42 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.
43 The same duties of confidentiality 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 anonymise the information before disclosing it
~ inform the patient 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’s 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.
Sharing information with the consent of a child or young person
44 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.
45 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
46 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.
Public interest
47 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.
48 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.
49 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 person
~ 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.
50 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
51 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
52 You must disclose information as required by law. You must also disclose information when directed to do so by a court.
Young people with capacity have the legal right to access their own health records and can allow or prevent access by others, including their parents. In Scotland, anyone aged 12 or over is legally presumed to have such capacity. A child might of course achieve capacity earlier or later. In any event you should usually let children access their own health records. But they should not be given access to information that would cause them serious harm or any information about another person without the other person’s consent.
54 You should let parents access their child’s medical records if the child or young person consents, or lacks capacity, and it does not go against the child’s best interests. If the records contain information given by the child or young person in confidence you should not normally disclose the information without their consent.
55 Divorce or separation does not affect parental responsibility and you should allow both parents reasonable access to their children's health records.
Child Protection
56 Doctors play a crucial role in protecting children 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.
Sexual Activity
57 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. That in turn presents dangers to young people’s own health and to that of the community, particularly other young people.
58 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.
59 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.
60 You should usually share information about sexual activity involving children under 13, who are considered in law to be unable to consent. 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.
61 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.^
62×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.
63 You can provide contraceptive, abortion and 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.
64 You should keep consultations confidential even if you decide not to provide advice or treatment (for example, if your patient does not understand your advice or the implications of treatment), other than in the exceptional circumstances outlined in paragraphs 46 to 52 and paragraphs 57 to 62.
Conscientious objections
65 If carrying out a particular procedure or giving advice about it conflicts with your religious or moral beliefs, and this conflict might affect the treatment or advice you provide, you must explain this to the patient and tell them they have the right to see another doctor. You should make sure that information about alternative services is readily available to all patients. Children and young people in particular may have difficulty in making alternative arrangements themselves, so you must make sure that arrangements are made for another suitably qualified colleague to take over your role as quickly as possible.
Suitability to work with children and young people
Children are not miniature adults. Good clinical care for children relies on specially trained clinical staff together with equipment, facilities and an environment appropriate to children’s needs. If you have children and young people as patients, you should make sure you have the appropriate training and experience in the clinical care of children in your speciality. You should take steps to make sure that, wherever possible, you and members of your team have access to the appropriate premises, equipment and other resources necessary to provide good care. If you also have adults as patients, you should audit separately the care you provide to children and young people.
67 If you are responsible for recruiting or employing people, or if you otherwise control who can work with children or young people in your care, you should make sure that their suitability is checked. NHS Employers (part of the NHS Confederation) issues advice on good employment practice, including pre- and post-employment, Criminal Records Bureau, alert notice, vetting and barring scheme and other checks.
68 You should follow the GMC’s guidance on raising concerns about patient safety if you have concerns that children or young people are, or may be, at risk of harm because of a colleague’s conduct, performance or health.
69 You should always take children and young people’s complaints seriously. You should help them to complain if their rights or interests have been denied or abused, or if they are unhappy with the care they have received or because they have been denied care.
70 If you prescribe medicines for children, you should be familiar with the current guidance published in the British National Formulary for Children.