Spiritual Care and Chaplaincy

10. Data Protection and Patient Confidentiality

NHSScotland is committed to providing spiritual and religious care to patients who wish it, as part of a holistic health service. In this the Scottish Government Health and Wellbeing Directorate is in full agreement with the World Health Organisation.

There is increasing evidence that health outcomes for patients may be considerably enhanced when their beliefs and values, their social context and their relationships are fully taken into account within a clinical context. Increasing emphasis on Patient Focus within the NHS and a developing awareness of Equality and Diversity issues have brought patients' spiritual needs higher up the NHS agenda. To be treated in a culturally and spiritually sensitive way, within the context of their faith and beliefs, can be as important to patients as the meeting of their other physical or psychological needs.

While patients have a right to receive appropriate spiritual care as part of their health care, they also have a right of confidentiality and data protection. NHSScotland has a duty to ensure that both of these rights are met. Achieving this balance requires good communication, and an understanding by all healthcare staff involved throughout the clinical care process. It is important to ensure that over emphasis on privacy of information does not result in failure to provide patients with available spiritual and religious care. Similarly, patients' rights to confidentiality must be upheld where they do not wish information to be passed on to a spiritual/religious care provider. The legal position is that a patient's faith or belief stance is sensitive information that may only be made available to another party with informed consent. In exceptional circumstances where informed consent or otherwise is impossible to obtain e.g. if a patient is unconscious or impaired, then the views of carers, and common sense, should prevail.

NHSScotland has received supportive guidance from the UK and Scottish Information Commissioner's offices to the effect that consent to make available information as to a patient's faith or belief stance, may be given by patients either in writing or orally at any time throughout the care process. The time of admission to hospital is important but is not always the time when a patient's broader emotional or spiritual needs are evident. It is important to recognise that such consent may be given by patients (or staff members) at any point of their health care journey and needs to be listened for rather than demanded. It may, for example be given to a chaplain through a decision to enter into conversation, providing the chaplain has indicated his or her role. What is important is for all NHS staff to remain sensitive to patients' spiritual and religious needs and respond appropriately by making the necessary chaplaincy referral.

The needs and rights of members of faith communities/belief groups for appropriate care, often of a sacramental or religious nature, should not be underestimated and all staff should be aware of how important it is to offer to facilitate this by sensitively asking and seeking appropriate help.

All patients should be informed at the time of admission, or at another appropriate time, of the spiritual care which is available within the NHS. Health care providers should think about how questions should be asked of patients. For example, it may be better to ask if a patient has a way of understanding life and illness and would like to have someone to talk with about this, before asking directly if they are part of any faith community or belief group. If they do formally record a religious faith or belief preference, they should be informed that, if they consent, this can be passed to the Department of Spiritual and Religious Care for use in providing them with spiritual care. Patients and staff should also be informed that the spiritual care team is happy to be consulted on any issue of concern.

Chaplains who form the spiritual care team are generally employed within the NHS and have a duty of confidentiality in terms of their employment contract. In addition, the Chaplaincy Associations have a mutual "Code of Ethical Conduct for Healthcare Chaplains" to which all members of these Associations ascribe. Access to patient information, the keeping of spiritual care departmental records and the use of that information must also conform to the Caldicott Committee Guidelines. All spiritual care volunteers should sign an appropriate local confidentiality statement.

It is proposed to make more information on this subject available for patients and staff through leaflets and other general information channels. Health Boards are encouraged to use patient experience questionnaires to ensure that patients' spiritual and religious needs are being both properly assessed and addressed.