Breach of Confidentiality and Whistle-blowing - Essay Example

? Breach of Confidentiality and Whistle-blowing Breach of Confidentiality and Whistle-blowing This work attempts to analyze if there can be justification for breaching of individual patient confidentiality in the wider interest of service. It takes into account the case of Margaret Haywood; a nurse who was taken off the register of midwives and nurses for exposing poor services in the hospital she worked. It takes a view that there cannot be justification for breaching of individual patient confidentiality in the wider interest of service. In 2005, Margaret Haywood, a health worker, filmed a patient suffering in filthy conditions. The clip was used in a BBC Paranoma documentary that caused a stir in the health sector at the time. In the film, Margaret intended to bring to the world’s attention some of the healthcare issues that the institution she worked for did not give importance. Nursing and Midwifery Council resorted to sacking her citing gross misconduct. The council said that the nurse did not conduct herself in public interest nor did she observe her ethical obligation to uphold patient privacy. The World Medical Association in its Declaration of Geneva affirmed the rule of confidentiality and in its International Code of Medical Ethics and promoted confidentiality as an absolute requirement: 'Doctors shall preserve absolute secrecy on all he knows about his patient because of the confidence entrusted in him'. In the UK the principle of confidentiality is a matter of professional conduct and as the GMC states 'patients have a right to expect that information about them will be held in confidence by their doctors' (GMC 2000). Action taken by Miss Margaret is termed as whistle-blowing. Whistle-blowing can be directly employed by a service provider or by a third party that provides service to the provider. The whistle blower reports concerns where there is risk of harm or actual harm to people. A report is also made where an individual or an organization feels there is possible criminal activity. An employee may decide to blow the whistle in case the employer has not discussed pressing organizational issues or used internal whistle-blowing policy to correct existing mishaps. It also employed where the employees do not feel confident that their employer will handle their concerns adequately and choose to address their issues to a regulatory body instead. Public Interest Disclosure Act of 1998 gives protection to employees who blow the whistle over issues as long as there is an element of truth. Whistle-blowing is not the same as a complaint. It refers to a scenario where a worker addresses concerns about where he works or used to work. Individuals who use services may raise complaints about particular services of an organization. This raising of service provision concerns could be through the management of an organization or through service’s complaint procedures such as complaint boxes. This is, however, not referred to whistle-blowing as long as the concerns are not made known to the public or relevant regulatory bodies by an organization insider. Every organization should have a good whistle blowing policy in place. A good procedure-based service provider provides its employees with a conducive atmosphere to report what they do not feel comfortable with within the organization. The organization goes a step further to look into its employees’ complaints, investigates and provides amicable solutions to each. An open organizational culture helps workers to be confident in raising their issues. If the procedures are easy to use, the organization can deal with problems within its functioning at an early stage. The procedures should allow workers to go out of their normally arranged management duties and accountability arrangements to report problems. It should also clarify to the staff that they have protection from PIDA in the event that they whistle-blow. Likewise, the workforce should have the information that malicious or knowingly untrue allegations reported either internally or externally is not protected by PIDA. Lacking a good whistle-blowing policy has the following implications to a health organization: Bad practice could persist for a longer period than necessary The institution will have more complaints from people who rely on their services or representatives A high rate of staff turnover, making the institution loose most of its most qualified personnel Dampened staff morale leading to poor performance Reception of many negative reports on services delivered A worse situation would entail employees going to an outside world to relay their concerns with evidence. A case like Miss Margaret’s would lead to dented institutional image and reputation. Whenever an organization decides or feels that its employee has blown the whistle against its policies, it has to follow proper legal procedure in taking disciplinary actions against the employee. All NHS trusts and health sector employees have the recommended guide to help them know the right scheme of taking disciplinary steps. Advisory Conciliation and Arbitration Service (ACAS) Code of Practice together with advisory booklet of 1996 outlines the recommended disciplinary actions against health workers. Another document that is helpful in making healthcare managers good judges of disciplinary cases is a booklet published in 1997 by Myland. This booklet was specifically written for NHS managers (Nursing Management, 1999). In addition to the publications, healthcare managers with intention of taking action against workers thought to have grossly misconduct themselves need to seek advice from personnel departments and human resource managers at the earliest possible stage of the case (Care Quality Commission 2011, 39) Taking disciplinary action against a health worker (and any other employee) takes four distinct stages. These include a verbal warning, a first written letter, a second written warning and finally, dismissal. Each stage comes as a result of the employee failing to meet certain requisite standards of the organization. These include a breach of work place rules and regulations or any other form of misconduct. The manager investigates the incident, and depending on the degree of the mess, he takes action. Severe misconduct such as theft and physical violence may lead to suspension of an employee with full payment. Suspension is used to protect the member of staff under investigation, patients or colleagues. It is not a tool that is used to determine guilt of a suspected health worker (Martin 2010, 57). Investigations into a suspected misconduct should be comprehensive. It includes interviews of all those with any substantial information on the issue under investigation. These include written and verbal statements from the accused, patients and colleagues. This should be done as immediately as possible when the incident is still fresh in the minds of the witnesses. The health facility, however, should not haste as some workers may not be willing to write statement without advice from their representatives of trade unions and staff. Some patients may not be willing to write statements and should not be compelled to do so. The manager then arranges a hearing should he feel that the employee has a case to answer. He informs the employee of all the allegations leveled against him and allows the accused to come to the hearing with a representative or a friend. The manager should also have a witness. In most cases, the witness is usually the personnel manager. The final stage is dismissal. The employee may face a sack, demotion or transfer to a different branch or department depending on the weight of the misconduct. Dismissal of an employee is an action most NHS employers take with much pain. It is inevitable to them in some cases. Employers class certain actions within healthcare provision as gross misconduct. Theft is the first misconduct that NHS employers will always reward with a dismissal. Secondly, physical violence against colleagues or patients falls in the category of gross misconduct. In addition, employers treat incidences that involve use of alcohol and drug abuse as part of gross misconduct. Category of gross misconduct calls for immediate dismissal without prior warnings (Care Quality Commission 2011, 30). A health worker summarily dismissed on such grounds has the liberty to appeal in an industrial tribunal. In the tribunal, the actions of the employer to summarily dismiss an employee are scrutinized to determine if it was fair and suited the situations that surrounded the misconduct. Is does not determine whether the employee deserved to get a summary dismissal. Likewise, if a trial goes through the previously outlined stages, the employee reserves the right to appeal at every stage. The list below outline five reasons why employee may be fairly dismissed: An employee is incapable to carry out the duties he is employed to undertake; incapability When an employee breaks standards of work behavior as outlined in his contract of work; misconduct When an employee is redundant When an employee contravenes legal requirements of his profession (Nursing Management, 1999) Due to some other substantial reasons as maybe decided upon by the employer (Nursing Management, 1999) For a nurse to avoid the penalties described above, it is of essence that he adheres to the codes of ethics of the health profession. The new code of ethics according to and Midwifery Professional Register provides protection to the employer, patient, public and health profession. The Contract of Employment within the codes of ethics protects employers. They have to abide by the regulations of the contract and any breach against them is solved in employment tribunals. The public is protected under the criminal law. Patients are protected from civil laws. Nurses care for the patients and are answerable to the civil courts for negligence, civil wrong doings and trespass on the patients. Nursing profession is protected by NMC (Martin 2010, 93). Clause 3 (NMC 2002a) is the clause of interest in Margaret’s case. The clause states that autonomy of the client and the patient must be respected. Patients have the right to decide whether or not to undergo any form of health intervention. This right remains in action even if refusal to undergo the health intervention leads to the death of the patient or fetus. It persists unless the law orders otherwise. Principle of confidentiality within the nurses’ codes of ethics demand that information about clients should be treated confidentially and only be used for the purposes it was given. Although it is impractical for nurses to totally avoid sharing information about a patient, they should ensure that the information is used in the proper enclosure. Such difficulty of guarding information becomes impossible as some of a patient’s information must be passed from one stage of healthcare procedure to another. A patient must give his consent about his willingness for a nurse to share information about him with friends and family members. Disclosing a patient’s information is, however, justifiable if it is in public interest. This means that information about a client can be shared if it prevents a third party from harm or risk. It is important to distinguish between serious harm to the individual to who information relates and serious harm to others. Confidentiality disclosure can only be justify if it prevent harm and death to others and where the adult involve lack capacity then the mental capacity act applies and in the best interest of the patient concern then the disclosure of confidentiality is justified, this means that disclosure can prevent the person without capacity from being harm (Martin 2010, 54). Margaret Haywood’s case was a complicated one to decide whether she acted in a breach of the codes of ethics, acted in the interest of public good or whether hers was a case of misconduct. Given the fact that PIDA allows external whistle blowing in the event that an institution does not heed the concerns of its employers, she was at liberty to sound an alarm. She might have raised the issue with her employer without a chance of hearing. Instead of leaving the patients to continue languishing in filthy situations, she acted in public interest. Although exposing the client to an international media seemed like a breach of principle of confidentiality of patients, her major goal was to stop the sufferance of many others. PIDA needed to have come to her rescue. There cannot be justification for breaching of individual patient confidentiality in the wider interest of service. Bibliography MARTIN. (2010). Whistleblowing at work. London, Athlone. CARE QUALITY COMMISION (2011). Guidance for Providers who are Registered with Care Quality Commision, NSW, Federation Press. NURSING MANAGEMENT (1999). Employment Laws. Leichhardt, NSW, Federation Press. MARTIN, S. (2010). Continuing Professional Development. London, Royal Collage of Nursing Read More