to enforce confidentiality policies on independent providers. Although some voluntary sector agencies have
always maintained stricter codes of confidentiality than the statutory services, others have been very lax
in this regard. Despite all the attempts to maintain confidentiality, anyone who works in the NHS or in a
local authority, social services will know that they are rather ‘ leaky ‘ so far as confidentiality is concerned.
Nearly everyone who works in a health or social care context works in an organisation which
has a written confidentiality policy and/ or belongs to an occupational group which has it’s own code of
practice. Confidentiality policies quite rightly differ from agency to agency, because different agencies
have ‘ a need to know ‘ different kinds of information, and because different agencies are confronted with
different challenges in trying to keep information confidential. In unit 25 activity 1 we learned how NIAS
a fictional ‘street ‘ drug agency, which offers information and counselling to people who have problems with
drugs set about keeping the kinds of information which might be ‘sensitive’ and which it considered
confidential. NIAS did so through various confidentiality policies namely : the responsibilities of
employees/ volunteers, the scope of the policy, information obtained other than through work in the agency,
information obtained through the work of the agency, transfers of information beyond the agency, releasing
information without consent, authorising transfers of information without consent, to name few of it’s list
of clauses. Even though that at first sight it may not seem to be too serious a matter if someone’s private
affairs become known by outsiders to the health and care services, however, once information is outside the
group of people who are bound by a confidentiality policy there is no knowing where it might get to,
or how distorted it might become in the retelling. Some kinds of information can very discrediting, for
example information that someone has had a paternity test or a test for HIV or has attended Alcoholics
Anonymous, or a drug rehabilitation centre. These could be damaging information for celebrities or high
calibre persons in the sense that it could affect their career and there is always the possibility of blackmail.
Regarding the sort of information which might be obtained from and recorded about a service
user we can take the Deanna Egan situation where she took offence about an assessment queries. Given that
central government allocates finances to social services departments on the assumption that they will raise
income from charging for services such as this, and that charges should be levied according to ability to pay,
it does seem as if the council needs to have this information if it is likely to levy charges in the future.
Another example for the need of information is the case of the blind and physically disabled woman who
said to be shocked by ‘insulting and personal’ questions used in her reassessment for her place at a
rehabilitation day centre. Given that this is a rehabilitation centre whose task is to help users to improve their
daily living skills, it does seem important that staff know what users can do, and how much their abilities
change over time. Asking service users for their views on this seems rather better than staff recording
such matters without asking. Recording of information allows for continuity of care and since this is publicly
funded service, it has to be accountable for providing appropriate services to people who have a need for
them and benefit from them. It is difficult to see how it could be accountable without recording service users’
abilities and progress. Regarding financial situations, the only way in which a social services department
can demonstrate that it is levying charges according to its own scheme of charging is to make records of
the financial circumstances of the service users and of the fees they are charged. Publicly funded services
are not private matters between a service user and a service.
There is sometimes a conflict between the need to co-ordinate services, the need to protect the public
and the need to protect the confidentiality of information and the client’s right to determine who shall see the
records about him or her. The case of Christopher Clunis unit 23 section 4.3 exemplifies the difficulties
of the co-ordinating care at the same time as keeping information confidential. Christopher Clunis was
with mental illness and killed Jonathan Zito someone stranger to him. Through the enquiry which followed the
death ( Ritchie et al .1994 ) it emerged that Christopher Clunis was always getting separated from the records
made about him by various services and mental hospitals. Thus he suddenly appeared as a ( new case)
in a new agency and everything stated from scratch. In these regards this case is a model of how not to
co-ordinate community mental health care. It may or may not be the case that the unco-ordinated care
experience by Christopher Clunis led to the death of Jonathan Zito. But it was certainly the case that many
hostel staff and residents were placed at considerable risk because information about him was withheld
from them.As in many aspects of health and social care the benefits of one individual may well be achieved
to the disadvantage of another {Kohner,1996}.
Like all rights,the rights to privacy and confidentiality are conditional.People have such rights
Only if they satisfy certain conditions. The European Convention on Human Rights covers both privacy
and confidentiality in Article 8 {Brownlie,1983 p246}.The court is most interested in striking a balance
between one individual”s right to privacy and the benefits to others of the information not remaining
private.There are situations in which the argument for disclosing confidential information is more persuasive
than the argument for keeping it confidential. These situations include mostly of people with a list of criminal
activities, such as child abuse, drug dealing, money laundering, terrorism, and so on. Other examples where it
might be appropriate to override considerations of confidentiality are when an organisation attempts to keep
safety hazards or unsafe levels of staffing a secret by including “gagging” clauses in the contracts of employees.
Some people also consider that a person should not have a right to privacy or confidentiality of information if
This right means that harm will come to them.People who work in health and social care are usually regarded
by the civil courts as having a “duty of confidentiality” and may be sued if confidentiality is breached.However
the courts may also regard those worker as having a duty to warn and a duty to protect when the safety of a third
party is involved. A general consideration is always this question, “ will more harm be done by maintaining
confidentiality than by breaching it?”.
We learned that for any health or social care service there will be a minimum of information clients
are required to disclose as a condition for receiving the service. Hence a would-be service user has no real
choice about disclosure. There are different circumstances where it might be appropriate to override considera-
tions of confidentiality. Through the Deanna Egan case we saw information being recorded by the council on a
strictly “need to know” basis.It seems that the best practice is always to make efforts to explain to service users
what information collected about them will be used for, and with whom it is likely to be shared.However,
Health Services are frequently presented with dilemmas in trying to balance the right of individuals to have
Their affairs kept private.
