3.3. Explain the potential tension between maintaining confidentiality and the need to disclose information

This guide will help you answer 3.3. Explain the potential tension between maintaining confidentiality and the need to disclose information.

Maintaining confidentiality while sometimes needing to share information presents challenges in health and social care settings. Workers must balance respecting individuals’ rights to privacy with protecting their safety or the safety of others. This tension is particularly important because how information is handled can directly affect the trust between the worker and the individual, as well as the effectiveness of care provided.

This guide covers why confidentiality matters, when disclosure is necessary, and the challenges health and social care practitioners face in balancing the two.

Understanding Confidentiality

Confidentiality means keeping information private and only sharing it with those authorised to know. In health and social care, this involves safeguarding any details about service users, including medical records, care plans, and personal circumstances. Respecting confidentiality ensures:

• The service user’s dignity and privacy are protected.
• They feel safe sharing sensitive information.
• A relationship of trust develops between practitioners and service users.

Legal frameworks govern confidentiality practices. These include the Data Protection Act 2018 and the UK General Data Protection Regulation (UK GDPR). These laws require organisations and workers to protect information, use it appropriately, and prevent unauthorised access or disclosure.

When Maintaining Confidentiality May Conflict with Disclosure

While confidentiality is crucial, certain situations require disclosing information. Disclosures are often made to promote safety, protect the service user, or comply with legal obligations. Below are common situations where the need to disclose arises:

1. Preventing Harm to the Individual
   Workers may need to share details if there’s a risk the person may harm themselves. For example, a young adult expressing suicidal thoughts might require intervention, such as informing mental health services.
2. Preventing Harm to Others
   If a service user threatens to harm someone else or acts in a way that endangers others, confidentiality cannot always be maintained. For instance, if someone shares plans to commit violence, the worker may have to inform the police.
3. Child Protection
   If there are concerns about the safety or wellbeing of a child—for example, evidence of neglect or abuse—workers must share information with child safeguarding teams or social services immediately.
4. Legal or Criminal Situations
   Workers may need to disclose information when required by law or a court order. If authorities request information about an investigation involving the service user, compliance with the law may override the principle of confidentiality.
5. Duty of Care
   Health and social care professionals have a duty of care to prioritise the safety of individuals. If withholding information endangers the person, disclosure becomes necessary. For example, in cases where someone refuses medical treatment but is experiencing a life-threatening condition, sharing information with their family or medical team might be appropriate.

Legal and Ethical Context

The legal and ethical frameworks surrounding confidentiality and disclosure create a structured way of making decisions. These include:

• The Data Protection Act 2018 – Dictates how personal data should be handled.
• The Children Act 1989/2004 – Requires agencies and professionals to take action if a child is at risk of harm.
• Human Rights Act 1998 – Balances the rights of individuals to privacy with the responsibility to protect others.
• Professional Codes of Practice – Health and social care workers follow guidance issued by bodies like the Health and Care Professions Council (HCPC) or the Nursing and Midwifery Council (NMC). These codes outline when sharing information is appropriate.

Examples of Ethical Tensions

Confidentiality and disclosure can present moral or ethical dilemmas for health and social care practitioners. Below are examples that often cause tension:

1. Conflict Between the Service User’s Wishes and Safety
   A service user with mental health issues might refuse help, stating they’re fine when confiding they have suicidal thoughts. Workers must balance the need to respect their wishes with their duty of care.
2. Family Requests for Information
   Relatives may ask workers about a loved one’s condition, especially during emergencies. Workers cannot disclose information without the individual’s consent unless safeguarding concerns arise.
3. Cultural or Belief Systems
   Individuals from different cultural or religious backgrounds may have specific expectations about privacy. Professionals must manage confidentiality within this context while meeting legal requirements.
4. Breakdown of Trust
   If a service user learns their personal information was shared without consent, even for safety reasons, it might reduce their trust in the care system. Rebuilding that trust can take time and effort.

Managing Tensions: Strategies for Workers

To handle these situations effectively, health and social care workers need to follow best practices. Strategies include:

• Following Policies and Procedures
  Organisations provide clear guidelines on confidentiality and disclosure. Workers should familiarise themselves with these and act within the framework provided.
• Obtaining Consent
  Wherever possible, workers should seek the individual’s permission to share their information. For example, asking if it’s okay to inform their GP about their mental health concerns.
• Discussing Limits to Confidentiality Early
  At the start of any relationship, workers should explain confidentiality policies, including situations where information might need to be disclosed. For example, informing service users that safeguarding overrides confidentiality helps manage expectations.
• Using Professional Judgement
  Workers must assess each situation to decide if the need for disclosure outweighs the right to privacy. Supervisors, managers, or safeguarding leads can provide advice if workers are unsure.
• Maintaining Accurate Records
  Keeping a record of what information was shared, with whom, and why can help justify decisions. For example, documenting a safeguarding referral demonstrates that the worker acted appropriately.

Examples of Good Practice

1. Case Example: Safeguarding a Child
   A teacher notices signs of neglect in a child, such as poor hygiene and hunger. Although the teacher respects the family’s preference for privacy, they raise their concerns with the school’s safeguarding lead, sharing limited details. The safeguarding team involves social services discreetly to protect the child.
2. Case Example: Protecting the Individual
   An elderly person receiving home care confides that their carer has been stealing from them. The worker reports this to their manager despite promising to keep it confidential. By sharing this information, the worker protects the individual from further harm.

Conclusion

Balancing confidentiality with the need to disclose is a key part of working in health and social care. Workers have a responsibility to respect privacy but must also act to safeguard individuals and others when necessary. They rely on legal guidance, ethical frameworks, and organisational policies to make these decisions. Understanding the boundaries of confidentiality and when disclosure is needed ensures that they provide safe, effective, and respectful care.