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Careless talk costs confidence

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VOL: 98, ISSUE: 07, PAGE NO: 33

Bernard Place, PhD, MSc, RGN

The recent outcry surrounding the alleged neglect of an elderly patient in the A&E department at London's Whittington Hospital NHS Trust was a lesson in why nurses and midwives need to maintain patient confidentiality, whatever the provocation.

The recent outcry surrounding the alleged neglect of an elderly patient in the A&E department at London's Whittington Hospital NHS Trust was a lesson in why nurses and midwives need to maintain patient confidentiality, whatever the provocation.

The key health professionals involved seemed to think that, by deciding to make their concerns public, the patient's family had waived their right to confidentiality.

On one level the hospital's response is easy to understand: it may have felt there was justifiable cause. However, there is a legal principle that a breach of confidence by one party does not justify a counter breach by another.

Given their privileged access to clinical records, how much information should a nurse, manager or doctor impart to a third party? A breach of the principle of upholding patient confidentiality has potential for 'slippery slope' disclosure.

What are the circumstances when we might feel that a breach of confidentiality is justified? When a service is under fire? When it becomes a political football? When staff morale is very low? Or when media interest becomes intense?

Guidelines exist to ensure strict patient confidentiality, and NHS employees' employment contracts also contain clauses emphasising this. One of the key elements of the UKCC code of conduct is the need to keep patient information in strict confidence.

Each NHS organisation is bound by the Caldicott guidelines, which describe the legitimate use of identifiable clinical information. Finally, the Data Protection Act 1998 makes it clear that because a patient gives consent for a particular treatment, this does not mean that they automatically consent to their data being used for any other purpose.

There is a real danger that a nurse engaging in a public debate about a particular patient could be in breach of his of her professional code of conduct as well as breaking the law.

People who choose to pursue their concerns through politicians or the media should realise that they will quickly lose control of the argument and their agenda - the best care for their loved one.

Their cause for concern will be treated as an item of public consumption, and reduced to populist arguments about 'goodies' and 'baddies'.

However, public rebuttals of patients' or relatives' allegations undermine the confidence which underpins the 'social contract' that health care professionals hold with the public. We hear a lot about the need to maintain public confidence in the NHS - and the public expects confidentiality to be maintained.

When the people who seek to capitalise on frenzied media debates about patients on trolleys or hospitals using outdated equipment are long gone, nurses, doctors and health care assistants will still be working long, antisocial hours for the good of all NHS patients.

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