Protecting children and young people: The responsibilities of all doctors

Confidentiality and sharing information

Key points

  • Tell an appropriate agency promptly if you are concerned that a child or young person is at risk of, or is suffering, abuse or neglect. Get advice if you are concerned about the possibility of abuse or neglect, but do not believe that the child or young person is at risk of significant harm.
  • Ask for consent to share information unless there is a compelling reason for not doing so. Information can be shared without consent if it is justified in the public interest or required by law. Do not delay disclosing information to obtain consent if that might put children or young people at risk of significant harm. Do not ask for consent if you have already decided to disclose information in the public interest.
  • Tell your patient what information has been shared, with whom and why, unless doing this would put the child, young person or anyone else at increased risk.
  • Get advice if you are not sure what information to share, who to share it with or how best to manage any risk associated with sharing information.

The principles of confidentiality

28

Confidentiality is central to the trust between doctors and patients and an essential part of good care. Without assurances about confidentiality, children and young people, as well as adults, may be reluctant to get medical attention or to give doctors the information they need to provide good care.

29

Teenagers may be particularly concerned about keeping confidential information from their parents, schools, children’s services, the police and other statutory agencies. Young people, parents and other adults receiving psychiatric care, and other vulnerable people might have similarly increased concerns about sharing confidential information.

30

But sharing information appropriately is essential to providing safe, effective care, both for the individual and for the wider community. It is also at the heart of effective child protection. It is vital that all doctors have the confidence to act on their concerns about the possible abuse or neglect of a child or young person.

31

Confidentiality is not an absolute duty.9 You can share confidential information about a person if any of the following apply.

  1. You must do so by law19 or in response to a court order.20 
  2. The person the information relates to has given you their consent to share the information (or a person with parental responsibility has given consent if the information is about a child who does not have the capacity to give consent).21 
  3. It is justified in the public interest – for example, 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.
9

General Medical Council (2017) Confidentiality: good practice in handling patient information London, General Medical Council.

19

In England and Wales doctors are under a legal duty to report known cases of female genital mutilation in girls and young women aged under 18 to the police. HM Government has published two guidance documents on FGM: Multiagency practice guidelines: female genital mutilation and Mandatory reporting of female genital mutilation: procedural information

20

It is not always straightforward to assess whether there is a legal requirement to disclose information. If in doubt, you should seek legal advice. If disclosure has been ordered by the court, and you are unsure about the relevance of information or records, you should seek clarification from your instructing solicitors or the court.

21

See appendix 1 to this guidance for advice on assessing capacity. There is more guidance in 0–18 years: guidance for all doctors.

Sharing information about those at risk

32

You must tell an appropriate agency, such as your local authority children’s services, the NSPCC or the police, promptly if you are concerned that a child or young person is at risk of, or is suffering, abuse or neglect unless it is not in their best interests to do so (see paragraphs 39 and 40). You do not need to be certain that the child or young person is at risk of significant harm to take this step. If a child or young person is at risk of, or is suffering, abuse or neglect, the possible consequences of not sharing relevant information will, in the overwhelming majority of cases, outweigh any harm that sharing your concerns with an appropriate agency might cause.

39

Any decision to delay sharing information with an appropriate agency where a child or young person is at risk of, or is suffering, abuse or neglect must be taken cautiously and only in circumstances where the increased risk to the safety or welfare of the child or young person clearly outweighs the benefits of sharing information. You must be able to justify your decision. You must record the decision not to immediately share information, along with your reasons and any advice you have received.

40

If, exceptionally, you decide that sharing information immediately with the local authority children’s services or another appropriate agency would not be in the child’s or young person’s best interests, you should discuss this with the child or young person, or their parents. You must keep in contact with the child or young person and regularly review the decision to delay sharing information. You must try to make sure that the child or young person gets the care and support they need.

33

When telling an appropriate agency about your concerns, you should provide information about both of the following:

  1. the identities of the child or young person, their parents and any other person who may pose a risk to them
  2. the reasons for your concerns, including information about the child’s or young person’s health, and any relevant information about their parents or carers.
34

You should ask for consent before sharing confidential information unless there is a compelling reason for not doing so. For example, because:

  1. delay in sharing relevant information with an appropriate person or authority would increase the risk of harm to the child or young person
  2. asking for consent may increase the risk of harm to the child, young person, you or anyone else.
  3. you have already decided that disclosure is justified in the public interest.
35

You should ask the child or young person for consent if they have the capacity to give it. If not, you should ask a person with parental responsibility. You should also ask for consent from any adults you want to share information about. When asking for consent, you should explain why you want to share information and how it will benefit the child or young person. You should also explain all of the following:

  1. what information you will share
  2. who you will share it with
  3. how the information will be used
  4. where they can go for independent advice and support (see Sources of independent advice and support for parents and families for examples of organisations).

Sharing information without consent

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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, objects to information being disclosed, you should consider their reasons,  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.

Delay in sharing information

39

Any decision to delay sharing information with an appropriate agency where a child or young person is at risk of, or is suffering, abuse or neglect must be taken cautiously and only in circumstances where the increased risk to the safety or welfare of the child or young person clearly outweighs the benefits of sharing information. You must be able to justify your decision. You must record the decision not to immediately share information, along with your reasons and any advice you have received.

40

If, exceptionally, you decide that sharing information immediately with the local authority children’s services or another appropriate agency would not be in the child’s or young person’s best interests, you should discuss this with the child or young person, or their parents. You must keep in contact with the child or young person and regularly review the decision to delay sharing information. You must try to make sure that the child or young person gets the care and support they need.

41

In sharing concerns about possible abuse or neglect, you are not making the final decision about how best to protect a child or young person. That is the role of the local authority children’s services and, ultimately, the courts. Even if it turns out that the child or young person is not at risk of, or suffering, abuse or neglect, sharing information will be justified as long as your concerns are honestly held and reasonable, you share the information with the appropriate agency, and you only share relevant information.

Following up your concerns

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You should follow up your concerns and take them to the next level of authority if you believe that the person or agency you told about your concerns has not acted on them appropriately and a child or young person is still at risk of, or is suffering, abuse or neglect.

Minor concerns that might be part of a wider picture

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Risks to children’s or young people’s safety and welfare often become apparent only when a number of people share what seem to be minor concerns. This may include people from different agencies. If a child’s or young person’s condition or behaviour leads you to consider abuse or neglect as one possible explanation, but you do not think that they are at risk of significant harm, you should discuss your concerns with your named or designated professional or lead clinician or, if they are not available, an experienced colleague. If possible, you should do this without revealing the identity of the child or young person.

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If your discussions do not provide a clear view about the possibility of abuse or neglect, you should consider sharing limited relevant information with other agencies that are in contact with the child or young person to decide whether there is a risk that would justify sharing further information. Relevant information would include the identity of the child or young person and a brief summary of the cause for concern. You must ask for consent to do this as described in paragraph 35. If the person or people you ask refuse to give consent, you should assess whether the possible benefits of sharing information outweigh those of keeping the information confidential as described as in paragraph 37.

35

You should ask the child or young person for consent if they have the capacity to give it. If not, you should ask a person with parental responsibility. You should also ask for consent from any adults you want to share information about. When asking for consent, you should explain why you want to share information and how it will benefit the child or young person. You should also explain all of the following:

  1. what information you will share
  2. who you will share it with
  3. how the information will be used
  4. where they can go for independent advice and support (see Sources of independent advice and support for parents and families for examples of organisations).
37

If a child or young person with capacity, or a parent, objects to information being disclosed, you should consider their reasons,  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.

45

If you are not satisfied that sharing information is justified in the circumstances, you should regularly review the position, considering the safety and welfare of the child or young person. You should encourage the parents, or child or young person, to get help and support. If you later become concerned that the child or young person is at risk of, or is suffering, abuse or neglect, you must tell an appropriate agency as set out in paragraph 32.

32

You must tell an appropriate agency, such as your local authority children’s services, the NSPCC or the police, promptly if you are concerned that a child or young person is at risk of, or is suffering, abuse or neglect unless it is not in their best interests to do so (see paragraphs 39 and 40). You do not need to be certain that the child or young person is at risk of significant harm to take this step. If a child or young person is at risk of, or is suffering, abuse or neglect, the possible consequences of not sharing relevant information will, in the overwhelming majority of cases, outweigh any harm that sharing your concerns with an appropriate agency might cause.

Responding to requests for information

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You should consider all requests for information for child protection purposes seriously and quickly, bearing in mind that refusing to give this information, or a delay in doing so, could increase the risk of harm to a child or young person or undermine efforts to protect them.

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You must respond fully and quickly to a court order asking for information. You must also cooperate with requests for information needed for formal reviews22 carried out after a child or young person has died or been seriously harmed and abuse or neglect is known, or is suspected, to have been a factor. The purpose of such a review is to learn lessons from mistakes and to improve systems and services for children and young people. You should also cooperate with procedures set up to protect the public from violent and sex offenders.23 

22

For example, serious case reviews in England and Wales, significant case reviews in Scotland, case management reviews in Northern Ireland, inquests and inquiries, and inquiries into sudden or unexpected child deaths.

23

For example, multi-agency public protection arrangements (MAPPA) in England, Wales and Scotland and public protection arrangements in Northern Ireland (PPANI). See paragraph 71 of Confidentiality for further guidance.

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 Before sharing confidential information, you should do all of the following.

  1. Check the identity of the person who has asked for the information – for example, by calling them back if you receive a telephone request from a person or agency you do not recognise.
  2. Check that the request is valid, understand why the person or agency is asking for the information, what information they need, and how they may use the information in the future.
  3. Make sure that you have met one of the conditions for sharing information set out in paragraph 31.
31

Confidentiality is not an absolute duty.9 You can share confidential information about a person if any of the following apply.

  1. You must do so by law19 or in response to a court order.20 
  2. The person the information relates to has given you their consent to share the information (or a person with parental responsibility has given consent if the information is about a child who does not have the capacity to give consent).21 
  3. It is justified in the public interest – for example, 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.
49

You should only share information that is relevant to the request. This will include information about the child or young person, their parents and any other relevant people in contact with the child or young person. Relevant information will include family risk factors, such as drug and alcohol misuse, or previous instances of abuse or neglect, but you should not usually share complete records.24 If you share information without consent you should follow the advice in paragraph 38.

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.

24

If you are not sure whether information is relevant and whether or not to share certain information, see paragraphs 42 - 52 of 0–18 years: guidance for all doctors.

50

If you are not sure whether to share information, you should discuss your concerns and the best way to manage any risk to a child or young person with your named or designated professional or lead clinician or, if they are not available, an experienced colleague.

Sharing information in the healthcare team/others providing care

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If a child or young person who is suspected to be at risk of, or suffering, abuse or neglect is referred for specialist healthcare, you should make sure that you include relevant information about the child protection concerns in the referral. You should tell the child or young person, or parents, what has been shared and with whom unless doing this would put the child, young person or anyone else at increased risk.