Much has been written about both the importance of confidentiality and information sharing, and people are often confused by what is meant. It can also be confusing trying to decided what it is ok to share and in what circumstances.
Starting right
It is helpful to start any professional relationship by telling people what you mean by confidentiality, and in what circumstance you might need to share information with colleagues or those outside of the organisation. For example:
‘Its important to start by talking about confidentiality. Any information you give me today or during our sessions will be kept securely, and although I may share information with my supervisor and/or team members, we won’t usually share your information with people outside of the organisation without your knowledge and consent unless we are concerned that you or someone else may be at a serious risk.’
Asking Questions of others need not breach confidentiality ‘simply asking for information from carers, relatives, friends or other people about a patient without the patient’s consent need not involve any breach of confidentiality, providing the person requesting the information does not reveal any personal confidential information about the patient which the carer, relative, friend or other person being asked would not legitimately know anyway.’ Mental Health Act 1983 Code of Practice 18.10
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Although the quote above comes from a mental health law source, the principles expressed are applicable to other situations. For example, if a neighbour or another parent expresses concerns to you about a child, listening and asking questions will not automatically break confidentiality, as long as you don’t release any information that they couldn’t legitimately have known anyway.
Is the information confidential?
‘Confidential information is information of some sensitivity, not already lawfully in the public domain (or not readily available from another public source), which has been shared where the person giving the information understood that it would not be shared with others. For example, a teacher may know that a parent misuses drugs. That is sensitive information, but it may not be confidential if, it is widely known or it has been shared in circumstances where the person understood it would be shared with others. But shared, in a counselling session, it would be confidential’. (from London Child Protection Procedures v4. 3.3.2-3.3.3
In other words, not all information a person tells you will be confidential, either because it is already widely known, or because it was shared in a way that the person knew it would be shared.
Gaining Consent to share
Clearly, the ideal situation would be to share confidential information with the knowledge and consent of those concerned. ‘informed consent’ implies that the person whose consent is sought Has the capacity to make the decision about releasing the information (ie understand what is being asked, understands the consequence of sharing and is able to reach a decision and communicate it.) Is not acting under duress – ie the consent is freely given
However, there will be situations where it isn’t practical or safe to gain the consent of the person concerned. For example because you are concerned that seeking consent will put a child or adult at risk or additional risk.
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Keeping parents on board
Although it won’t always be possible, working in a collaborative yet honest manner with parents is better – so for example, even where you are really concerned about the safety of a child, and need to breach their confidentiality, if you are able to talk to the parent and tell them what you feel you need to share and why, even if the parent is angry and scared about what might happen next, you are more likely to be able to maintain an ongoing relationship with them.
The key is to be clear about what might happen if they don’t share the information – ie would it be proportionate to the risks involved, to share the information even without consent?
What to do if you are not sure
If you are not sure what to do, there are lots of people who you can talk to get advise.
For example, all NHS organisations have named or designated doctors, nurses, and other professionals who you can turn to ask advise. Trusts and social care organisations will also have ‘Caldecott guardians’ who have responsibility for protecting the confidentiality of patient and service-user information and enabling appropriate information-sharing.
Schools are also expected to have identified lead professionals for safeguarding.
Finally, the option of calling local child protections services and asking for their advice also exists. You could for example pose a ‘hypothetical’ case to them first as a way to protect the anonymity of the person or persons you are worried about.
