Health and Social Care: the Right to Confidentiality

The Data Protection Act 1998 gives people the right to confidentiality of personal information. Confidentiality means keeping information given to oneself private and not sharing it with anyone that does not ‘need to know’. In the care setting, providing confidentiality requires confirmation that personal and private information belonging to service users cannot be accessed by others. Any information given by a service user should not be disclosed without the service user’s permission.

Personal/private information a care setting will regularly come across can include: * Information being discussed orally, for example in a nursery care setting a care worker discussing/debating with a parent of a child (also a service user) how they should deal with and act upon their child’s behavior issue. * Written information, for example, in a nursery care setting before a service user starts to fully attend the nursery they should be given personal detail sheet to fill in and hand back to the care setting, the nursery should then make sure these are stored safely and securely.

* Electronic record, for example, in a nursery care setting service users’ medical history should be stored securely on a computer with only authorized personnel having access. Keeping personal information given by service users confidential is very important in a care setting; this is because confidentiality is an important right of all clients.

The following reasons will explain this importance: * Trust: if a service user knew that a certain care worker would not pass on things that they have said, they will be more likely to tell that care worker what they really think and feel. If a service user was to tell a care worker something personal, and then that care worker went on to tell someone else for no apparent reason, merely just to on-go a gossip, if the service user found this out they could potentially feel extremely upset, embarrassed, angry, etc.

And there would be loss of trust, and a massive decrease in the likelihood of the service user ever telling that specific care worker anything private ever again. For example in a nursery care setting a service user privately told a care worker that their child, attending the nursery, was not fully potty trained during day. Later on that day, the same care worker that was given the personal information was in the care setting toilet with a fellow colleague supervising the young infants as they washed their hands before dinner.

The care worker said to her collegue, in a loud tone, “oh I almost forgot, some will have to check on Joseph (the service user that is not potty trained), he isn’t potty trained and has probably messed his pants by now”, this form of oral communication taking place allowed other service users that were washing their hands to hear, they laughed and later on teased Joseph on the fact he was not fully potty trained unlike the majority of them. At the end of the day when the service user came to collect her child she noticed the other children teasing Joseph about this matter and found herself reacting in a very upset manner.

Confidentiality was broken in this scenario and it was not classified as a ‘need to know basis’, therefore the service user was very upset and significantly lost trust for this care worker, which concluded in the service user not wanting a further relationship to build with this individual and the service user not telling the specific care worker anything personal again. * Self esteem: if a care worker was to keep things confidential between themselves and a service user or colleague it would show that they have respect and value the individual and that they believe that what the service user or colleague says matters.

Therefore maintaining confidentiality in a care setting will lift levels of self-esteem within individuals more than if private details were to be shared with others. For example in a nursery a service user approaches a care worker and privately puts forward their concerns on their sons development, the service user explains to the care worker how they feel that their son, attending the nursery, is slightly slow in reaching his milestones and whether this affects his nursery experience (for example will he be able to still join in everyday nursery activities if he is intellectually not as capable as the rest of the children?).

After having this discussion, the care worker went onto tell another service user who was experiencing a similar dilemma which then went onto telling other service users/friends. Soon enough a lot of people in the care setting knew about this private information and the service user soon to realize when fellow service users approached inquiring about their sons intellectual well-being.

Once the service user had realized that their personal information that they had shared with the care worker was no longer confidential and others knew, the service user felt upset and disrespected, they felt as if they were not valued as a person by the care worker, which resulted in the lowering of their self esteem. This example shows that one of the reasons for the maintenance of confidentiality in a care setting being so important is that it raises individual’s levels of self esteem and make them generally feel better within them self.

* Safety: a service user may have to leave their property or personal possessions unattended to at times, and if a care worker was to tell someone else this they may be tempted to break into or steel the eservice users belongings, or they may pass the information on to someone else who may break in, steel, etc. from the service user. It is important that care workers must therefore keep personal information confidential to protect service users’ property and personal safety.

An example of when a care worker does not maintain confidentially and safety is affected is, in a nursery care setting a parent is dropping off their child when becoming involved in a friendly interaction with the care worker that which greeted them as they entered. The service user and care worker soon got on to the subject of the approaching weekend and began to go into detail about what they were both doing, the service user explained how the whole family were going down south for the whole weekend to visit their family, and then explained that this meant their house was going to be left unattended for the duration of the weekend.

Later on that day the care worker got into a conversation with another service user picking up their child from the nursery, in this interaction the care worker said “oh I wish I was doing something interesting this weekend, I really want to be taking the family down south like Gwen (the service user from earlier)” this comment led to further questions and information being exchanged which allowed the service user with enough information to then break into the house during that weekend and put the house in a state that makes it no longer safe to live in.

Therefore this example shows that if a care setting/care worker fails to maintain confidentiality a service users safety and state of property could be in jeopardy. * Professionalism: a professional service that claims to provide and maintain confidentiality must be seen to keep private information confidential. Maintaining confidentiality is part of a care workers professional code of conduct.

For example in a nursery if a care worker was to break confidentiality without a good reason behind it, this would be seen as very unprofessional and the care worker, depending on the severity of the situation itself, can potentially suffer serious consequences, such as being fired, this is because care settings are legally permitted to provide service users and staff with the right to confidentiality. * Legality: there are legal requirements to maintain the confidentiality of personal records.

A mandatory such as The Data Protection Act 1998 gives service users in care setting the legal right to confidentiality, meaning it is illegal for care workers to not provide and maintain confidentially unless under the exception of a ‘need to know’ situation and the service user has given their permission. For example for a nursery care setting to remain legal they need to make sure that the care setting and each individual care worker provide all service users with confidentiality and maintain it.

Therefore to ensure legality the nursery should produce a series of policies, one that which applies focus to confidentiality, for the service users to see, and to help represent legality. An example of a policy that visually shows service users that they are provided with the right to confidentiality, and follows various data protection acts is given as follows: This policy represents the agreed principles for confidentiality throughout the Nursery. All Nursery staff, representing Jack in the Box Nursery have agreed this policy.

Jack in the Box works with many children and families and sometimes will be in contact with confidential information. We will respect confidentiality in the following ways: * Parent will have ready access to the files and records of their own children but will not have access to information about any other child. * Issues to do with the employment of staff whether paid or unpaid, will remain confidential to the people directly involved with making personnel decisions. * Staff will not discuss the individual children, other than for purposes of curriculum planning/group management, with people other than the parent/carers of the child.

Any anxieties/evidence relating to a child’s personal safety will be kept in a confidential file and will not be shared within the group except with the child’s key worker or managers. Information given by parent/ carers to the managers or key person will not be passed onto other adults without permission. Students on work experience or other recognized courses observing in Jack in the Box will be advised of our confidentiality policy and required to respect it. All the undertaking above as subject to the paramount commitment of the nursery as is the safety and wellbeing of the child.

Please see our child protection policy. The nursery will comply with all requirements of the Data Protection Act. * Discrimination: confidential information passed on to those that do not need to know could result on a service user feeling discriminated against or put in danger if care workers were to pass on personal information to their friends, neighbors or other members of the public, service users may feel as if they have lost control over their lives. For example in a nursery care setting a child, you attends the nursery, has mother with mental health problems that is kept totally under control with medication.

The father has explained these new issues occurring to the nursery as he feels that his child could be affected and that the nursery should know about this. However this soon becomes the subject of gossip in the care setting and the mother with these issues soon was seen as a threat to other service users, resulting in resentment and abusive comments being indicated to the particular service user. This example shows that if a care setting does not full provide and maintain confidentiality service users can feel discriminated against, which can lead to extreme upset or offense.

However it is very important for a care worker/ care setting to make sure that they never promise not to pass on personal information. It should be explained to service users that personal information they may provide should not be passed on unless there is a very good reason to do so, also known as a ‘need to know basis’. All care workers should know if it is necessary to break confidentiality, because there will be occasions that occur when breaching confidentiality is the only solution or way to deal with the situation.

The main reasons for sharing confidential information are: * If someone said they were going to harm themselves * If someone has said they intend to harm another person * If someone said they plan to be (or have been) involved in a criminal offense * If someone reveals information that can be used to protect another person from harm If any of these ‘need to know’ situations where to arise then the personal information needed to be passed on should be made sure to only be passed on to the ‘named’ or responsible person in the care setting, as this person will know how to best deal with the situation and are more likely to take correct action.

For example in a nursery child confesses to a care worker they have got a particularly strong relationship with that their father has recently been physically abusive towards them and revealed a series of cuts and bruises to back up this accusation. After saying this the child however told the care worker that is was a secret and said if anyone was to find out he would just get in trouble with his father and suffer ongoing and possibly worse abuse.

The care worker in this scenario instantly reacted by explaining to the child that they may not be able to keep all information confidential (obviously adjusting their pace, tone, clarity and vocabulary to do so in a way that which the child completely understood and was successful), basically saying “oh right, well this is very serious you’know Josh (the name of the child) if this is true, and maybe I can fix it and stop you getting hurt, but I would need a little help, I promise you will not get in any more trouble josh”, the service user nodded allowing the care worker to take further action.

The care worker knew that this is only an accusation and it could well be untrue or misunderstood, however if it was true the safety and wellbeing of a service user is at potential risk of harm, therefore the care worker knew that confidentiality needed to be breached as it was necessary to proceed with this case. The care worker decided to tell no one apart from a senior member of staff in the nursery that had a lot of experience and insight in this profession.

Telling this care worker was the correct thing to do as they knew how to deal with this situation and efficiently and professionally, which therefore allowed the scenario to result successfully as the child was took away from his abusive father (as it was proven) and was able to carry on his schooling life without domestic problems occurring and the previous risks to his wellbeing were dramatically decreased. This example shows a care worker breaching confidentiality in order to handle a situation successfully.

Therefore this further backs up the fact that not all personal information should be kept completely confidential, however when it is necessary to break it only minimal amount of people should be told of this personal information and only if they need to know. It is part of every care workers role, however, to be able to assess situations and determine whether confidentiality needs to be broken because in some cases care workers should realize that it is unnecessary to break confidentiality to handle some situations.

For example if a child at a nursery was unable to complete an activity as successful as the rest, a care worker indentifying this should realize that no one other than the child’s parents really needs to know this and if the care worker went on to tell friends or a series of work colleagues they would not be maintaining the right of confidentiality to the service user as it is not necessary for anyone other than the parents to know.

Therefore it is important for care workers to accurately sum up situations and asses them in a way which will correctly determines whether someone else needs to know and requires their involvement, this is vital as potential harm or upset could occur, for example if a child in a nursery told a care worker that they get physically abused and the care worker didn’t really believe them thinking that their parents were really nice and decided it was best to keep this information completely confidential, the child then suffers from a high risk of further abuse which could really question their wellbeing and could potentially lead to serious harm to the child. Care workers in all types of care settings must know how to provide and maintain confidentiality to service users, and make sure that in the case of a ‘need to know’ situation only minimal people will be informed of the private information and it is not further spread.

Therefore care workers must know about and effectively carryout and maintain methods that help provide and maintain confidentiality to service users, some of these methods that maintain confidentiality in the care setting are as follows: * Keeping personal information secure and away from people who do not need to know: care settings, in order to maintain confidentiality, should provide secure environments for personal information to be kept in, as this will put others (that do not need to know) off from accessing the information. For instance, a very old, fragile filing cabinet was holding private information, seeing that it is not very secure and will be easy to access will tempt a person more to access the private information and read it.

Also for example in a nursery care setting if a child was to accidently run into the insecure filing cabinet; due to their playful nature at that age, with it not being secure the filing cabinet could easily break and reveal private information about service users to everyone in the care setting which would therefore break confidentiality under unnecessary terms. Part of providing a secure environment for personal information is making sure that it has some means of security protecting it, this will put others off from access the information as it will make it much more difficult to do so, for example putting a password on a computer; if you were attempting to access private documents in a computer see it had a password guarding these files would instantly make it more difficult to access a d therefore put you off more.

However with security there become a responsibility that care workers must adopt, for example if a care worker had a security device such as a key to protect their filing cabinet containing private information, it would then become the care workers responsibility to keep the key safe and always with them, not allowing anyone else to access it. Also placing a device that stores personal information is very important too and should be well considered, this is because placing, for example a filing cabinet, in an open area where a lot people pass and can see is more likely to tempt people to attempt to access it and it is less likely for someone to unintentionally access , for example if a filing cabinet was placed in the middle if a play area in a nursery, there is a chance that a child could accidently run into the filing cabinet resulting in it breaking and potentially revealing private documents and information.

Therefore it is best to keep devices that store private information, such as filing cabinets, computers, etc. out of the way of public, ideally they should be kept in places such as a care workers office because most service users in the care setting will not come across it and therefore not be tempted into or accidently accessing the private documents that it holds. * Preventing access to files containing personal information by keeping them in locked filing cabinets: with filing cabinets it is important that they are always locked so that no one can access them and it is a care workers responsibility to make sure that their filing cabinets are locked at all times, apart from when in use.

Care workers are also responsible for the safeguard of the key required to lock and unlock the filing cabinet and ensure that it does not end up in the wrong hands and allow others to access the personal information that the filing cabinet holds. Part of safeguarding a key is to avoid things such as labels or key chains which will identify what the key is used for, for example a care worker has a lot of keys and they regularly get them all confused and mixed up, therefore she decides to label them all to remind her. She labels the key for the filing cabinet ‘filing cabinet’ in clear words across a key ring she attached, however one day the care worker dropped this key whilst distracted by the vast tasks her everyday career was demanding, the care worker therefore did not realize this.

The key was picked up by a passing service user which was then instantly able to identify what the key was for, due to this gain of knowledge the service user suddenly became more encouraged and more tempted to access the filing cabinet and view the personal files, whereas if the key was not labeled or labeled in a way that did not give away its use (for instance through use of color code, which would remind the care worker however not properly give away to others its true use) a service user picking it up would have no idea what the key’s initial use was and therefore put them off and make it much more harder for them to access what the key was protecting, that which in this case was the filing cabinet. Also with keys not only should a care worker carefully consider how they plan on identifying their key without obvious labels that make it apparent what their use is, they should also consider where they are going to keep the key.

It is important that keys are kept safe and are very unlikely to get lost, picked up or stolen as this could potentially lead to the unnecessary breach of confidentiality which is deemed as illegal within any care setting. Keys should never be left next to or near a filing cabinet as this will make it easier for those not supposed to access it actually access it. One of the safest places for a care worker to keep a key is actually on their body, as this will also allow them will full access to the filing cabinet at any time they wish to in the working day. However when placing a key on the body/clothing it is important that this is thought carefully about, because even the type of care setting can influence decisions on where to keep the key.

For example in a nursery care setting the majority of service users care workers come across are infants, so if a care worker decided to wear their keys clipped onto their pants allowing everyone to easily see them, the shininess and other properties of the key a more likely to attract the infantile age group, and make them experience urges to grab and pull the keys, which could lead to the care worker losing their key to the filing cabinet or a child unintentionally stealing the key and even passing it on to others.

Because of this the nursery care worker decided that it was best to keep keys hidden away out of service users’ sight, as this further prevent the chance of any mishaps occurring and the key becoming out of the care workers possession. The care also decided to avoid putting the key in any jacket pockets as it is likely for her to take her jacket off at some point during the day and she could easily forget that it holds the key.

Putting a key in a pocket is also very predictable and will always be one of the first places people will suspect a key to be kept, and also again relating back to service users, with the care setting being a nursery, the children also be more likely to fiddle with the care workers pocket and potentially access any possessions that the care worker has kept in them. In the end due to careful thinking the care worker decided to keep the key in a pouch in her bra, this may sound inappropriate at first however when you think about it, it is simply genius. A pouch in a bra provides a hidden environment unlike to ever be accessed in the working day as no one would try and steal from there or even think that a key would be hidden there in the first place, also with this environment it will be hidden away from the sight of service users therefore not encouraging them to grab or pull the key.

Keeping the key in the pouch in her bra will also mean the care worker has full access to the key at anytime during the working day as it will always be on the care worker and is unlikely to be lost or dropped, especially without the care worker not realizing. This example really helps to back the previous statement that it is important for a care worker to carefully consider where they want to keep their keys and where will avoid the likelihood of anyone access the key and going on to open the filing cabinet. Therefore when given a key to a filing cabinet that they must guard to maintain confidentiality, care workers should ask themselves these questions: Does my key avoid any labels/key rings that clearly identify what it is used for?

Is the key on me at all times preventing anyone from trying to access it without me realizing? Is it in a safe, secure place that is out of sight? Are the service users I work with going to influence where I put my key (for example nursery children are more likely to fiddle with a care workers zippy pockets, due to their age, which will therefore mean that a key put in a zippy pocket is more likely to be unintentionally taken in a nursery care setting)? Can I access my key at all times during the working day when needed? And finally, have I got a special designated place to keep my key so that I know where it is at all times and will not get lost?

Keys are very important devices to prevent access to filing cabinets and therefore confidential information, so it is vital that they are kept in a safe place and no one will be able to take them and go onto access private files that it is protecting. * Having passwords that must be used for accessing electronic records: it is important that every care setting, in order to maintain confidentiality, adopts security systems in all electronic devices that hold private information, as these will provide passwords in order to access such documents. Passwords are a necessity as they allow care workers to own their own accounts which can hold private information, and make it so they are the only ones that can access their own account so long as they do not tell anyone at all their password.

Passwords will also put others off from attempting to access files, for example if you wanted to see some private files without permission and decided to look on a computer, you would instantly be put off if the account was protected by a password as it makes it much harder to actually access. Most, if not all care workers should have their own electronic accounts that which must be protected by passwords, with this however comes responsibility that the care workers must adopt. Care workers should choose a sensible password that they are likely to remember without writing it down and needing a password hint because if someone was to find this or catch on to the hint it will allow them to access the account and view the private files that is on.

Passwords should also not be obvious and easy for someone else to guess, for example if trying to access a care workers computer without permission and found they had a password on, you may attempt to guess the password. When trying to guess you would try very common passwords, such as ‘password’ or ‘5555’ and maybe you would guess words relating more to the care workers personal life, like the password may have something to do with their favorite band, hobbies, etc. therefore when coming up with a password care workers should make it so that they will remember it and not rely on writing it down or having a password hint, and they should also make it completely random (not relating to them or their personal preferences, etc.) so that if someone attempts to guess the password they do not get it right and gain the ability to view all personal documents.

Care workers should also make sure to never tell anyone their password, as they could pass this on, or the care worker may fallout with the person they have told, and this could lead to them access the care workers account or allowing someone else to, which will therefore mean that confidentiality has been broken. Passwords are very important and are very cleaver devices that guard electronic documents, however to get full benefit from them care workers need to carefully consider factors, such as those listed above, when coming up with a password because if not there is a chance of the breaching of confidentiality.

* Not gossiping about service users or speaking about them by name in front of others so they can be identified: there are times when it is important to keep confidences and information that you have about service users to yourself, for example if a child at the nursery where you work messed their pants, you would be breaching confidentiality to reveal these things to your friends (gossiping). A care worker should not breach confidentiality in situations where service users have the right to privacy or where their comments or behavior do not cause anybody harm or break the law. Where care workers gossip or talk publically about events or issues that happen at work they are betraying the trust that service users and colleagues put in them.

Therefore care workers should always consider what they are saying, and think about what they are about to say before actually saying it, because when talking about things that happen at work when it is not necessary will break confidentiality and therefore failing to provide service users with all of their rights they are legally obliged to. It is very easy to break confidentiality when chatting to a friend or colleague. Talking about a service user to another colleague, by name, loudly enough for people in the waiting room to hear is one example. Another example is going home and saying “you’ll never guess what Tom said today. He…. ”. The care worker in this example has given the name of the service user and broken confidentiality.

Therefore not only is it important to refer to individuals in such a way that they cannot be identified, but it is also important to keep a low tone of voice when discussing private subjects or other individuals (loud enough for the other person to hear, however not loud enough for anyone else to hear), this is because having aloud tone of voice will encourage others to listen into the interaction, and therefore could potentially break confidentiality. The care relationship is based on trust and particularly on the need for care workers to maintain confidentiality whenever possible; confidentiality is an important value in the care profession. That is why it is important that whenever private information is given; care workers consider carefully whether it needs to be disclosed and how to work around situations when it does.

Maintaining and breaching confidentiality (when necessary) should be discussed with service users to hear their side and how they would prefer situations to be handled and what they may want to avoid. For e