Confidentiality in Health and Social Care

Confidentiality is a key concept of health and social care. The guiding principle is that personal data – i.e. personal details or sensitive information about health conditions – should be shared only with consent and/or when necessary. In care, this also refers to anything that might be divulged about somebody’s personal life, as care workers can work closely with people and their families in their own homes.

Confidentiality in health and social care refers to the ethical and legal responsibility to protect the privacy of vulnerable people’s personal and medical information. This obligation ensures that sensitive details shared during the course of the support are not disclosed without proper authorisation, maintaining the trust that is fundamental to the working relationship in care.

 

In practice, confidentiality means that care providers must keep sensitive records, conversations, and any personal information secure. Only individuals directly involved in the person’s care or those who have a legitimate need to know for legal or safety reasons should have access to this information. 

 

Maintaining confidentiality involves a few key concepts. It requires securing any data about a person’s health, identity, and social circumstances, both in written records and verbal communications. People in care must also be informed about how their information will be used and must give their consent for its use outside of their immediate care context, unless there are compelling reasons for disclosure. These reasons could include preventing serious harm to the patient or others, complying with legal mandates, or addressing public health concerns. The concept and processes of preventing harm and abuse is known as safeguarding.

 

Confidentiality is central to fostering a safe and trusting environment where patients feel comfortable sharing personal information, knowing it will be handled with discretion and respect. Breaching this confidentiality is only permissible under specific, justified circumstances where the benefits of disclosure outweigh the need for privacy.

The Caldicott Principles

The Caldicott Principles are a set of guidelines established to ensure the confidentiality and proper handling of information which could identify people receiving care in the UK. Originally developed in 1997 and updated over the years, these principles guide how personal data should be used and shared, balancing the need for information sharing in healthcare with the necessity to protect patient privacy.

The 8 Caldicott Principles are:

  • Justify the purpose for using confidential information. Each use or transfer of confidential information should have a clear and justified purpose, and its ongoing use should be regularly reviewed.
  • Use confidential information only when necessary. Identifiable information should only be used when it is essential for the intended purpose. If the objective can be achieved without using such information, it should not be used.
  • Use the minimum necessary confidential information. When identifiable information is necessary, only the minimum amount required should be used to achieve the purpose.
  • Access to confidential information should be on a strict need-to-know basis. Only those individuals who need the information to perform their duties should have access to it, and they should only access the specific data they need.
  • Everyone with access to confidential information should be aware of their responsibilities. All staff and individuals with access to confidential information should understand their responsibilities to protect and respect confidentiality.
  • Comply with the law. The use of identifiable data must always comply with legal requirements, including data protection laws.
  • The duty to share information can be as important as the duty to protect confidentiality. Health and social care providers should be confident in sharing information when it is in the best interest of the individual, as long as it complies with these principles.
  • Inform service users about how their confidential information is used. People should be informed about how their information is used, ensuring transparency and avoiding any surprises regarding their data handling.

How Does GDPR Apply to Health and Social Care?

GDPR is governed in the UK by the Data Protection Act (2018). It is a relatively new concept, but it is effectively an update to the principles of data protection which existed previously. It is EU legislation designed to apply data protection principles to the modern world in which websites and other digital systems commonly store our data.

Appearing complex at first glance, data protection is essentially the legislation of confidentiality in data. Other laws such as the Health and Social Care Act (2012) relate to health and social care, but the key concepts apply closely to confidentiality in care. There are specific provisions around the storage of sensitive information such as the right of the individual to request its deletion, but the guiding principles are relatively simple:

  • Data must be collected and used legally and fairly. People should know how their data is being used.
  • Collect data for clear, specific reasons and don’t use it for anything else.
  • Only gather the data that is necessary for the intended purpose.
  • Keep data accurate and up to date. Correct or delete any inaccurate data quickly.
  • Don’t keep personal data longer than needed. Dispose of it when it’s no longer required.
  • Keep data safe from unauthorised access, loss, or damage. Use proper security measures.
  • Organisations must show they follow all these rules and are responsible for their data practices.

The General Data Protection Regulation has significantly impacted health and social care by enforcing strict rules for managing and protecting personal data to ensure privacy. Organisations must handle data lawfully and transparently, collecting it only for specific, legitimate purposes and keeping it accurate and secure. Health data, considered highly sensitive, requires a valid legal basis for processing, such as patient consent or public health needs.

People receiving care have enhanced rights under GDPR, including accessing, correcting, and requesting the deletion of their data. They can also control how their data is used and transfer it to other providers. In case of a data breach, organisations must notify authorities within 72 hours and inform affected individuals.

Health and social care providers must appoint a Data Protection Officer to ensure compliance, train staff, and manage data protection issues. Agreements with third-party processors must ensure GDPR compliance, and research data should be anonymised and used only for its intended purpose. GDPR sets high standards for protecting patient data and maintaining trust in the healthcare system.

When can Confidentiality be Broken in Health and Social Care?

Confidentiality in health and social care is a core principle that protects patient and client information. However, there are specific circumstances where breaking confidentiality is permissible and necessary to balance ethical, legal, and safety considerations.

One primary situation where confidentiality may be broken is when there is a significant risk of harm to the person or others. For example, if an individual expresses intentions to commit suicide or harm someone else, healthcare providers might need to disclose this information to prevent imminent danger and protect lives.

Legal obligations also play a role in breaking confidentiality. Care providers are required to report certain infectious diseases to public health authorities to prevent and control outbreaks. Additionally, if a court issues an order, providers must comply and release the necessary patient information as mandated by law. Cases of suspected child or adult abuse also necessitate breaking confidentiality, as professionals are legally obligated to report these incidents to protect vulnerable individuals from harm, neglect or abuse.

Another important factor is safeguarding concerns, especially when dealing with children or adults who lack mental capacity. In these situations, if there is evidence of abuse or neglect, or if a vulnerable person cannot protect themselves, disclosure may be required to ensure their safety and well-being.

Consent is critical in determining when confidentiality can be breached. If a person gives explicit permission, their information can be shared for the agreed purposes. In emergency situations where obtaining consent isn’t feasible, healthcare providers might disclose necessary information to provide immediate care. For people who lack the capacity to consent, information can be shared if it serves their best interests, particularly regarding their health or safety.

Public safety considerations also justify breaching confidentiality when non-disclosure could pose significant risks to the community. For instance, during a pandemic, sharing information might be essential to prevent widespread health threats. If disclosing information can help prevent serious crimes, such as acts of terrorism, it may also be necessary.

Care providers might also be required to disclose information to fulfil regulatory or professional obligations. For example, they may need to report to safeguarding hubs with local authorities if a colleague’s actions jeopardise patient safety. Within a multidisciplinary care team, sharing patient information is sometimes crucial for providing comprehensive care, provided it respects confidentiality principles.

Deciding to breach confidentiality involves careful consideration and often consultation with colleagues, legal advisors, or ethical committees. The goal is to ensure that any breach is justified, limited to the necessary information, and serves the best interests of those involved.