Criterion 2.1.3 Presence of a third party
Subject to safety and security considerations, the presence of a third party observing or being involved in clinical care during a consultation occurs only with the permission of the patient being given before the consultation.
► A. Our staff can describe how and when they obtain prior consent from a patient for the presence of a third party during a consultation, subject to safety and security considerations (interview).
► B. Our health service has a policy about the presence of third parties in consultations (documents review).
The privacy and confidentiality of therapeutic treatment is generally accepted by health professionals as a patient’s right and is explicitly supported within these Standards. Compromising on this aspect of a patient’s rights may affect the trust they have in the health service and may reinforce power imbalances that are detrimental to a patient’s health and wellbeing.
In some circumstances, a member of the clinical team may feel more comfortable if there is a third party present during an examination. Appropriate consent needs to be obtained from the patient where the health professional requests the presence of a third party and the patient’s permission needs to be sought before the consultation occurs. It is not acceptable to ask permission in the consulting room, as some patients may feel ambushed and unable to refuse. The presence of a third party in the consultation (including interpreters) should be documented in the patient’s health record.
There may be tension between the need to respect the privacy and confidentially of a patient and the need to manage any security or safety risks that the patient may pose to health professionals during a consultation. For health services in prisons, a policy for managing these potentially conflicting needs may need to be negotiated with the relevant government department and prison management. The policy would need to outline the circumstances in which third parties such as a prison officer need to be present during a consultation for safety or security purposes, and the way in which disclosure of personal health information to the third party would be minimised.
At maximum security facilities, having prison staff in the consultation room may be part of the standard operating procedure and if this is the case health service staff will have to accommodate this in the way they provide care. In facilities with other security classifications, the convention of ‘within sight and sound’ may be sufficient to maintain appropriate security levels as well as the privacy of the patient. Health service staff should consult with the relevant government department and the prison’s management company to determine what is required in relation to a third party presence, and incorporate such provisions into the way they deliver healthcare to ensure the best possible security as well as patient privacy and confidentiality.