Confidentiality means respecting someone’s privacy, and abstaining from sharing personal or potentially sensitive information about an individual, especially if that information has been shared in confidence. Show
In the context of health and social care, patient confidentiality is an important principle of providing good care which medical professionals and care practitioners should follow. It means not disclosing information about a patient or client to anyone who should not know or does not strictly need to know, unless consent has been given. It is of course vital to protect the rights of client where appropriate, but health and social care workers and clients alike should bear in mind that a carer’s duty to share information – where required – is of equal importance. Confidentiality legislation in health and social careHealth and social care providers are given extensive training regarding what is appropriate in regards to confidentiality, but to outsiders, it can be difficult to know what legislation is in place and how it is implemented. There are five rules of confidentiality in health and social care:
The 2013 HSCIC Guide to Confidentiality provides detailed information on navigating the complexities of confidentiality legislation as a health and social care worker. How is confidentiality maintained in health and social careConfidentiality in health and social care is essential because it helps patients and clients have confidence that they can share information, and this can be extremely important in ensuring they get the care they need. Maintaining confidentiality is therefore vital for medical professionals and care staff so that they can do their important work. Maintaining confidentiality in medical and social care settings can involve simple practical measures such as positioning computer screens so that information isn’t accidentally seen by third parties, as well as following official guidelines in sensitive and complex situations. Those working in the health and social care sector have legal and professional responsibilities to uphold confidentiality, and will have to undergo significant training on the subject. Day to day maintaining of confidentiality means:
When can you break confidentiality in health and social care?There is no absolute confidentiality in health and social care. This is due to the fact that breaking confidentiality is sometimes in the best interests of the client, or in the best interests of another party whose needs are more important than those of the client in the present situation. For example, health and social care practitioners may need to discuss a client’s symptoms with a fellow practitioner in order to ensure that they receive optimum support. This includes referring a client to another service that may be better suited to their needs. Care workers can also break confidentiality if they suspect an individual is going to seriously harm themselves or someone else. This does not generally include self-harm or drug use unless the practitioner thinks that the client might harm themselves in a life-threatening way by mistake, or the client does not have full mental capacity. Another situation in which it is appropriate for a care worker to break confidentiality is if they suspect that their client is going to commit a criminal act – this is a rule of health and social care practice with which many people are familiar. Again, this does not typically refer to drug use unless the individual in question is supplying. In extreme situations, a health and social care worker may also need to reveal information about their client in court if called upon to do so. At ENA our team are experts in confidentiality in health and social care. If you need any help or advice on matters of confidentiality, or about our specialist care services, please get in touch and we’ll be happy to advise you. Published: January 2015 | Last updated: January 2019 This guide is part of a range of products to support implementation of the adult safeguarding aspects of the Care Act 2014. Sharing the right information, at the right time, with the right people, is fundamental to good practice in safeguarding adults but has been highlighted as a difficult area of practice. Key messages
This guide is part of a range of products to support implementation of the adult safeguarding aspects of the Care Act 2014. Sharing the right information, at the right time, with the right people, is fundamental to good practice in safeguarding adults but has been highlighted as a difficult area of practice. Frontline staff and volunteers should always report safeguarding concerns in line with their organisation’s policy. Policies should be clear about how confidential information should be shared between departments in the same organisation. Effectiveness should be monitored and any internal communication problems resolved. This guide focuses on the sharing of sensitive or personal information between the local authority and its safeguarding partners (including GPs and health, the police, service providers, housing, regulators and the Office of the Public Guardian) for safeguarding purposes. This may include information about individuals who are at risk of abuse or neglect, service providers or those who may pose a risk to others. It aims to enable partners to share information appropriately and lawfully in order to improve the speed and quality of safeguarding responses. The Care Act emphasises the need to empower people, to balance choice and control for individuals against preventing harm and reducing risk, and to respond proportionately to safeguarding concerns. The Act deals with the role of the safeguarding adults board (SAB) in sharing strategic information to improve local safeguarding practice. Section 45 ‘the supply of information’ covers the responsibility of others to comply with any request for information from the safeguarding adults board for the purposes of progressing an enquiry. Sharing information between organisations as part of day-to-day safeguarding practice is not covered in the Care Act because it is already covered in the common law duty of confidentiality, the Data Protection Act 2018, the General Data Protection Regulation (GDPR), the Human Rights Act and the Crime and Disorder Act. The Mental Capacity Act is also relevant as all those coming into contact with adults with care and support needs should be able to assess whether someone has the mental capacity to make a decision concerning risk, safety or sharing information. This guide summarises key parts of these laws to help increase understanding of the basic principles in relation to safeguarding practice and, in particular, the sharing of safeguarding information. This guide will be useful to frontline workers and managers from a range of sectors who work with people with care and support needs. Why do we need to share adult safeguarding information?Organisations need to share safeguarding information with the right people at the right time to:
Adult serious case reviews (now called Safeguarding Adults Reviews) frequently highlight failures between safeguarding partners (local authorities, GPs and health, the police, housing, care providers) to communicate and work jointly. Such failures can lead to serious abuse and harm and in some cases, even death. How to improve communication and joint workingStrategic
* MARAC: A multi-agency risk assessment conference is a means of coordinating risk based responses to domestic abuse. [2] Joint training and policy development
View SCIE’s Social Care TV film, Lessons from the murder of Steven Hoskin.
False perceptions about needing evidence or consent to share safeguarding informationSome 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. How to address false perceptions
Complex networks between safeguarding partner agenciesThe 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 2014. 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 2014 (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. The safeguarding adults board should ensure that it ‘has the involvement of all partners necessary to effectively carry out its duties’. [7] Addressing problems caused by complex networks:
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. The board’s annual report must provide information about any safeguarding adults reviews (SARs). This can include learning to inform future prevention strategies. Some areas have developed multi-agency safeguarding hubs (MASHs) where key agencies are co-located to enable ‘real-time information-sharing, decision-making and communication’. [8] 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.
It is good practice, unless there are clear reasons for not doing so, to work with the carers, family and friends of an individual to help them to get the care and support they need. Sharing information with these people should always be with the consent of the individual. If the person lacks the mental capacity to make a decisions about sharing information with key people, then the Mental Capacity Act should be followed to ensure each decision to share information is in the person’s best interests. Decisions and reasoning should always be recorded. There are only a limited number of circumstances where it would be acceptable not to share information pertinent to safeguarding with relevant safeguarding partners. These would be where the person involved has the mental capacity to make the decision and does not want their information shared and:
Safeguarding adults boards should set out a clear policy for dealing with conflict on information-sharing. If there is continued reluctance from one partner to share information on a safeguarding concern the matter should be referred to the board. It can then consider whether the concern warrants a request, under Clause 45 of the Care Act, for the ‘supply of information’. Then the reluctant party would only have grounds for refusal if it would be ‘incompatible with their own duties or have an adverse effect on the exercise of their functions’. [7] The Safeguarding Vulnerable Groups Act (2006) places specific duties on those providing regulated activities. An employer must refer to the Disclosure and Barring Service (DBS) anyone who has been dismissed or removed from their role because they are thought to have harmed, or pose a risk of harm to, a child or adult with care and support needs. This applies even if they have left their job and regardless of whether they have been convicted of a related crime. A Disclosure and Barring Service has a factsheet on Local authority: Referral duty and power Professional codes of practiceMany professionals, including those in health and social care, are registered with a body and governed by a code of practice or conduct. These codes often require those professionals to report any safeguarding concerns in line with legislation. Care workers or care assistants are not registered but there is a voluntary code of conduct published by Skills for Care. The code states that as a healthcare support worker or adult social care worker in England, you must:
Social workers are registered by Social Work England. The professional standards require social workers to
and to
Duty of candourRegulations under the Care Act place a duty of candour on all service providers registered with the Care Quality Commission from April 2015. The duty:
CommissionersThose commissioning services should consider whether contracts should place an obligation on service providers to share safeguarding information. Any specifications would need to be in line with policy, regulation and the law. SCIE resources on Adult Safeguarding: Commissioning Sharing information on prisonersThe statutory guidance to the Care Act requires local authorities to share information about people with care and support needs in, or in transition from or to, prison or custodial settings. This includes ‘the sharing of information about risk to the prisoner and others where this is relevant’. [7] Sharing information on those who may pose a risk to othersThe police can keep records on any person known to be a target or perpetrator of abuse and share such information with safeguarding partners for the purposes of protection ‘under Section 115 of the Crime and Disorder Act 1998, provided that criteria outlined in the legislation are met’. All police forces now have IT systems in place to help identify repeat and vulnerable victims of antisocial behaviour. The statutory guidance to the Care Act states that safeguarding adults boards should have a ‘framework and process for any organisation under the umbrella of the SAB to respond to allegations and issues of concern that are raised about a person who may have harmed or who may pose a risk to adults’. The control of information in respect of individual cases must be in accordance with accepted Data Protection and Confidentiality requirements’. Information-sharing is related to a number of different pieces of legislation:
Empowerment Prevention Proportionality Protection Partnership Accountability
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