Principles for all ages

Importantly whatever your age under 18, a doctor / nurse must always

• Keep a child’s or young person’s best interests at the heart of any decision, and
• Ensure a child or young person is involved in the decision-making process as far as possible.

Confidentiality and consent to treatment 16 to 18

If you are aged 18 and over
In UK law a person’s 18th birthday draws the line between childhood and adulthood, so that in healthcare issues an 18 year old is treated the same as any other adult.

If you are aged 16 and 17
Young people aged 16 or 17 are presumed in law, like adults, to have full confidentiality and the capacity to consent to medical treatment.

The only exceptions will occur very rarely.
As the Care Quality Commission suggest
“However, unlike adults, their refusal of treatment can in some circumstances be overridden by a parent, someone with parental responsibility or a court. This is because we have an overriding duty to act in the best interests of a child. This would include circumstances where refusal would likely lead to death, severe permanent injury or irreversible mental or physical harm.” Care Quality Commission

This is explained also by the Mix in the situation of self-harm
Confidentiality and self-harm Confidentiality and self-harm – TheMix.org.uk

Confidentiality under 16

As Brook explain simply
“ Young people under 16 still have the same rights to confidentiality as anyone else, and you should not be treated any differently.

Doctors and nurses have very strict rules on confidentiality and the law says they have to keep all patient records and information completely private. However, in exceptional circumstances, like when a doctor or health worker thinks you might be in serious danger, they might feel there is a need to pass information on but, even if they do, they must talk to you first before they tell anyone else. This applies to everyone, no matter what age you are.” Sexual health services: your rights – Brook

Consent to treatment under 16

If you are aged 13 -15
2 separate guidelines (called Gillick and Fraser) help guide doctors and nurses about consent to treatment for under 16 year olds. Treatment might for example include contraception.

Gillick competency test
Children under 16 can consent to a treatment if they have sufficient understanding and intelligence to fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options.

Fraser guidelines
The ‘Fraser guidelines’ specifically relate only to contraception and sexual health, in particular giving contraceptive advice and treatment to those under 16 without parental consent.

The Fraser guidelines allow advice and contraceptive treatment to be given if a child

• He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
• He/she cannot be persuaded to tell her parents or to allow the doctor to tell them
• He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment
• His/her physical or mental health is likely to suffer unless he/she received the advice or treatment
• The advice or treatment is in the young person’s best interests.

As the care quality commission suggest
“Health professionals should still encourage the young person to inform his or her parent(s) or get permission to do so on their behalf, but if this permission is not given, they can still give the child advice and treatment. If the conditions are not all met, however, or there is reason to believe that the child is under pressure to give consent or is being exploited, there would be grounds to break confidentiality”. Care Quality Commission

Consent to treatment if you are under 13

As the care quality commission suggest
It would rarely be appropriate or safe for a child less than 13 years of age to consent to treatment without a parent’s involvement. When it comes to sexual health, those under 13 are not legally able to consent to any sexual activity, and therefore any information that such a person was sexually active would need to be acted on, regardless of the results of the Gillick test. Care Quality Commission

Who can consent for a child if a child is not able to give consent is explained by NHS choices
Children and young people – Consent to treatment Consent to treatment – Children and young people – NHS

Sexual health Advice – under 16

Sexual health advice for children under 16 is further explained by Brook. They also make some helpful suggestions for children under 13 about sexual health
I’m 15, can I have sex? – Brook

The NHS explains this further
If I use a sexual health service will they tell my parents? – NHS

Mental health advice – under 16

Confidentiality and mental health are well explained by Mind
Understanding confidentiality – for young people Information for young people on confidentiality and mental health – Mind

Your health data (access to your GP health record) – under 16

The NHS explains your health data and your rights when aged under 16
Information for under-16s on parents and guardians accessing your doctor’s services – NHS