Further information to inform decision-making

4.1 Toinform yourdecision-makingthissectionsetsoutfurtherinformationillustrating the key principlesunderlyinginformationsharing. Thissectionexplainsthesethrough eight key questions. Therelationship betweenthem isillustratedintheflowchartatthe endofthissection. Theyare:

1. Istherealegitimate purposeforyouoryouragencytosharetheinformation? 2. Doestheinformationenablea persontobeidentified?

3. Istheinformationconfidential?

4. Iftheinformationisconfidential, doyouhaveconsenttoshare? 5. Isthereastatutorydutyorcourtordertosharetheinformation?

6. Ifconsentisrefused, ortherearegoodreasonsnottoseek consenttoshareconfidential information, isthereasufficient publicinteresttoshareinformation?

7. Ifthedecisionistoshare, areyousharingtherightinformationintherightway? 8. Haveyou properlyrecordedyourdecision?

Is there a legitimate purpose for you or your agency to share information?

4.2 Ifyouareaskedtoorwishtoshareinformationaboutachildoryoung person, you needtohaveagoodreasonorlegitimate purposetoshareinformation. Thiswillbe relevanttowhetherthesharingislawfulinanumberofways.

4.3 Ifyouwork forastatutoryservicesuchaseducation, socialcare, healthoryouth justice, orifyouwork inthe privateor voluntarysectorandarecontractedbyoneofthe statutoryagenciesto provideservicesontheirbehalf, thesharingofinformation mustbe withinthefunctionsor powersofthatstatutorybody. Itislikelythatthiswillbethecaseif youaresharingtheinformationasanormal partofthe jobyoudoforthatagency.

4.4 Whetheryouwork forastatutoryserviceorwithinthe privateor voluntarysector, any sharingofinformation mustcomplywiththelawrelatingtoconfidentiality, data protection andhumanrights. Establishingalegitimate purposeforsharinginformationisan

important partof meetingthoserequirements. Thereis moreinformationaboutthelegal framework forsharinginformationinthedocumentSharing Information: Further Guidance on Legal Issues availableatwww.ecm.gov.uk/deliveringservices/informationsharing.

4.5 Differentagencies mayhavedifferentstandardsforsharinginformation. Youwill needtobeguidedbyyouragency’s policiesand procedures, anylocalinformationsharing protocols, and – whereapplicable – byyour professionalcode.

Does the information enable a person to be identified?

4.6 In mostcasestheinformationcoveredbythisguidancewillbeaboutanamedchild oryoung person. It mayalsoidentifyothers, suchasa parentorcarer. Iftheinformationis anonymised, itcanlawfullybesharedaslongasthe purposeislegitimate. If, however, the informationdoesallowa persontobeidentified, itissubjecttodata protectionlawand you mustbeopenaboutwhatinformationyoumightneedtoshareandwhyandyoumust alsotakeaccountofotherrelevantlaws.

Is the information confidential?

4.7 Confidentialinformationisexplainedin paragraph 3.7. Thissection providesfurther information.

4.8 Therearedifferenttypesofconfidentialrelationship. Oneiswhereaformal

confidentialrelationship exists, asbetweenadoctorand patient, socialworkerandclient, orcounsellorandclient. Intheserelationshipsallinformationshared, whetherornot directlyrelevanttothe medical, socialcareor personal matterwhichisthe mainreasonfor therelationship, needstobetreatedasconfidential.

4.9 Anotherisaninformalconfidentialrelationship thatexistsbetween, say, ateacher anda pupil. A pupil maytellateacherawholerangeofinformationsomeofwhichisnot confidential, but mayalsoask theteachertotreatsomespecificinformationasconfidential. Then, forthe purposesoftheconfidentialinformationonly, theteacherand pupilwillhave aformalconfidentialrelationship.

4.10 Sometimes people maynotspecificallyask youto keep informationconfidential whentheydiscusstheirown problemsor passoninformationaboutothers, but may assumethat personalinformationwillbetreatedasconfidential. Inthesesituationsyou shouldcheck whethertheinformationisorisnotconfidential, thelimitsaround

confidentialityandunderwhatcircumstancesinformation mayormaynotbesharedwith others.

4.11 Publicbodiesthatholdinformationofa privateorsensitivenatureaboutindividuals forthe purposesofcarryingouttheirfunctions (forexamplechildren’ssocialcare) mayalso oweadutyofconfidentiality, as peoplehave providedinformationontheunderstanding thatitwillbeusedforthose purposes. Insomecasesthebody mayhaveastatutory obligationto maintainconfidentiality, forexampleinrelationtothecasefilesoflooked afterchildren.

Do you have consent to share?

4.12 Consentissuescanbecomplex, andlack ofclarityaboutthem cansometimeslead practitionerstoincorrectassumptionsthatnoinformationcanbeshared. Thissectiongives furtherinformationtohelp youunderstandandaddresstheissues. Itcovers:

• whatconstitutesconsent;

• whoseconsentshouldbesought;

• whennottoseek consent.

What constitutes consent

4.13 Consent mustbe ‘informed’ – this meansthatthe persongivingconsentneedsto understandwhyinformationneedstobeshared, whowillseetheirinformation, the purposetowhichitwillbeputandtheimplicationsofsharingthatinformation.

4.14 Consentcanbe ‘explicit’or ‘implicit’. Obtainingexplicitconsentisgood practiceand itcanbeexpressedeitherorallyorinwriting, althoughwrittenconsentis preferablesince thatreducesthescopeforsubsequentdispute. Implicitconsentcanalsobe validin many circumstances. Consentcanlegitimatelybeimpliedifthecontextissuchthatinformation sharingisintrinsictotheactivity, andespeciallyifthathasbeenexplainedattheoutset, for

examplewhenconductingacommonassessment. A furtherexampleiswherea GP refersa patienttoahospitalspecialistandthe patientagreestothereferral; inthissituationthe GP canassumethe patienthasgivenimpliedconsenttoshareinformationwiththehospital specialist.

4.15 Theapproachtosecuringconsentshouldbetransparentandrespecttheindividual. Forexample, itisgood practicetosetoutclearlyyouragency’s policyonsharing

informationtochildren, young peopleandfamilies, whentheyfirstaccesstheservice. Consentcannotbesecuredthroughcoercion, orinferredfrom alack ofresponsetoa requestforconsent. Ifthereisasignificantchangeintheusetowhichtheinformationwill beputtothatwhichhas previouslybeenexplained, orintherelationship betweenthe agencyandtheindividual, consentshouldbesoughtagain. Individualshavetherightto withdrawconsentaftertheyhavegivenit, althoughin practicethisisrarelyexercised.

Whose consent should be sought

4.16 You mayalsoneedtoconsiderwhoseconsentshouldbesought. Wherethereisa dutyofconfidenceitisowedtoa personwhohas providedtheinformationonthe

understandingitistobe keptconfidentialand, inthecaseof medicalorotherrecords, the persontowhom theinformationrelates. A young personaged 16 or 17, orachildunder 16 whohasthecapacitytounderstandand maketheirowndecisions, maygive (orrefuse) consenttosharing.

4.17 Childrenaged 12 orover maygenerallybeexpectedtohavesufficient

understanding. Youngerchildren mayalsohavesufficientunderstanding. Whenassessinga child’sunderstandingyoushouldexplaintheissuestothechildinawaythatissuitablefor theirage, languageandlikelyunderstanding. Whereapplicable, youshouldusetheir preferred modeofcommunication.

4.18 Thefollowingcriteriashouldbeconsideredinassessingwhethera particularchildon aparticularoccasionhassufficientunderstandingtoconsent, orrefuseconsent, tosharing ofinformationaboutthem:

• Canthechildunderstandthe questionbeingaskedofthem?

• Doesthechildhaveareasonableunderstandingof: – whatinformation mightbeshared?

– the mainreasonorreasonsforsharingtheinformation?

• Canthechildoryoung person:

– appreciateandconsiderthealternativecoursesofactionopentothem? – weighup oneaspectofthesituationagainstanother?

– expressaclear personal viewonthe matter, asdistinctfrom repeatingwhatsomeone elsethinkstheyshoulddo?

– bereasonablyconsistentintheir viewonthe matter, oraretheyconstantlychanging their mind?

4.19 In mostcases, whereachildcannotconsentorwhereyouhave judgedthattheyare notcompetenttoconsent, a personwith parentalresponsibilityshouldbeaskedto consentonbehalfofthechild.

4.20 Where parentalconsentisrequired, theconsentofonesuch personissufficient. In situationswherefamily membersareinconflictyouwillneedtoconsidercarefullywhose consentshouldbesought. Ifthe parentsareseparated, theconsentoftheresident parent wouldusuallybesought. Ifyou judgeachildoryoung persontobecompetenttogive consent, thentheirconsentorrefusaltoconsentistheonetoconsiderevenifa parentor carerdisagrees.

4.21 Theseissuescanraisedifficultdilemmas. You mustalwaysactinaccordancewith your professionalcodeof practiceandinthebestinterestsofthechild, evenwherethat meansoverridingrefusaltoconsent.

When not to seek consent

4.22 Therewillbesomecircumstanceswhereyoushouldnotseek consent, forexample wheretodosowould:

• placeachildoryoung personatincreasedrisk ofsignificantharm; or • placeanadultatrisk ofseriousharm; or

• prejudicethe preventionordetectionofaseriouscrime; or

• leadtounjustifieddelayin makingenquiriesaboutallegationsofsignificantharm.

Is there a statutory duty or a court order to share information?

4.23 Insomesituationsyouarerequiredbylawtoshareinformation, forexample, inthe NHS wherea personhasaspecificdiseaseaboutwhichenvironmentalhealthservices must benotified. Therewillalsobetimeswhenacourtwill makeanorderforcertaininformation orcasefilestobebroughtbeforethecourt.

4.24 Thesesituationsarerelativelyunusualandwheretheyapplyyouwill knoworbetold aboutthem. Insuchsituationsyou mustsharetheinformation, evenifitisconfidentialand consenthasnotbeengiven. Wherever possible, youshouldinform theindividual

concernedthatyouaresharingtheinformation, why, andwithwhom.

Is there sufficient public interest to share information?

4.25 Elicitingthe viewsofchildren, young peopleand parentsisimportantandrepresents good practice. However, evenifconsentisrefused, thatdoesnotautomatically preclude youfrom sharinginformationaboutachildaboutwhom youhaveaconcern. Paragraphs 3.6-3.12 aboveexplainthisin moredetail, includingthe publicinteresttest, theneedto considerthe publicinterestin maintainingconfidenceinconfidentialityandhowarisk of significantharm toachildorseriousharm toanadultincreasesthe publicinterestin sharing. Therewillbecaseswheresharinglimitedinformationwithoutconsentis justified toenable practitionerstoreachaninformeddecisionaboutwhetherfurtherinformation shouldbesharedoractionshouldbetaken.

4.26 Indecidingwhetherthe publicinterest justifiesdisclosingconfidentialinformation withoutconsent, youshouldbeabletoseek advicefrom yourline manageroranominated individualwhoseroleistosupportyouinthesecircumstances. Ifyouareworkinginthe NHS oralocalauthoritythe Caldicott Guardian maybehelpful. Advicecanalsobesought from professionalbodies, forexamplethe General Medical Councilorthe Nursingand Midwifery Council.

4.27 Iftheconcernisabout possibleabuseorneglect, allorganisationsworkingwith childrenandyoung peoplewillhaveanamed personwhoundertakesaleadroleforchild protection, soconsultingthis person mayalsobehelpful.

4.28 Ifyoudecidetoshareconfidentialinformationwithoutconsent, youshouldexplain tothe personthatyouintendtosharetheinformationandwhy, unlessoneofthe pointsat 4.22 is met.

If the decision is to share, are you sharing the proper information in the proper way? 4.29 Ifyourdecisionistoshare, youshouldshareinformationina properway. This means:

• sharetheinformationwhichisnecessaryforthe purposeforwhichitisbeingshared;

• sharetheinformationwiththe personor peoplewhoneedto know;

• check thattheinformationisaccurateandup-to-date;

• establishwiththerecipientwhethertheyintendto passitontoother people, and

ensuretheyunderstandthelimitsofanyconsentwhichhasbeengiven;

• inform the persontowhom theinformationrelates, and, ifdifferent, anyother person

who providedtheinformation, ifyouhavenotalreadyanditissafetodoso.

Have you properly recorded your decision?

4.30 Youshouldrecordyourdecisionandthereasonsforitwhetherornotyoudecideto shareinformation. Ifthedecisionistoshare, youshouldrecordwhatinformationwas sharedandwithwhom.

4.31 Youshouldwork withinyouragency’sarrangementsforrecordinginformationand withinanylocalinformationsharing protocolsin place. Thesearrangementsand protocols mustbeinaccordancewiththe Data Protection Act 1998 – the key provisionsofwhich aresummarisedinSharing Information: Further Guidance on Legal Issues available atwww.ecm.gov.uk/deliveringservices/informationsharing.

You are asked to or wish to share information

Is therea legitimate purpose for sharing information? Yes No No Yes Yes You can share Yes Yes No No No Do not share No (para 4.2–4.5)

Does the information enable a person to be identified?

Yes

(para 4.6)

Is the information confidential? (para 4.7–4.11) Do you have consent?

(para 4.12–4.22) Do you have a statutory obligation or court order to share information?

(para 4.23–4.24) Is there sufficient public

interest to share? (para 4.25–4.28) Share information:

• Identify how much information to share. • Distinguish fact from opinion.

• Ensure that you are giving the information to the right person. • Inform the person that the information has been shared if they were not

aware of this and if it would not create or increase risk of harm. (para 4.29)

Record the information sharing decision and your reasons, in line with your agency’s procedures or local protocols

(para 4.30–4.31)