiality Autumn 10 of Next Article. Coroners, inquests and your responsibilities Autumn 11 of When patients are at risk of abuse or neglect, doctors must decide whether or not to breach their duty of confidentiality and share information with the relevant authorities.
Dr Sarah Jarvis explains how these decisions are made. Releasing information There are three types of situations where doctors are asked to release information.
More from this issue. Feature Hints for handovers. Student dilemma When should I declare a police caution? Confidentiality is not an absolute duty. Example Dr A is a consultant in substance misuse.
Example Dave is the son of a frail elderly patient with dementia. Any 'best interests' assessment will ordinarily involve discussion with those close to the individual. In relation to domestic abuse however care has to be taken to ensure that anyone consulted who is close to the individual is in fact acting in his or her interests.
Although the past and present wishes of an incapacitated adult need to be taken into account when making a best interests assessment, they are not necessarily determinative. The decision needs to be made on the basis of the individual's current circumstances and needs, including, where necessary and appropriate, referral to appropriate authorities. Home Advice and support Ethics Adults at risk, confidentiality and disclosure of information This guidance sets out the current legal and ethical position on disclosure of information relating to adults who retain capacity but may be subject to some form of duress.
Location: UK. Audience: All doctors. Updated: Tuesday 8 September Key messages. Where people have decision-making capacity under the MCA, doctors have no legal authority to make best interest decisions on their behalf.
Whenever doctors seek to discuss confidential information about competent adults, they should consider in the first instance whether they can obtain consent. Information relating to adults with capacity should only be shared without consent where it is in the public interest or where there is other lawful authority such as a court order or statute.
Competent adults have the right to make decisions about how they manage the risks to which they are exposed. Where health professionals have serious concerns about whether a competent adult who is at risk is being coerced into a decision they should consider taking legal advice about approaching the courts. Where adults lack capacity, decisions can lawfully be made on their behalf, based on an objective assessment of their best interests.
The moral dilemma. Some exceptions to this are discussed below. Adults at risk, confidentiality and the disclosure of information. Consent and the disclosure of confidential information. The duty to keep patient information confidential is not absolute.
Disclosure to the police, social services and partner organisations. Public interest and the competent adult. Adults at risk and jurisdiction of the High Court. The Independent Police Complaints Commission report [ 5 ] found that police responses to hate crimes were isolated and unstructured. This has led to a number of key changes in the way the police are expected to respond to repeat vulnerable victims.
Home Office, Some frontline staff and managers can be over-cautious about sharing personal information, particularly if it is against the wishes of the individual concerned. They may also be mistaken about needing hard evidence or consent to share information. The risk of sharing information is often perceived as higher than it actually is. It is important that staff consider the risks of not sharing safeguarding information when making decisions.
Tammy has mental health problems. She visits the GP for a routine check on her medication. While there, she mentions that her partner is violent towards her. The GP is mindful of his duty of confidentiality to the patient. He knows that Tammy has no children, and he does not think that she lacks the capacity to make decisions about living with her partner.
He decides that it is her right to make the decision to not tell anyone about the violence, but he does make a note on her file about what she has said. The next time Tammy comes to the surgery she sees a different doctor.
Tammy has a bruise on her face; she says she fell over and that her jaw is very painful. The GP sends her to the hospital for an X-ray and it turns out she has a broken jaw. She has treatment from the hospital. A few weeks later Tammy calls the police.
Her partner has cut her arm open with a knife and is threatening to kill her. The local authority has the lead responsibility for safeguarding adults with care and support needs, and the police and the NHS also have clear safeguarding duties under the Care Act Clinical commissioning groups and the police will often have different geographical boundaries and different IT systems.
Housing and social care service providers will also provide services across boundaries. This makes sharing information complex in practice. The Care Act Section 6 places duties on the local authority and its partners to cooperate in the exercise of their functions relevant to care and support including those to protect adults.
Sharing information between organisations about known or suspected risks may help to prevent abuse taking place. The safeguarding adults board has a key role to play in sharing information and intelligence on both local and national threats and risks.
This can include learning to inform future prevention strategies. Early evidence [ 8 ] suggests that multi-agency safeguarding hubs may improve:. There may be benefits to other approaches that reflect local needs and resources.
These include virtual links between organisations as opposed to co-location and establishing a single point of reporting. Whatever model suits the locality can be used — the emphasis is on improving the quality and speed of responses to safeguarding concerns through better information-sharing.
The police have received a report from Age UK that a number of local older people have paid a lot of money up front for repair work on their houses but that after a couple of days the workers have not returned to finish the job and cannot be contacted.
Age UK has notified Trading Standards. The police representative and the designated adult safeguarding manager on the safeguarding adults board are contacted and asked to share this information with safeguarding partners.
Adult social services decide to try and alert older people with care and support needs about this danger by:. Following this, one older person who became suspicious was able to give the police the registration number of a van possibly related to the rogue traders. In Birmingham, a partnership approach to tackling antisocial behaviour has been developed by the Safer Birmingham Partnership.
The Safer Estates Agreement is used by all social landlords in Birmingham to enable the sharing of information. Home Office Information sharing for community safety: guidance and practice advice SCIE Report Prevention in adult safeguarding examines other initiatives that may help to prevent abuse.
As long as it does not increase the risk to the individual, the member of staff should explain their responsibility to share the concern with their manager. Managers will need to make decisions about sharing information with external agencies, including the police and local authority. Individuals may not give their consent to the sharing of safeguarding information for a number of reasons.
For example, they may be frightened of reprisals, they may fear losing control, they may not trust social services or other partners or they may fear that their relationship with the abuser will be damaged. Reassurance and appropriate support along with gentle persuasion may help to change their view on whether it is best to share information. If a person refuses intervention to support them with a safeguarding concern, or requests that information about them is not shared with other safeguarding partners, their wishes should be respected.
However, there are a number of circumstances where the practitioner can reasonably override such a decision, including:. If none of the above apply and the decision is not to share safeguarding information with other safeguarding partners, or not to intervene to safeguard the person:. If the person cannot be persuaded to give their consent then, unless it is considered dangerous to do so, it should be explained to them that the information will be shared without consent.
The reasons should be given and recorded. The safeguarding principle of proportionality should underpin decisions about sharing information without consent, and decisions should be on a case-by-case basis. If it is not clear that information should be shared outside the organisation, a conversation can be had with safeguarding partners in the police or local authority without disclosing the identity of the person in the first instance.
They can then advise on whether full disclosure is necessary without the consent of the person concerned. It is very important that the risk of sharing information is also considered. In some cases, such as domestic violence or hate crime, it is possible that sharing information could increase the risk to the individual. Safeguarding partners need to work jointly to provide advice, support and protection to the individual in order to minimise the possibility of worsening the relationship or triggering retribution from the abuser.
SafeLives previously CAADA provide resources for identifying the risk victims face including a Dash risk checklist, which is a risk assessment tool for practitioners who work with adult victims of domestic abuse. It offers a consistent approach to identifying those who are at high risk of harm and whose cases should be referred to a MARAC multi-agency risk assessment conference meeting in order to manage their risk.
If you are concerned about risk to a child or children, you should make a referral to ensure that a full assessment of their safety and welfare is made. Mrs Tweedy is 83 and needs some help at home with shopping and cleaning. She has a son who abuses alcohol. Terry explains to Mrs Tweedy that now she knows about this she really should let her manager know. Mrs Tweedy has the mental capacity to make a decision about this. Terry reassures her that she just needs to tell her manager and that nobody else will be told at this stage.
The manager, Eddie, arranges to visit Mrs Tweedy to discuss the situation. Again Mrs Tweedy is clear that she does not want the police or social services involved with her family affairs. Mrs Tweedy is making a clear decision about her son taking money but Eddie is concerned about the threat of violence. He decides to explore with Mrs Tweedy why she thinks that her son might be violent.
Mrs Tweedy says the violence is usually shouting and hitting the wall and that her son has never assaulted her. She says she can cope with this but she does wish there were some help for her son. She agrees:. They have found it difficult to engage with him, but while they acknowledge that there is some risk to Mrs Tweedy, they do not believe he poses a significant risk to others.
The housing officer has frequent contact with him so they can arrange a joint visit, to appear routine, so there will be no indication that Mrs Tweedy has raised a concern. Then they can explore how best to help him. Eddie feeds this back to Mrs Tweedy.
Department of Health: Confidentiality and information sharing for direct care; guidance for health and care professionals. The Data Protection Act and the GDPR both have provisions that explain the way organisations, charities, and businesses must handle information.
This includes care settings and provisions relating to clients, patients, and employees. There are many uncertainties surrounding confidentiality in health and social care.
This means you may override your duty if:. In these instances, you should always report your concerns to your manager or supervisor. You should also help and contribute to any further actions that are taken to reduce the risk of harm. However, sometimes things are not this simple and it can be easy to misread and misunderstand the signs.
If you have any concerns about someone, or a confidentiality issue arises, you should always ask your manager or supervisor for advice. Consider the following scenario, which explains why over-riding confidentiality is sometimes necessary. You are a care worker and you have gone to assist an elderly male at his home.
When you are helping him to get dressed, you notice several bruises on his back. When you enquire about these, he explains that his usual nurse attacked him last week and caused the bruises. He believes that he said something silly because the care worker started calling him names and then hitting him. There is a clear conflict in this situation.
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