0–18 years: guidance for all doctors
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 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.
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.
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.
See Sexual Offences Act 2003, Sexual Offences (Northern Ireland order) 2008 and Sexual Offences (Scotland) Act 2009.
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
Working Together to Safeguard Children (pdf) (Department for children, schools and families, 2010) includes advice and a list of considerations (at 5.29) to be taken into account when assessing risk in underage sex. See also Working Together: Q&A on sexual activity of under 16s and under 13s: (Department for Education and Skills, 2006) Children and Families: Safer from Sexual Crime – The Sexual Offences Act 2003 (pdf) (Home Office, 2004) and the Confidentiality Toolkit (Royal College of General Practitioners, 2000).
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.