LO: Describe and discuss the legal and professional duties of confidentiality

Confidentiality

• Patient's right and must be respected by the entire healthcare team
• Must get patient's express consent before disclosing confidentiality information about them or identifies them
• Unless the law allows or requires clinician to disclose
• Comes from Common law, Statute, Contract of employment and Regulatory bodies

Confidential information

• Medical records
• Current illness or condition and treatment
• Personal details
• Record of appointments
• Audio or video recordings
• The fact that a person is or was a patient of yours

LO: Discuss the limits to the legal and professional duties of confidentiality

Regulatory bodies (GMC)

• Confidentiality: good practice in handling patient information
• 0-18 years: Guidance for all doctors
• Confidentiality is central to the trust between doctors and patients
• Without assurances about confidentiality, patients may be reluctant to seek medical attention or give information needed to provide good care

Technology

• Misdirected emails
• Email forwarding
• Information lost/left/stolen
• Unencrypted memory sticks
• Handover notes

Conversations

• Patients in the public eye

Social media

• Doctors' Use of Social Media
• Social media as a medical student
• Ethics of social media use for doctors

Enquiries about patients

• Inappropriate accessing or using private medical information of colleagues or family members
• By telephone: verify caller, security checks and does the patient want information shared

Consequences of a breach of confidentiality

• Serious or persistent failure puts registration at risk with GMC
• Criminal prosecution
• Dismissal
• Embarrassment and bad publicity for employer
• Financial penalty or civil claim for employer

LO: Describe confidentiality and the 'Gilick' competent child

Children

• 0-18 years
• Young people (16-17) are presumed competent for the purposes of consent to medical treatment
• These young people are entitled to the same duty of confidence as adults

Under 16

• All doctors and healthcare professionals have a duty of care and confidentiality regardless of age

'Gilick' competence

• Rights of the child to have confidential advice and treatment more important than any right of the parent
• Without confidentiality, child unlikely to seek advice and treatment
• Not 'Gilick' competent: Parents usually involved in decisions about their medical treatment

LO: Discuss the professional and legal duties of confidentiality; the role of GDPR and the situations where disclosure is appropriate

Adults who lack capacity

• Owed a duty of confidentiality
• Mental Capacity Act 2005 states that people who are involved in their care should be consulted about their wishes and any relevant values and beliefs
• Discussions must be limited and disclosures in the best interest of the patient

Deceased patients

• Duty of confidentiality survives a patient's death
• Respect any request by the patient for their information to remain confidential after death
• Disclose to assist the Coroner or by the law

Breach confidentiality

• Consent of the patient (implied or expressed)
• In the patient's best interests
• Required by Law (Statute and judge-ordered)
• For protection of patients and others - 'Public interest'

Patient consent

• Must understand and agree what is being disclosed
• Disclosure kept to minimum
• Implied consent: family members, other members of the healthcare team
• A wish not to disclose information to other healthcare professionals must be respected

Best interests

• Emergency situations
• Only disclose relevant information

Law

• Legislation provides obligatory disclosure of information
• Must give information required by a court of law
• If you have to breach confidence as a court witness, this is 'privileged'

Public interest

• Prevent and support detection, investigation and punishment of serious crime
• Prevent abuse or serious harm to others
• Public good > Obligation of confidentiality
• Proportionate and limited to relevant details
• Each decision must be on its own merits
• Disclosure should be discussed with the individual concerned and consent sought
• Record should be kept to show the circumstances in which the decision to disclose was made
• Healthcare professionals $\ne$ police informants
• NHS Code of Practice - supplementary guidance: public interest disclosures

Police have less power

• Theft, fraud or property damage is not substantial and does not warrant breach of confidence
• Personal records held in confidence are 'excluded material' and are outside the usual powers of the police
• Order from a circuit judge required to obtain records of a victim
• Special procedure warrant if investigating a serious arrest-able offence

Data protection laws

GDPR and DPA 2018

• All personal data must be processed fairly and lawfully
• Does not apply to deceased patients or where information is adequately anonymised
• DPA gives every living person the right to apply for access to their health records
• Applies to public and private health records
• Applies to employers who hold information about health

Caldicott principles

• By Dame Fiona Caldicott
• Caldicott guardian responsible for safeguarding and governing the use of patient information

1. Justify the purpose/s for using confidential information
2. Use confidential information only when necessary
3. Use minimum confidential information
4. Access to confidential information should be strictly need-to-know basis
5. Everyone with access should be aware of responsibility
6. Comply with law
7. Duty to share information is as important as the duty to protect confidentiality
8. Inform patients about how the information is used

Rights

Rectification

• Data subjects have the right to correct data if inaccurate or incomplete
• Clinical opinion is not inaccurate data, unable to remove clinical opinions but allow patient to add a note to indicate disagreement

Erasure

• Allows individual to request removal or deletion of personal data where data is no longer necessary for the collection purpose
• Does not apply to health records
• Allowed to refuse to comply with request if in public interest, in exercise of official authority or public health purposes

Notes of deceased patients

• Remain confidential but Access to Health Records Act 1990 can apply
• Permits access to records of deceased patient by those with a claim arising out of the patient's death