Briefing on Brook's Wise Up! campaign

Brook’s Wise Up! campaign aims to uphold the principle of confidentiality for young people seeking sexual health advice and services, to build support for and raise awareness of young people’s rights in relation to sexual health, and to encourage health professionals to follow best practice on working with young people.   The following briefing provides the background evidence and policy context for the campaign objectives.


Key points


Confidentiality

  • Young people consistently say that confidentiality is one of their top concerns when visiting a sexual health service and that worries about confidentiality are a major deterrent to service uptake.
  • Professional codes and current government guidance make clear that health professionals have a duty of confidentiality to patients that should only be breached in exceptional circumstances and that the right to confidentiality owed to someone under 16 is the same as to an adult.
  • Young people’s right to confidential services is currently under threat through moves to
    - create information sharing databases
    - establish child protection protocols that require professionals to share information about underage sexual activity with social services and the police regardless of the circumstances
    - challenge the legal basis for the Department of Health’s guidance for professionals on provision of advice and treatment to young people under 16 on contraception, sexual and reproductive health.

High quality services for young people

  • Evidence based guidance on good practice in relation to services for young people, including sexual health provision, is now widely available. More details of best practice guidance are available here.
  • Despite such guidance young people too often report that they have experienced services that are obstructive, judgmental or fail to respect their right to confidentiality.

Enforcement of rights

  • Many young people are unaware of their current rights in relation to sexual health services
    Complaints procedures are often complex and fail to support young people in making complaints

Background


Young people and confidentiality
Fear over lack of confidentiality remains one of the biggest deterrents to young people seeking help. One survey found that that young people under 16 were six times more likely to mention worries about confidentiality and fear of being too young as deterrents– not to having sex – but to visiting a clinic for contraceptive advice.

A duty of confidence arises when one person discloses information to another in circumstances where it is reasonable to expect that the information will be held in confidence.   The concept of confidentiality is recognised by common law and is a requirement established in health and other professional codes of conduct. The duty of confidentiality owed to a person under 16 is the same as that owed to any other person. Exceptional situations may occur where a professional believes the health, safety or welfare of the patient or others is at grave risk. In these circumstances it would be usual to counsel the person to try to get them to agree to pass information on. If the patient will not agree to this, the decision whether to disclose information in these circumstances would depend on the degree of current or potential harm. It does not depend on the age of the patient.


Although it is an offence to have sexual intercourse with a young woman or young man under the age of consent, in England, Wales and Scotland there is no legal obligation on a health professional or any other individual to report a sexual offence. In Northern Ireland, legislation requires any individual who has knowledge of a crime, to report it to the police.

Young people’s right to confidential services is clearly set out in current government guidance for professionals and is summarised in the enclosed document.


Threats to young people’s right to confidentiality

Young people’s right to confidentiality is currently under challenge from a number of directions.   

Information sharing databases
The Children Act 2004 gives the Secretary of State for Education and Skills powers to make regulations to require the establishment of information sharing databases in children’s services as part of a package of reforms intended to safeguard and promote the wellbeing of children and young people. The databases include basic data in order to identify a child and whether they are using universal education and primary health care services; names and contact details of other practitioners involved with the child or young person and an indicator of whether a practitioner currently has a concern about the child or young person. 

It is proposed that the majority of practitioners will record their involvement with children and young people as a matter of routine.  Following consultation the government has conceded that details of practitioners working with children and young people in sensitive services such as sexual health can only be recorded with informed and explicit consent.   Concern remains about the potential for misinformation to discourage young people from using services or for their consent to be implied rather than sought explicitly.

Child protection protocols
A number of Area Child Protection Committees in England have adopted protocols on working with sexually active young people under the age of 18 which require professionals to inform social services about any young person who is sexually active under the age of consent regardless of the circumstances. They also suggest the information about young people and their partners be sought from the police.  In Northern Ireland a similar protocol has been adopted into the regional child protection policy and procedures.

The government in England is currently consulting on a revised version of Working Together to Safeguard Children and is seeking views on whether similar requirements to share information should be included in national guidance.


Sexual Offences Act
Home Office guidance issued following the implementation of the Sexual Offences Act stated that although the age of consent remains at 16, the law is not intended to prosecute mutually agreed sexual activity between two young people of a similar age, unless it involves abuse or exploitation. Young people, including those under 13, will continue to have the right to confidential advice on contraception, condoms pregnancy and abortion.   However, despite this guidance, the child protection lead for the Association of Chief Police Officers has recently argued that the police must be informed if anyone under 13 is involved in sexual activity.


Judicial review
A mother has won the right to a judicial review of the Department of Health’s best practice guidance on treatment of under 16s. Mrs Sue Axon wants to ensure that her daughters could not have an abortion without her knowledge. The review is due to take place in November.  


High quality services for young people

Research into young people’s views of health services has consistently shown that they would like services that are confidential, non-judgmental and accessible. The evidence from such studies has been incorporated into a range of good practice guidance including the National Service Framework for Children Young People And Maternity Services and You’re Welcome standards for young people’s sexual health services. Click here for further details of good practice guidance.

Despite this guidance Brook continues to receive a substantial volume of accounts from young people about service providers who have been obstructive, disrespectful or failed to recognise their right to confidentiality. The following are just three examples of experiences reported to the Brook Young People’s Information Service over the past year:

  • A 15-year-old girl went to her GP for emergency contraception. She was told by the GP that she was not old enough to be offered this. No other support or help was given by the GP. The caller was now concerned about possible pregnancy.
  • A caller tested positive for pregnancy with two pregnancy tests and went to see a doctor about a termination. When she told the doctor she was pregnant the doctor congratulated her and seemed dismayed when she said she wanted a termination. The doctor then did a pregnancy test with her and said it was negative, although the caller could see that the result had come back positive.
  • A teacher called to say that her 15-year-old pupil had been told by her GP to speak to her parents about being pregnant. If not the GP said he would call them himself.

Such experiences highlight the need to ensure that professionals are aware of and adhere to good practice guidance when delivering services to young people.


Young people’s knowledge of their rights on sexual health

A recent survey found that only 47% of young women under 16 and 40% of young men under 16 knew that contraception was available free of charge compared to 70% and 61% respectively of over-16s. 32% of young women and 45% of young men didn’t know that girls can get contraception without their parents’ involvement.   

Young people regularly tell Brook about their unsatisfactory experiences of sexual health services.   However, feedback from Brook clients suggests it is extremely rare for a young person to make a complaint about the treatment they have received.

Evidence suggests that young people’s knowledge about their rights to confidential services and the standard of care they are entitled to receive is low and this may influence young people’s readiness to complain, as well as making it less likely that they will use services in the first place.

Moreover, a review of complaints procedures has shown that few have versions that are young people friendly with young people likely to be deterred by the complexity of the process and perceived threat to their confidentiality it entails. Brook is therefore campaigning to raise young people’s awareness of their rights, ensure that professional bodies, service providers and regulators have young people friendly complaints procedures in place and to empower young people to complain.


How to support the Wise Up! Campaign

  • Respond to the Working Together consultation before 28 October. You can draw on the evidence presented in Brook’s response 
  • Sign up to the campaign at www.brook.org.uk
  • If you are Member of Parliament raise the issues in Parliament and your constituency.  
  • If you are a member of a professional organisation ensure your fellow members are aware of good practice guidance.
  • Make sure your organisation has a young people friendly policy in place to help young people give feedback and make suggestions and complaints 
  • If you are a young person share your experiences, good or bad, with us at www.brook.org.uk and make sure you know your sexual health rights (we will not publish the names of the people who send us their views, but we will use their comments anonymously to help explain to health policy makers why the right to confidentiality is so important)
  • Write to your MP and ask them to support the campaign
  • Write to your local health organisations and ask if their services follow national good practice guidance