Article 8 of The Human Rights Act explains that individuals’ have the right to a private and family life. The right to a private life is described as including having information about oneself, such as official records, photographs, letters, diaries and medical information kept private and confidential; unless of course there is a good reason for the collection and use of such information, (justice.gov.uk). Acceptable reasons for interference with Article 8 rights would include if it is in relation to: public safety, prevention of crime, the protection of health, and the protection of the rights and freedoms of others. Therefore under this legislation personal information should be kept confidential, but can be passed on in some particular circumstances where it is deemed necessary to do so.
Example
An elderly woman, Mrs Lee, lives in a care home and lately has been feeling dizzy, faint and coughing up small amounts of blood. She confides of her worsening health to her main carer who is very concerned at this, but Mrs Lee tells her not to mention it to anybody else as she doesn’t want to see a doctor because she believes that they do more harm than good.
In this example there could be danger to the health of Mrs Lee, and the Human Rights legislation states that confidentiality can be broken for the protection of health. The carer should pass on the information to the care manager within the setting, so that any necessary changes in the care provided to Mrs Lee can be determined.
Under the Children’s Act, children should have their privacy respected and have the right to confidentiality. However, how much information can morally and legally be disclosed without their consent is subjective to each child’s level of understanding of the given situation. For example, if a child who is in care is asked if they would like to return home now, and they respond no, then the care worker will have to determine whether the child has sufficient understanding and maturity to make that decision. It should always be remembered that the welfare of the child is paramount.
Policies and procedures
Policies are put in place in care settings to ensure that the requirements of legislation are being followed. A policy will provide care workers with guidelines on how to carry out their work, which will ensure that all carers take the same, most appropriate, approach to a task or procedure. A procedure gives instructions to care workers on the exact steps to take in a particular situation, (Fisher, 2006). A care setting will have policies in place relating to confidentiality, as well as other things such as access to records, storage of information, and equal opportunities. Information about the policies and procedures in place should be provided to both staff and service users’; service users are usually provided with a mission statement rather than a list of policies, (as this is more likely to be easily understood) upon admission to a setting.
Recording information
Information about service users’ should only be recorded if it is relevant to providing quality care. A care worker must make sure that they maintain good practice by recording factual information only, which means that any personal opinions the care worker has, or ‘padding’, should not be included. Care workers should bear in mind when recording information that the service user the records are about will have access to them, and any inaccurate information or judgemental opinions of the carer wrongly included in the record could upset or offend the service user if they read them.
Information should be:
- Accurate – incorrect information could result in a service user receiving the wrong treatment
- Legible – information must be written clearly so that other carers who require it in order to carry out their work can easily understand it
- Up to date – out of date information would be unhelpful and could lead to mistakes in care
Carers should also think about the purpose of the information they record; if personal information is recorded and held for no reason then it would go against one of the main principles of the Data Protection Act. Carers should think about how the information they are recording will be used and why it needs to be kept. Care settings should record and keep information if it is:
- Required for making decisions
- Information about a few select people who are close to a service user – this is kept as they may need to be contacted in certain situations, such as if the service user requires an advocate, or if the service user becomes seriously ill
- Vital to the care of a service user, for example a service user could require a particular medication to be administered daily or may be allergic to certain foods
Storage and security of information
Records can be stored in computerised or manual filing systems. It is important to make sure that information is stored in an organised manner to avoid misplacing files and also to ensure that records can be found easily when they are needed.
Ways of storing information manually:
- In an alphabetical system – fairly small organisations may simply store information in a filing cabinet or cupboard, with the files placed according to the surname of the person they are about (Nolan, 2008)
- In a numerical system – large organisations may need to number service users’ files; a numerical system will need to have an index system so that a person`s name can be attached to the correct number (Nolan, 2008)
Information stored manually should be kept in a locked room with the records stored in locked filing cabinets or cupboards to keep them secure. Only those who need to access the information for good reason should be able to do so.
Computerised systems are useful as they enable care settings to store a lot of information using very little space.
Computerised information can be protected by requiring those who attempt to access it to provide an identity number or name and a password. This would ensure that only authorised personnel can see service users’ confidential files. Because there is likely to be certain information carer workers do not need to know about, they may be restricted or limited to particular information on the computer, (Fisher, 2006).
Large organisations, who have a great deal of information to manage, may decide to appoint a member of staff to be responsible for the secure storage of information received and held by the setting. According to Fisher, (2006) a person with this responsibility would have to:
- Keep a record of all the information they hold
- Explain to others how the information can be used
- Agree on who will have access to information
- Agree what information each user will have access to
Care workers responsibilities when handling confidential information
When handling personal information about service users’ carers must make sure that information does not get passed on to those who do not have a need to know. In a busy care setting it could be easy for a carer to accidentally pass on information whilst carrying out their work. Care workers must be careful to avoid this though, as it is likely to cause problems.
Example
It is morning at a residential home, and some of the service users’ are up and in the sitting room. A care worker, Joe, is sitting with a resident and has their file out whilst having a discussion. Another care worker, Alice, walks to the door of the sitting room and asks “can you go see to Mr Cooper? He`s wet himself again this morning, and I have to get two other people up in time for breakfast”. Joe gets up to go assist Mr Cooper, and on his way out he places the file on the table.
There are several problems in this example; to start Joe had a service users’ file out whilst talking with a resident which means he may have been discussing private information. The sitting room may not have been a suitable place to have a private discussion as others may be able to overhear. Alice spoke about Mr Cooper in front of everyone in the sitting room, who would have learnt that he had wet himself. If another resident mentions anything about it to Mr Cooper it may cause him to feel embarrassed of himself or annoyed with his carer for letting others know. Joe should not have left the file on the table in the sitting room, as anyone could pick it up and read the confidential information it contains.
Care workers must ensure:
- That they do not discuss service users where others can over hear
- That they do not accidentally disclose information about service users’ when ‘chatting’ to someone
- They do not discuss service users’ with other service users’ in the care setting
- That they do not leave records where unauthorised people could have access to it – files should only be accessed when needed and returned straight away when the care worker is done with them
- That they do not pass on information without the permission of the service user
- Service users should be told who will have access to their personal information and why it is necessary
Personal information regarding service users’ has to be shared between care staff so that they are able to carry out their duties. Information may also need to be shared between organisations, for example a service user may move to a different residential home in which case his files would need to be transferred. Care settings may also require medical information from service users’ GP`s so that they are aware of any additional needs the service user may have. Information should only be shared between those who need to know; even the relatives of service users’ should not be told personal information unless the service user has given their permission. This could be difficult at times as sometimes relatives believe they have a right to know about the status and care of the service user they are related to. Carers will have to explain that they are not permitted to disclose confidential information, and rather than asking for permission to give information and then giving information it would be simpler to ask family members of service users to speak directly with their relatives.
When exchanging information with another care worker it is important to make sure that they are who they say they are before releasing information to them. This would not be a problem in the day to day running of a setting where carers know each other well and are required to wear identity badges, but in certain situations it may be more difficult to identify a person, such as if someone phones saying that they are a social worker and require particular information about a service user. In such a situation a care worker should check the number that the person is calling from; a care setting is likely to have a list of numbers of organisations (such as the number for social services). Or if the phone does not have caller ID the carer should ask to call them back before they release any information.
Disclosure of information
Care workers must remember not to promise a service user that they will not pass on confidential information, but rather they should explain that they will not pass on personal information unless there is a very good reason to do so, (Fisher, 2006). There may be occasions when information must be disclosed, even without the permissions of the service user.
Example
A carer in a nursery notices a large bruise on a child`s arm, and so asks how he got it. The child says that his mother`s boyfriend hits him when he is naughty, but asks the carer not to tell anyone about it.
The child has a right to confidentiality, however as the child`s safety is in question so the carer must tell someone, such as a supervisor, so that steps can be taken to prevent the child being abused further.
Even if a service user is an adult there may be similar situations in which information must be passed on without the service users’ consent. Disclosure is necessary if:
- A service user is being abused
- There is a significant risk of harm to the service user
- There is a significant risk of harm to the care worker or other service users
Support available to care workers
Care workers may find it helpful to talk things though with another member of staff if they are unsure of how to manage a particular situation. However, carers must avoid talking about the actual problem or issue if it is confidential, (Fisher, 2006). Another care worker may have greater experience and could be able to offer advice and help to find a solution to the issue at hand.
Example
Jess has recently begun work in a residential care home where several of the residents suffer from dementia. When speaking with another carer she says how stressful she finds it when a resident keeps asking the same thing over and over again. Her colleague replies “yes it can be stressful, when I`m in that sort of situation I usually try to distract them with an activity or something else to keep them occupied”. Jess keeps this in mind and the next day when a resident keeps saying that she has to pick her children up from school Jess tries to think of what would keep her occupied. Jess brings the resident their photo album which is in her room. The resident enjoyed looking through the photos and some of the pictures reminded her that her children are grown and don`t need picking up from school.
In this example the care worker was able to offer advice to Jess, which proved very helpful, and none of the residents were named so confidentiality was respected.
The line manager in a care setting would also be a good source of support as they are likely to have a great deal of experience and would be familiar with legislation and the policies and procedures within the setting, (Fisher, 2006). The line manager would be able to offer advice to care workers and in some cases may decide to deal with a situation themselves if the carer is having difficulty. For example, a line manager may take over a situation if the carer has trouble dealing with an aggressive service user or if a service user wants to make a formal complaint.
Summary
Confidentiality means keeping personal information about service users’ private and only sharing information on a need to know basis. Care settings must maintain confidentiality in order to comply with government legislation, such as the Data Protection Act, the Access to Personal Files Act and the Access to Medical Records Act. Policies and procedures in care settings will reflect the requirements of legislation and help to maintain standards by providing guidelines on how members of staff are to carry out their work. Care workers have a responsibility to make sure that private information about service users’ does not get passed on to those who do not have a need to know; confidential information should only be disclosed if necessary for the care and safety of the service user, or for the safety of the staff caring for them. Care workers must make sure that they record information accurately and legibly, and include factual information only; not opinion. Care settings must store records in an organised and secure manner so that they are safe and easy for authorised personnel to find. If a care worker needs support they could seek advice from fellow staff with more experience in care settings, or from their line manager who would be better qualified to help the care worker deal with a particularly difficult situation.
Bibliography
Fisher. A (2006) Health Social Care and Early Years. Heinemann. Oxford
Nolan. Y (2008) Health and Social Care. Heinemann. Oxford
(cited on 21/09/09)
