Rule 2: Members of a care team should share confidential information when it is needed for the safe and effective care of an individual

It is vitally important that health and social care professionals understand that they have a duty to share confidential information in the best interests of an individual in their care – when they are providing ‘direct care’⁸. Confidential information should be shared within the direct care team if that is expected to result in better or safer care. Most people who use health and social care services assume social workers, doctors, nurses and other professionals will share confidential information among the care team.

Sometimes individuals are put at risk when confidential information is not shared. For example, a vulnerable adult being looked after by a care worker who does not know what medication was prescribed when they were discharged from hospital. Tragically, lives have been put at risk when information has not been shared and this has been identified as the root cause of failure in many serious case reviews such as the Baby P⁹ case.

However, even where it is clearly beneficial  to share information for direct care, rules about confidentiality and privacy still apply. That means that only those who have a clear ‘need to know’ should have access to the relevant confidential information.

Sharing with whom? 

Of course, the individual has a right to see their records and this should be at the forefront of the minds of those recording notes and administering care.

Safe and effective care is dependent upon relevant confidential information being shared amongst all those involved in caring for an individual. Generally, individuals should be informed about who will see their confidential information. Without such advice they may not be aware of the wide range of staff who are part of the direct care team, including social workers, doctors, nurses, laboratory staff, social care staff, those that provide specialised care and the administrative staff who support care provision. When an individual agrees to being treated by the wider care team it creates a direct care relationship between the individual and the professional, as well as their team. In these situations it is reasonable for staff to assume that the individual is also agreeing to confidential information about them being shared by the care team.¹⁰

An individual’s decision about particular pieces of information being shared or not being shared within the care team, or with others providing care, should be respected. However, there are other duties or obligations that might outweigh the duty of confidentiality, for example the obligation to report notifiable diseases.¹¹

An individual may decide to withdraw their consent (permission) to a disclosure of particular items of confidential information that members of staff consider to be essential to the provision of safe care. In circumstances where an individual does ‘opt out’ or withdraw their consent, staff should explain that failure to disclose that information may compromise the individual’s care.

This could include opting out of having a Summary Care Record. The Summary Care Record enables healthcare staff caring for an individual to be made aware of any current medications or allergies they may suffer from. This confidential information can ensure that safe treatment can be provided in an emergency situation. Some patients may have already communicated their wish to opt out of their clinical information being used in a Summary Care Record and this wish will continue to be respected and implemented.

Often clinicians will be aware that they are working with only parts of confidential information and should balance the risks and benefits of proceeding with care with only parts of the information. In some exceptional cases, an individual’s request not to share confidential information within the care team may effectively mean that care cannot be provided. The individual’s choice to refuse to share confidential information about them in this way is tantamount to refusal of care. However, individuals do have the right to choose whether or not to accept a form of care.

Individuals may also choose whether confidential information about them can be shared more widely than the direct care team, for example with family members or carers. Where the individual lacks the capacity to decide, it may be judged that sharing confidential  information with a carer or family member is beneficial for their care.

When considering whether to share confidential information with a carer or family member, the guidance below should be followed:¹²

• professionals should establish with the service user or patient what information they want to be shared, with whom, and in what circumstances.
• confidential information should be shared with the carer when the service user or patient has given explicit, informed consent and when the carer consents to be told.
• where the service user or patient does not have capacity to give valid consent, confidential information should be shared with the carer where it is in the person’s best interests

What should be shared?

When confidential information is shared within the care team, only information that is relevant, necessary and proportionate should be shared. Close attention must be paid when applying this test to avoid compromising care. There are data protection principles¹³ involved, such as the need to demonstrate that:

• there is a clear purpose, for example to help with a diagnosis.
• the purpose could only be achieved by the sharing of confidential information.
• the extent of the information sharing is kept as limited as possible, consistent with achieving the clear purpose

Where confidential information is stored in a way that makes it practicable to separate pieces of confidential information, it is not acceptable to share all information in an individual’s care record unless the confidential information is relevant and appropriate to the individual’s care. For example, only part of a patient’s medical history may be relevant to a new referral so the rest of the medical record should not be shared unless there is a clinical reason to do so. In circumstances where it is impossible to separate out the relevant information, such as in the case of paper records, sharing in the interests of care is the priority. Confidentiality should not become a barrier to safe and effective care.

It is important to remember that individuals have different needs and values. Even if something does not appear to be sensitive, it may be considered to be sensitive by the individual service user or patient. It is likely that individuals will regard matters relating to their mental and sexual health as particularly sensitive. There are special rules that apply to information concerning these matters.¹⁴

Safeguarding

The need to share confidential information becomes an absolute imperative in cases involving a threat to the safety of others. An example of this could be the prevention of abuse of a vulnerable elderly person. This may necessitate the sharing of confidential information with the police or other organisations.

In addition, everyone who comes into contact with families has a role to play in safeguarding children. Where there is reasonable cause to believe that a child or young person may be suffering or may be at risk of suffering significant harm, practitioners should always consider referring their concerns to children’s services or the police¹⁵