When we consider the example of the NIAS confidentiality policy, which states, 'information about clients would be kept confidential, and this was essential for maintaining their trust in the agency and hence essential for running the service' (K100, Offprints, p.126), we can see this highlights confidentiality is of the utmost importance for this service to continue successfully. The NIAS policy also contains further clauses relating to the transfer of clients' confidential information beyond the agency, it then goes on to expand circumstances in which a transfer may happen, and gives guidance around transferring the information with explicit consent from the service user or under a court order.
In the story of Wayne (Unit 23, pp. 75 & 77) the NIAS have been asked to disclose whether Wayne is a drug user. Wayne had not previously provided his consent to the NIAS and is in no position to give consent as he is barricaded in his room and on the verge of being removed from his home under the Mental Health Act (Section 136). Clause 5b(iii) of the NIAS confidentiality policy would be relevant in this situation, as the client is not in a position to give consent and information would be released in the client's best interests, due to his behaviour being driven by drug taking rather than a mental disorder.
In contrast to Wayne, in Jonti's story (Unit 23, p.75) he had given his consent to the NIAS that information about him could be disclosed, therefore clause 5a would apply if information was requested or came to light. In the story Jonti goes on to request that newly discovered information should not to be disclosed, therefore clause 5a would no longer be valid. Although the request was received, there was concern for Jonti's health, therefore a review of Clause 5b of the confidentiality policy about releasing information without a client's consent would be useful. Unfortunately, Jonti's situation does not fall under these guidelines, and therefore his request for non-disclosure would remain valid. This situation could raise the dilemma of having to continue working with Jonti whilst being aware of the information he wishes not to be disclosed. A further dilemma would also exist around advising the relevant organisations that information about Jonti can no longer be disclosed.
There are many examples of records that are kept regarding service users throughout their lives, across many different organisations. Records can be extremely useful for monitoring, co-ordinating, authorisation, accountability and collating and storing information for decision making. A record may have many different uses at the same time, and systems that are used to document one set of information, may not be suitable for documenting another. Numerous groups can also make various demands on record systems. In addition to records providing these different uses to organisations, records can also be useful to the service user. 'The Data Protection Act 1998 and the Freedom of Information Act 2000 gave service users the right to access information held on them by public bodies, although there are exceptions if access puts the service user or anyone else under serious physical or mental harm' (Unit 23, p.57). For example, a wife may pass information to a doctor about her husband, which is in her husbands' best interests from a health perspective. If the wife explicitly requests her husband should not know who had passed the information to the doctor, and access to his records was requested by the husband, this part of the records may be denied by the doctor in the interests of both husband and wife.
The European Convention on Human rights, to which Britain is party, covers both privacy and confidentiality, Article 8 of the convention states that 'everyone has the right to respect for their private and family life, home and correspondence', as with the Data Protection Act 1998 and Freedom of Information Act 2000, there are exceptions that take into account, terrorism, safety, the prevention of crime and the protection of health (Unit 23, p.81). People who are involved in these types of activities are not afforded the same rights to confidentiality as someone who isn't. An example of the conflict for the need to disclose confidential information in the interest of public safety could be exampled by the aim of the campaign for Sarah's Law to allow controlled access to the Sex Offenders Register, so parents with young children would know if a child sex-offender was living in their area. This campaign has raised issues such as the risk of vigilante reprisals, which has been demonstrated in the United States where those on the sex offenders register have become victims of violence and in several cases people on the register have been killed.
There have also been cases of mistaken identity, both in the United Kingdom and the United States, where people have been attacked despite not being sex offenders (www.wikipedia.com).
Any agency has a statutory responsibility to provide protection for vulnerable individuals they may think are at risk. In the story of 'A stabbing on Christmas Eve' (Unit 25, p.137) a stabbing was committed and witnessed. 'The victim insists the matter should not be reported to the police as the dispute was about illegal business, and the client who stabbed the victim was on probation, and would probably go back to prison if charged with an additional offence'. The responsibility to provide protection for vulnerable individuals would equate to both clients, as well as the perpetrator, the victim may also be at risk of prison due to the illegal nature of the business over which the stabbing occurred. To evaluate whether more harm than good would come of reporting the incident, the seriousness of the incident could be evaluated by taking into account any harm that may occur if the information was kept confidential against any harm which might be done if the information was disclosed, both of these points could be looked at in relation to the agency, the worker, the victim, the client who stabbed him, the probation service and to the public. Any decision that is concluded would have to be reported to management and reasoning would have to be justified against both the option chosen and the option rejected (Unit 25, pp. 137-138).
The correct course of action for the disclosure of any type of confidential information is not a straight forward one and there are many factors to weigh up. The reason behind any disclosure would need to be considered, along with whether explicit consent had been given by the service user, whether their situation had changed since the consent was given and whether they had requested for consent to be revoked at anytime, also whether the request for disclosure was received under a court order. In addition to this, the risk of adverse implications to the service user, the agency, the agency employee, and the public all need to be evaluated. Above all of this should remain the agencies responsibility of confidentiality, clear confidentiality policies, governance, appropriate training, along with transparent complaints procedures for service users.
In summary, confidentiality policies are intended to assure service users they can trust an organisation that may hold confidential information about them. Confidentiality policies also provide guidelines that should be followed when and if there is a need for confidential information to be disclosed outside of an agency. The health and welfare of the service user and the safety of others should always be considered in conjunction with guidance in the policy. There are numerous records kept by many different organisations and these records can be extremely useful especially for decision making. Although service users have rights to view any records held about them, discretion is generally used with consideration being given to the health and wellbeing of the service user and others at the time of disclosure. Although confidentiality is a human right, there can be exceptions especially when activities break the law, this in itself can raise the dilemma of disclosure in the interest of public safety and the agencies statutory right to provide protection for vulnerable individuals that may be at risk.
Word Count: 1,600
References:
Brownlie, I. (ed.) (1983) Basic Documents on Human Rights (2 edn), Clarendon, Oxford.
Open University (2005), K100, Understanding Health and Social Care, Block 6: Who Needs to Know What? Issue 4.
Open University (2003), K100, Understanding Health and Social Care, Offprints, NIAS Confidentiality Policy, Offprint 30.
www.doh.gov.uk/dpa98/The Data Protection Act 1998: Protection and Use of Patient Information
www.wikipedia.com
