Confidentiality In Health And Social Care

CONFIDENTIALITY

THE HISTORY OF CONFIDENTIALITY IN HEALTH AND SOCIAL CARE.

One of the oldest documents we can find about confidentiality is the Hippocratic Oath what was written in the 4th century BC.

We all know that nurses are not taking this oath, but we are bound to the same confidentiality regulations as doctors and other health professionals including social workers. Untrained or ancillary workers should not have access to patient's records and there is no need for them to know certain confidential information.

A famous author in social work, (Biestek, 1957) has written a classic book and writes about confidentiality. He states that "confidentiality is an essential principle in a helping relationship …..and crucial to develop a trusting
relationship with the clients.

Health professionals need to comply with these ethics and principals according to the law and the NMC Code. (The Code, 2008)

LEGAL SIDE, CALDECOTT REPORT

The following Acts and Legislation are all about our (as patients and as health professionals) right to confidentiality as stated in the NMC Advices sheet about Confidentiality. These are just a few of a lot:

Data Protection Act, 1998_._

Access to health records,1990.

Computer Misuse Act, 1990

. Human Rights Act, 1998

Health and Social Care Act, 2001: section 60.
Police and criminal evidence Act, 1984

The Caldecott Report according to the Department of Health website:

"Following the production of The Protection and Use of Patient Information in 1996, the Chief Medical Officer of England commissioned the Caldicott Committee to review the transfer of patient-identifiable information from NHS organisations to other NHS and non-NHS organisations." (DoH, 1997)

This report is to help guide health professionals to maintain maximum security of keeping, storing, using, patient's confidential information and personal data. It contains sixteen recommendations about the way of handling information safely and correctly. It recommends also that Caldecott Guardians must be set up in health care settings whose responsibility will be to make sure all health care staff understand and follow the recommendations. A Caldecott Guardian is usually a senior health care professional.

CONFIDENTIALITY AND
TECHNOLOGY.

Nowadays as most medical records are on computerized data holders, breaching confidentiality is much easier and quicker can happen then before technology has been involved in data storing. Health professionals should pay far more attention how to use their computers and make sure that all the security measures have been applied. This means not to leave computers on with client's data shown, logging off in a certain time (few minutes) after the computer has not been used, or even better is just logging off immediately after using it.

Although confidentially is frequently discussed and can be found in all sorts of legislation and company documents, confidentially in relation to technology is often minimally addressed.
There are attempts in the NHS to use a Cryptography Strategy where certain information will be encrypted. This can be accessed at the Department of Health website:" The 'Strategy for Cryptographic Support Services in the NHS', published in January 2001, set out aspirations and targets for the identification and implementation of appropriate technical, operational and management arrangements. These included requirements for both central infrastructure and national services, and the necessary functionality to enable data encryption, digital signing, authentication and non-repudiation services."
(DoH.2002)

BREACHING CONFIDENTIALITY

There are cases when confidentiality can or must be breached, these are exceptions that allow disclosure, when someone is legally required to disclose by court order or inquiries, or in case of there is a need to prevent a serious crime or someone getting hurt or abused. These are called the Public Interest exceptions.

Confidentiality and consent to give out personal data are closely linked. It is usually appropriate to ask a patient and gain their permission to share information clarifying what information can be shared and with whom. There are some cases when getting consent from patients is crucial for the future, as some illnesses progress and the patient will not be able to give consent in a later stage. This is called explicit consent and can be written or spoken. (NMC, 2009) Explicit consent is different from a general consent as it is directly about something specific like someone's physical or mental health or with whom to share medical records. (University of Essex, 2006)

In the case, when patient's capacity is questioned a Multi Disciplinary Team can decide what the patient's best interest is. Sometimes these are called best interest meetings. (Mental Capacity Act, 2005)

CONCLUSION

REFERENCE LIST:

The Hippocratic Oath. Available at: http://www.greekmedicine.net/whos_who/The_Hippocratic_Oath.html (Accessed: 15-12-2009)

Biestek, P.(1957) _The casework relationship._ Loyola University Press

Confidentiality NHS Code of Practice. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4069254.pdf (Accessed: 10-12-09)

The Caldecott Report. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4068404.pdf (Accessed :10-12-09)

NHS cryptography strategy, March 2002

http://www.dh.gov.uk/en/Managingyourorganisation/Informationpolicy/Informationsecurity/DH_4015412 (Accessed: 16-12-09)

NMC advice sheet http://www.nmc-uk.org/aArticle.aspx?ArticleID=3614 (Accessed: 07-12-09)

The Code: http://www.nmc-uk.org/aDisplayDocument.aspx?DocumentID=5982 (Accessed: 07-12-09)

General principles of Data Protection, Caldecott Principles, 'Significant Event Review' Practice Nursing 2009, (20) No 8. Online available: www.internurse.co.uk/ Accessed: 12-12-09

Mental Capacity Act, 2005

http://www.opsi.gov.uk/acts/acts2005/ukpga_20050009_en_1

Explicit consent

http://www2.essex.ac.uk/rm/guide/faqs.shtm#explicit