Children and young people services

Confidentiality Policy for Teenagers

CONFIDENTIALITY (TEENAGERS) POLICY

Introduction

This policy is specific to patients under the age of 18, and should be read in conjunction with the Staff Confidentiality Policy and Agreement ^[*], and Fraser (Contraceptive) Guidelines (see Resources).

Policy

The principles of confidentiality apply equally to all patients regardless of age. Young people (including those under 16) are entitled to equal confidentiality, male or female, as all other patients. This includes respecting their wishes to withhold information from parents or guardians. The GP involved will determine the competency of a young person seeking treatment and will determine the extent to which confidentiality guidelines apply in each case.

Care must be taken to ensure that this right of confidentiality is not inadvertently breached by following the procedural guidelines in force.

It is generally recognised that parents will accompany children up to 13 years of age. Many will continue to do so past this age but the clinician can check if they are happy to have the parent there if it is regarding something personal.

A child under 16 can come and see a clinician alone. However a clinician must believe that they are capable of understanding the choices of treatment and their consequences. This includes contraceptive advice, but the principles apply to other treatments, including abortion.

The policy of the practice is to support young people in exercising their choice of medical treatment, and to deal with them in a sympathetic and confidential manner. Where a young person presents at the surgery without adult support they may be booked in to see a clinician in the normal way. Where there is some question of the urgency of an appointment the matter should be referred to a nurse in the first instance to triage the request.

The Fraser guidelines apply to the treatment of contraceptive advice and care for girls. A clinician should proceed to give advice and treatment where:

The Clinician is satisfied that the girl understands the advice given.
The Clinician cannot persuade her to inform the parents.
That she is likely to continue having sexual intercourse with or without contraceptive treatment.

That unless she receives contraceptive advice or treatment her physical or mental health or both are likely to suffer.
That her best interests require the clinician to give her contraceptive advice, treatment or both without the parental consent.

The Gillick Competency in brief is as follows:-

It is not enough that she should understand the nature of the advice which is being given but she should be sufficiently mature to understand it.

It is also commonly believed that “the parental rights yields to the child’s right to make his own decisions when he reaches a sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring decision”

Resources

BMA - Consent and Gillick competency

Fraser (Contraceptive) Guidelines

Children and young people - Consent to treatment

People aged 16 or over are entitled to consent to their own treatment. This can only be overruled in exceptional circumstances.

Like adults, young people (aged 16 or 17) are presumed to have sufficient capacity to decide on their own medical treatment, unless there's significant evidence to suggest otherwise.

Children under the age of 16 can consent to their own treatment if they're believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment. This is known as being Gillick competent.

Otherwise, someone with parental responsibility can consent for them.

This could be:

the child's mother or father
the child's legally appointed guardian
a person with a residence order concerning the child
a local authority designated to care for the child
a local authority or person with an emergency protection order for the child

Parental responsibility

A person with parental responsibility must have the capacity to give consent.

If a parent refuses to give consent to a particular treatment, this decision can be overruled by the courts if treatment is thought to be in the best interests of the child.

By law, healthcare professionals only need 1 person with parental responsibility to give consent for them to provide treatment.

In cases where 1 parent disagrees with the treatment, doctors are often unwilling to go against their wishes and will try to gain agreement.

If agreement about a particular treatment or what's in the child's best interests cannot be reached, the courts can make a decision.

In an emergency, where treatment is vital and waiting for parental consent would place the child at risk, treatment can proceed without consent.

When consent can be overruled

If a young person refuses treatment, which may lead to their death or a severe permanent injury, their decision can be overruled by the Court of Protection.

This is the legal body that oversees the operation of the Mental Capacity Act.