Working with doctors Working for patients

 

Introduction

Dr Clifford receives a phone call from children's social services about Olly and Jacquie.

(The story so far...)

Jacquie, 23, is a single parent who is in treatment for heroin addiction

Ms Loo

Ms Loo

We are trying to see how we might be able to help Jacquie, but we really need some more information from you first. It would help if you could send us a copy of her medical records so we can make a decision about whether her drug problem is putting Olly at risk.

Dr Clifford

Dr Clifford

I explained the situation to your colleague last week, and gave her all the information that Jacquie agreed I could disclose, which was everything I considered to be relevant. Of course I'll let you know if anything happens which suggests that further disclosure may be justified. I just don't see what more I can tell you at this stage.

Ms Loo

Ms Loo

Yes, but we just need to make sure that we have the full picture. That way we can make sure we are giving her the right support. Also we'd like to find out a bit more about Olly's grandmother - Jacquie's mother. Jacquie suggested she might look after Olly sometimes. Is she a patient of yours?

What should the doctor do...? (Select A,B or C)

A

Provide social services with a copy of Jacquie's records and her mother's records, and any other information they request so that they can identify any information relevant to their role?

B

Refuse to provide social services with any further information without Jacquie's - and her mother's - consent?

C

Ask what kind of information they want and review Jacquie's records, and her mother's records, to see if there is anything else that it may be relevant to social services and the support they might provide?

Dr Clifford

See what the doctor did

Dr Clifford explained to the social worker that he would review Jacquie's records to see if there was anything else that might be relevant to them and the services they might provide. He also explained that he would need to speak to Jacquie and her mother about any further disclosures, but that he would contact them with anything that indicated Olly was at risk of significant harm in the meantime.

References

51. It may be appropriate to encourage patients to consent to disclosures you consider necessary for their protection, and to warn them of the risks of refusing to consent; but you should usually abide by a competent adult patient's refusal to consent to disclosure, even if their decision leaves them, but nobody else, at risk of serious harm.

22. You should do your best to provide patients with the information and support they need to make decisions in their own interests, for example, by arranging contact with agencies to support victims of domestic violence.

52. Disclosure without consent may be justified if it is not practicable to seek a patient's consent. See paragraph 38 for examples, and paragraph 63 for guidance on disclosures to protect a patient who lacks capacity to consent.

53. Disclosure of personal information about a patient without consent may be justified in the public interest if failure to disclose may expose others to a risk of death or serious harm. You should still seek the patient's consent to disclosure if practicable and consider any reasons given for refusal.

54. Such a situation might arise, for example, when a disclosure would be likely to assist in the prevention, detection or prosecution of serious crime, 23 especially crimes against the person. When victims of violence refuse police assistance, disclosure may still be justified if others remain at risk, for example, from someone who is prepared to use weapons, or from domestic violence when children or others may be at risk.

55. If a patient's refusal to consent to disclosure leaves others exposed to a risk so serious that it outweighs the patient's and the public interest in maintaining confidentiality, or if it is not practicable or safe to seek the patient's consent, you should disclose information promptly to an appropriate person or authority. You should inform the patient before disclosing the information, if practicable and safe, even if you intend to disclose without their consent.
(Confidentiality (2009) paragraphs 51-56)

22. The Adult Support and Protection (Scotland) Act 2007 requires health boards in Scotland to report to local authorities if they know or believe that an adult is at risk of harm (but not necessarily incapacitated) and that action needs to be taken to protect them. The Act also requires certain public bodies and office holder to co-operate with local authorities making inquiries about adults at risk and includes powers to examine health records for related purposes.

23. There is no agreed definition of 'serious crime' Confidentiality: NHS Code of Practice (Department of Health, 2003) gives some examples of serious crime (including murder, manslaughter, rape and child abuse; serious harm to the security of the state and public order and 'crimes that involve substantial financial gain or loss are mentioned in the same category). It also gives examples of crimes that are not usually serious enough to warrant disclosure without consent (including theft, fraud and damage to property where loss or damage is less substantial).

36. You can share confidential information without consent if it is required by law, or directed by a court, or if the benefits to a child or young person that will arise from sharing the information outweigh both the public and the individual's interest in keeping the information confidential. You must weigh the harm that is likely to arise from not sharing the information against the possible harm, both to the person and to the overall trust between doctors and patients of all ages, arising from releasing that information.

37. If a child or young person with capacity, or a parent, refuses to give consent to share information, you should consider their reasons for refusing, and weigh the possible consequences of not sharing the information against the harm that sharing the information might cause. If a child or young person is at risk of, or is suffering, abuse or neglect, it will usually be in their best interests to share information with the appropriate agency.

38. If you share information without consent, you should explain why you have done so to the people the information relates to, and provide the information described in paragraph 35, unless doing this would put the child, young person or anyone else at increased risk. You should also record your decision as set out in paragraph 54.
(Protecting children and young people, paragraphs 36 - 38)

 
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