Osteopaths are required to keep patients from harm. Osteopathic Practice Standard C4 states: You must take action to keep patients from harm.
The guidance to C4 states that you should have an awareness of safeguarding procedures relevant to your local area, and follow these if you suspect a child or vulnerable adult is at risk.
C4 guidance also illustrates the steps you might consider if you believe that the professional behaviour of a colleague or other healthcare practitioner is posing a risk to patients; or if you believe that a patient is at immediate and serious risk of harm.
The full guidance to Standard C4 is set out below:
1. You must comply with the law to protect children and vulnerable adults.
2. You should have an awareness of, and keep up to date with, current safeguarding procedures, including those relevant to your local area, and follow these if you suspect a child or vulnerable adult is at risk.
3. You should take steps to protect patients if you believe that the health, conduct or professional performance of a colleague or other healthcare practitioner poses a risk to patients. You should consider one of the following courses of action, keeping in mind that your objective is to protect the patient:
- 3.1 discussing your concerns with the colleague or practitioner
- 3.2 reporting your concerns to other colleagues or to the principal of the practice, if there is one, or to an employer
- 3.3 if the practitioner belongs to a regulated profession, reporting your concerns to their regulator
- 3.4 if the practitioner belongs to a voluntary register, reporting your concerns to that organisation
- 3.5 where you have immediate and serious concerns for a patient, reporting the colleague to social services or the police.
4. In any circumstances where you believe a patient is at immediate and serious risk of harm, you should consider the best course of action, which may include contacting the police or social services (though see standard D5 regarding confidentiality).
5. If you are the principal of a practice, you should ensure that systems are in place for staff to raise concerns about risks to patients.
6. You must comply with any mandatory reporting requirements, for example, those related to female genital mutilation (FGM) in England and Wales.
Disclosure of confidential information
Raising a safeguarding concern may involve disclosing confidential information without patient consent. The management and protection of patient information is referenced in Standard D5 of the OPS:
D5 You must respect our patients’ rights to privacy and confidentiality and maintain and protect patient information effectively.
Paragraph 7 of the D5 guidance deals with the disclosure of confidential information with the consent of the patient. This states:
7. There may be times when you want to ask your patient if they (or someone on their behalf) will give consent for you to disclose confidential information about them; for example, if you need to share information with another healthcare professional. In that case, you should:
- 7.1 explain to the patient the circumstances in which you wish to disclose the information, and make sure they understand what you will be disclosing, the person you will be disclosing it to, the reasons for its disclosure, and the likely consequences
- 7.2 allow them to withhold permission if they wish
- 7.3 if they agree, ask them to provide their consent in writing or to sign a consent form
- 7.4 advise anyone to whom you disclose information that they must respect the patient’s confidentiality
- 7.5 disclose only the information you need to (for example, does the recipient need to see the patient’s entire medical history?).
The guidance to D5 includes a section (paragraphs 8-12) on the disclosure of confidential information without patient consent. This states:
8. In general, you should not disclose confidential information about a patient without their consent; however, there may be circumstances in which you are obliged to do so. Such circumstances might include:
- 8.1 if you are compelled to do so by order of a court or other legal authority. You should only disclose the information you are required to under that order.
- 8.2 if it is necessary in the public interest. In this case, your duty to society overrides your duty to your patient. This might happen when a patient puts themselves or others at serious risk; for example, by the possibility of infection, or a violent or serious criminal act.
- 8.3 if it is necessary, in the interests of the patient’s health, to share the information with their medical adviser, legal guardian or close relatives, and the patient is incapable of giving consent.
9. In any such circumstances, you are strongly advised to seek appropriate legal advice.
10. If you need to disclose information without your patient’s consent, you should inform the patient, unless you are specifically prohibited from doing so (for example, in a criminal investigation), or there is another good reason not to (for example, where a patient may become violent).
11. Any disclosures of information should be proportionate and limited to the relevant details.
12. If a patient is not informed before disclosure of confidential information takes place, you should record the reasons why it was not possible to do so and maintain this with the patient’s records.
If you are faced with a child or vulnerable adult who is at risk of harm you should look at the local safeguarding procedures in place on the local authority or local council website.
If you consider that it is necessary to make a disclosure without the consent of the patient, you should seek immediate and urgent advice (from your insurer, the Institute of Osteopathy or legal advice) about if and if so how to disclose confidential information (including consent or not from the patient) and take action to keep the child or vulnerable adult safe. If the child or vulnerable adult is in immediate danger, the police should be called.