0–18 years: guidance for all doctors
Principles of confidentiality
Respecting patient confidentiality is an essential part of good care; this applies when the patient is a child or young person as well as when the patient is an adult. Without the trust that confidentiality brings, children and young people might not seek medical care and advice, or they might not tell you all the facts needed to provide good care.
The same duties of confidentiality24 apply when using, sharing or disclosing information about children and young people as about adults. You should:
- disclose information that identifies the patient only if this is necessary to achieve the purpose of the disclosure – in all other cases you should anonymise25 the information before disclosing it
- inform the patient26 about the possible uses of their information, including how it could be used to provide their care and for clinical audit
- ask for the patient’s26 consent before disclosing information that could identify them, if the information is needed for any other purpose, other than in the exceptional circumstances described in this guidance
- keep disclosures to the minimum necessary.
See GMC guidance on Confidentiality: Good practice in handling patient information, See also Working Together to Safeguard Children (Department for children, schools and families, 2010) and Information Sharing: Guidance for practitioners and managers (both HM Government, 2008) for governmental guidance for England.
See paragraphs 81 - 86 in GMC guidance on Confidentiality: Good practice in handling patient information.
or, where appropriate, those with parental responsibility for the patient.
or, where appropriate, those with parental responsibility for the patient.
Sharing information with the consent of a child or young person
Sharing information with the right people can help to protect children and young people from harm and ensure that they get the help they need. It can also reduce the number of times they are asked the same questions by different professionals. By asking for their consent to share relevant information, you are showing them respect and involving them in decisions about their care.
If children and young people are able to take part in decision-making, you should explain why you need to share information, and ask for their consent. They will usually be happy for you to talk to their parents and others involved in their care or treatment.
Sharing information without consent
If a child or young person does not agree to disclosure there are still circumstances in which you should disclose information:
- when there is an overriding public interest in the disclosure
- when you judge that the disclosure is in the best interests of a child or young person who does not have the maturity or understanding to make a decision about disclosure
- when disclosure is required by law.
You can disclose, without consent, information that identifies the child or young person, in the public interest. A disclosure is in the public interest if the benefits which are likely to arise from the release of information outweigh both the child or young person’s interest in keeping the information confidential and society’s interest in maintaining trust between doctors and patients. You must make this judgement case by case, by weighing up the various interests involved.
When considering whether disclosure would be justified you should:
- tell the child or young person what you propose to disclose and why, unless that would undermine the purpose or place the child or young person at increased risk of harm
- ask for consent to the disclosure, if you judge the young person to be competent to make the decision, unless it is not practical or appropriate to do so. For example it would be inappropriate to ask for consent if you have already decided that a disclosure is likely to be justified in the public interest.
If a child or young person refuses consent, or if it is not practical or appropriate to ask for consent, you should consider the benefits and possible harms that may arise from disclosure. You should consider any views given by the child or young person on why you should not disclose the information. But you should disclose information if this is necessary to protect the child or young person, or someone else, from risk of death or serious harm. Such cases may arise, for example, if:
- a child or young person is at risk of neglect or sexual, physical or emotional abuse (see paragraphs 56 to 63)
- the information would help in the prevention, detection or prosecution of serious crime, usually crime against the person27
- a child or young person is involved in behaviour that might put them or others at risk of serious harm, such as serious addiction, self-harm or joy-riding.
Doctors play a crucial role in protecting children31 from abuse and neglect. Early identification of risks can help children and young people get the care and support they need to be healthy, safe and happy, and to achieve their potential.
A confidential sexual health service is essential for the welfare of children and young people. Concern about confidentiality is the biggest deterrent to young people asking for sexual health advice.32 That in turn presents dangers to young people’s own health and to that of the community, particularly other young people.
You can disclose relevant information when this is in the public interest (see paragraphs 47 to 50). If a child or young person is involved in abusive or seriously harmful sexual activity, you must protect them by sharing relevant information with appropriate people or agencies, such as the police or social services, quickly and professionally.
You should consider each case on its merits and take into account young people’s behaviour, living circumstances, maturity, serious learning disabilities, and any other factors that might make them particularly vulnerable.
You should usually share information about sexual activity involving children under 13, who are considered in law to be unable to consent.33 You should discuss a decision not to disclose with a named or designated doctor for child protection and record your decision and the reasons for it.
You should usually share information about abusive or seriously harmful sexual activity involving any child or young person, including that which involves:
- a young person too immature to understand or consent
- big differences in age, maturity or power between sexual partners
- a young person’s sexual partner having a position of trust
- force or the threat of force, emotional or psychological pressure, bribery or payment, either to engage in sexual activity or to keep it secret
- drugs or alcohol used to influence a young person to engage in sexual activity when they otherwise would not
- a person known to the police or child protection agencies as having had abusive relationships with children or young people.34
You may not be able to judge if a relationship is abusive without knowing the identity of a young person’s sexual partner, which the young person might not want to reveal. If you are concerned that a relationship is abusive, you should carefully balance the benefits of knowing a sexual partner’s identity against the potential loss of trust in asking for or sharing such information.
You can provide contraceptive, abortion35and STI advice and treatment, without parental knowledge or consent, to young people under 16 provided that:
- they understand all aspects of the advice and its implications
- you cannot persuade the young person to tell their parents or to allow you to tell them
- in relation to contraception and STIs, the young person is very likely to have sex with or without such treatment
- their physical or mental health is likely to suffer unless they receive such advice or treatment, and
- it is in the best interests of the young person to receive the advice and treatment without parental knowledge or consent.36
The NHS Confidentiality Code of Practice explains that ‘the definition of serious crime is not entirely clear. Murder, manslaughter, rape, treason, kidnapping, child abuse or other cases where individuals have suffered serious harm may all warrant breaching confidentiality. ‘Serious harm to the security of the state or to public order and crimes that involve substantial financial gain or loss will also generally fall within this category. In contrast, theft, fraud or damage to property where loss or damage is less substantial would generally not warrant breach of confidence.’ It goes on to explain that less serious crimes, such as ‘comparatively minor prescription fraud’ might be linked to serious harm, such as drug abuse, which would justify disclosure.
If you judge that disclosure is justified, you should disclose the information promptly to an appropriate person or authority and record your discussions and reasons. If you judge that disclosure is not justified, you should record your reasons for not disclosing.
Disclosures when a child lacks the capacity to consent
Children will usually be accompanied by parents or other adults involved in their care, and you can usually tell if a child agrees to information being shared by their behaviour. Occasionally, children who lack the capacity to consent will share information with you on the understanding that their parents are not informed. You should usually try to persuade the child to involve a parent in such circumstances. If they refuse and you consider it is necessary in the child’s best interests for the information to be shared (for example, to enable a parent to make an important decision, or to provide proper care for the child), you can disclose information to parents or appropriate authorities. You should record your discussions and reasons for sharing the information.
Disclosures required by law
You must disclose information as required by law. You must also disclose information when directed to do so by a court.28