The Shirley Community Chaplaincy (North East)

Confidentiality Policy and Procedures

The Shirley Community Chaplaincy (North East) is committed to practices and procedures that ensure
confidentiality in respect of information relating to service users, volunteers and employees. Confidentiality
is an important issue, and Shirley personnel try to maintain a balance between encouraging openness,
avoiding unnecessary secrecy and bureaucracy, and ensuring that privacy is respected. The Shirley
Community Chaplaincy (North East) carries out all functions in accordance with the General Data Protection
Regulation (GDPR) 25 May 2018.

Information is accurate, up to date and accessible only to personnel who need it in the course of their work.
Trustees, staff and volunteers operate a policy of confidentiality within the organisation. All other personnel
will have access to information only on a genuine need-to-know basis. Staff & Volunteers are not covered
within the Data Protection Act to use personally owned computers to record or store information of service
users or personnel.

The Shirley Community Chaplaincy (North East) allows service users access to information held by the
Chaplaincy, on request, and to correct any inaccuracies in it. Individuals may have access to any information
held on them by making a verbal request to the Chaplain. Access should be arranged within 5 working days.
This notice is required as it may be necessary to check with third parties as to whether certain information
can be shared. An individual may not remove information, but permission may be given by the Chaplain to
photocopy items.

Information will be withheld from an individual only for a specific reason. This may include information
about or from a third party, or information that is subject to legal privilege. Personal information may
include simply factual records or detailed assessments on which major decisions may be taken. The
opportunity for a service user to see, comment on and correct information helps to ensure that the
information is complete, accurate, clear and unbiased. However, where there is a genuine risk of harm to a
third party, access may be refused.

Any complaint you may have about the operation of this policy should be made through The Shirley
Community Chaplaincy (North East) Complaints Procedure. A full copy of the confidentiality document
including procedures is available on the website and from the Chaplain.
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POLICY STATEMENT
The Shirley Community Chaplaincy (North East) is committed to practices and procedures that ensure
confidentiality in respect of information relating to service users and personnel.
The Shirley Community Chaplaincy (North East) will keep only information that is required for some
specified purpose and that is adequate, relevant and not excessive for that purpose. Information will be
accurate, up-to date and be accessible only to the personnel who need it to fulfil their duties within the
Chaplaincy.

The Shirley Community Chaplaincy (North East) will allow service users and personnel reasonable access to
any information about them held by the Chaplaincy and to correct any inaccuracies. Information can be
withheld from an individual only for a specific reason. Reasons will include information about or from a third
party, or information that is subject to legal privilege. Disclosure to other persons or agencies will be made
only with the informed consent of the person to whom the information relates.

PROCEDURES

A Regarding Service Users

1. Personal Information

a) Personal information is kept on individual people. The following information may be kept, where
relevant:

• Application forms completed by applicant.

• Referral letter/supporting information from agency.
• Notes of interviews/visits/telephone calls/correspondence.
• Copy of agreements with service user’s signature.
• Medical information in appropriate cases.
• Care plan/ action plan/resettlement plan.
• DSS correspondence and notes of phone calls.
• LA correspondence re payments and notes of phone calls.
• Correspondence/interviews/meetings/incidents/complaints/support needs.
• Correspondence/reports from other agencies.

b) Service users must be made aware of the specific purpose for which the Chaplaincy is collecting
personal information (see 2 below).

2. Purpose of holding information

Information on service users is held for one or more of the following purposes:
a) To assess applicant’s suitability for a service in accordance with the selection and allocation
criteria.
b) For the provision of appropriate support to service users, where required, and development of
programmes.

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 c) For the provision of continuing planned care.
d) For responding appropriately to accidents and emergencies and for seeking to ensure the health,
safety and well-being of other service users.

3. Access to personal information by a service user

a) Service users have the right to see personal information held about them and correct any
inaccuracies in it. Information can be withheld from an individual only for a specific reason (see 7
below).

b) Appointments for viewing such information should be made as soon after the request as
possible. If consent of a third party is needed before a particular piece of information can be
disclosed, this should not delay access to the rest of the information.

c) The individual or their authorised representative must provide identification (visual recognition
will be sufficient in most cases). If possible, a table, chair and degree of privacy should be
provided. An appropriate person should be available to explain anything, give assistance or
discuss the contents, where this is appropriate.

d) Where possible, photocopying facilities should be made available if the individual wishes to copy
the documents.

B Management of information

1. Keeping up to date

a) Where information is no longer relevant, it may be removed and disposed of by shredding.

b) Other information should be kept up to date, as necessary, and any inaccuracies corrected as
soon as identified.
c) Information about Individuals, electronic and in hard copy (eg referral forms), will be kept
securely.
d) Confidential material must be disposed of by shredding.

2. Keeping information confidential

a) All personal and confidential information must be kept in a secure area or locked storage, except
when actually in use. This includes any information, which would normally not be public
knowledge.
b) Keys to filing cabinets and offices must be held only by personnel who need regular access to
them.

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3. Access to information

a) As a general principle, personnel should have access to personal or confidential information only
when they need information in the course of their duties.
b) In practice, only employed staff will generally have access to personal information as required.
c) Other personnel will have such access as is required by their work.
d) Volunteers will have access to personal information only on a ‘need to know’ basis.
e) Ancillary personnel will not have access to personal information and will be provided with
information about service users only where it is relevant to the Chaplaincy’s work and the benefit
of its service users.
f) In all cases, care should be taken not to pass to anyone sensitive information that may cause
danger or embarrassment to service users.

4. Information that can be withheld

a) Information should be withheld only for one or more reasons set out in paragraph (c) below, and
never because a staff member or volunteer does not want someone to read what has been
written. Although some information may be very sensitive and unpleasant, the knowledge that
such information exists and that the person concerned is denied access to it can be equally or
more upsetting.
b) If any documents are to be withheld, a note of such items must be recorded and made known to
the individuals concerned. The Chaplain should take the opportunity to reassess the need to
keep such information. If it is not relevant, it should be destroyed or returned to the author.
c) Only the following reasons should be considered as valid for withholding information from
someone wanting to see their personal information:

• Information that relates to or identifies a third party, unless they have given their consent for it to be
disclosed to the person concerned. This includes other members of a family. Although in normal
circumstances information would be shared within a family, there are exceptional cases where a
member of a family expressly wishes information to be withheld from other members of the family.
This wish should be respected. This includes information provided by a child. In all cases staff should
take decisions on the merits of the case.

• Information provided by an outside agency on the understanding that it will not be disclosed to the
person it concerns. This sort of information should be kept only if it is relevant in providing a service
to that individual, otherwise it should be destroyed or returned to the author. The Shirley
Community Chaplaincy (North East) should always make clear that the policy of sharing personal
information with the person it concerns is considered necessary for the best possible services to be
provided. Outside agencies should also be encouraged to adopt a similar desire for openness and to
allow their contribution to be disclosed to the person concerned.

• Information that would cause physical or mental harm to another person, if it is disclosed to the
individual.

• Information that is the subject of legal, professional privilege or statutory requirement or is likely to
lead to legal proceedings being taken against the individual.

• Information where, in the opinion of a medical practitioner, immediate disclosure would be likely to
expose the individual to the risk of serious physical or mental harm. Individual work with a person

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 should aim to help them come to terms with the facts, and special counselling should be offered to
prepare the individual for the disclosure of such information.

• Information which, if released, could prejudice the effectiveness or financial interests of The Shirley
Community Chaplaincy (North East).

5. Disclosure of information to third parties.

a) The Shirley Community Chaplaincy (North East) will make personal information available where
required to do so by a court of statutory obligation, including information such as medical details,
rent arrears, domestic violence, child abuse, criminal behaviour and harassment.
b) Disclosure to other persons, agencies or contractors will be made only with the informed consent of
the person to whom the information relates. If the health, safety, security or welfare of service users
or others may be seriously compromised, the Chaplaincy and others with whom it may share
information have a moral duty to act appropriately on any information in their possession.
Disclosure without consent will be made only after consideration by the Chaplain in consultation
with the Chair (or Trustee delegated by the Chairman) or the Safeguarding Officer. Where
consultation is not possible, the Chaplain will inform the Chair or Safeguarding officer of any action
taken as soon as possible after the event. Personnel will not knowingly provide false information to
the police, DSS, housing benefits office, local authority or any other agency. Where appropriate, a
safeguarding referral to another agency will be made without delay.
c) No third party outside The Shirley Community Chaplaincy (North East) shall have access to personal
information without the consent of the individual.
d) If any personal information is passed onto a third party outside of The Shirley Community
Chaplaincy (North East), the fact will be recorded, together with details of information that has been
shared. This will be disclosed to the individual concerned.
e) In connection with the purposes defined above (a), The Shirley Community Chaplaincy (North East)
will need to pass on certain personal information to third parties. The guidelines refer to certain
common situations, which will be explained to service users at the outset and this consent obtained
at the time.
f) Consent should be informed consent and, where appropriate, in writing.

6. Publicity

a) Service users will be made aware of the Confidentiality Policy and what it means for them and for
others when they are offered a service from The Shirley Community Chaplaincy (North East). This
will be communicated on the Shirley Community Chaplaincy website, with a written summary of the
policy and its implication or a notice about it on any appropriate information leaflet.
b) External agencies, particularly referring agencies, will also be made aware of the policy.

7. Breaches of the Confidentiality Policy

The Shirley Community Chaplaincy (North East) will view very seriously any breach of its
Confidentiality Policy. Breaches by personnel will result in disciplinary action being taken in
accordance with the organisation’s Complaints & Grievance procedures.

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8. Complaints

Complaints by service users concerning any aspect of the operation of these policies and procedures
e.g. breach of confidentiality, access to information, holding of or disseminating inaccurate or
irrelevant information should be made through the organisation’s Complaints Procedure and Data
Privacy Notice.

9. Training

a) Training is provided for staff, volunteers and trustees in order to ensure that they understand the
policy, procedures and guidelines set out here. They will be made aware of the need and reasons for
maintaining confidentiality and the potential consequences of breaches of confidentiality for service
users and for themselves.
b) The Confidentiality Policy will be introduced to Chaplaincy personnel and service users as part of the
induction process. Procedures and training sessions are also be arranged for detailed consideration
of the implications of confidentiality.

10. Management Committee Information

At meetings of the Management Committee, or in mailings, service users will be referred to by a

‘coded’ first name or initial only, so that the identity of the individual is not revealed. No more
personal details than are necessary will be discussed. Members of the Management Committee
recognise that meetings and mailings are regarded as confidential.

C Guidelines

1. Legal obligations

a) The Shirley Community Chaplaincy (North East) seeks to comply with the data protection principles
(General Data Protection Regulation 25 May 2018), for any personal data held on computer.
b) The Shirley Community Chaplaincy (North East) may be obliged to give information to:
• Social Services authorities
• Police
• Government departments
• Local authorities

2. Telephone calls

a) When other agencies telephone requesting information on service users, personnel will take the
caller’s name, status and telephone number. If appropriate, a response will be delayed until the
caller is verified, in accordance with our procedures, the response has been thought out, and

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 permission to pass on information has been obtained from the Chaplain, Chairman or delegated
Trustee.

Returning the call (thereby justifying the number), if the organisation is known, and the caller is bona
fide, information may be provided. Non-confidential information may be passed to outside agencies
seeking details of former service users.

b) All such telephone conversations should be accorded appropriate privacy and should be recorded in
writing and noted according to established procedures.

3. Recording of information

a) Where records are kept, it is important that they are kept properly:
• using the person’s full name (unless there are exceptions e.g. working with children),
• they are factual and accurate,
• legible and dated, signed or initialled as appropriate,
• secured in a lockable filing cabinet or lockable storage place,
• if on computer there is an agreed limited access arrangement,
b) Feelings, assumptions and interpretations, if used, should be owned by the author.
c) Standard forms should be used where appropriate

4. Confidential discussions

Personnel must ensure confidentiality when they are discussing service users amongst themselves or
with other agencies, either in person, on the telephone or any form of recording or reporting. The
following precautions should be taken:

a) Ensure privacy.
b) Cease the conversation if someone, who should not have that information comes into the room.
c) If a phone call is received, ask the service user, personnel or visitor to leave the room or arrange to
phone back.
d) Replace information to its secure place when it is finished with.
e) Ensure derogatory comments are not used about anyone, anywhere.
f) Ensure day books or files are never left lying open or around.
g) Ensure that all handwritten notes and/or letters, which are subsequently typed and filed, are
destroyed.
h) Ensure that personal facts about one service user are not discussed with another service user.

5. Other clients asking for information

It should be made clear in such a situation that a staff member or volunteer is bound by the
Confidentiality Policy.

6. Other personnel asking for information

It should be explained to personnel who do not normally have access to personal information that they
are bound by the Confidentiality Policy, and that information should be given only where it is relevant to
the person’s job.

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7. Clients speaking confidentially to one member of staff or a volunteer

When a client wishes to tell a member of staff or a volunteer sensitive, contentious or personal
information, it should be made clear that the personnel work as a team and that it is therefore The
Shirley Community Chaplaincy (North East)’s policy that such information be shared with appropriate
personnel in the project. Precautions will be taken in accordance with paragraph 4, above.

8. Record Keeping and computer data

The principles outlined above in regard to record keeping, access, security and storage apply to these
documents as well as to service user’s individual files.

9. Monitoring information

Current monitoring procedures do not generally involve recording the names of service users.
Procedures will be actively followed which protect individual identification.

10. Unsolicited and anonymous information

Unsolicited information will be considered and if not required by The Shirley Community Chaplaincy
(North East) will be disregarded, returned or destroyed.

11. Information to the DSS, Housing Benefit, Local Authority

a) The Shirley Community Chaplaincy (North East) will provide information to any of the above in
order to assist service users in expediting legitimate claims for benefit to which they are legally
entitled. Service users will be informed about any information passed on.
b) When requests for information are received from the DSS or the local authority, it is good practice
to agree to ring back with details. Where there is uncertainty as to whether information may be
passed on, the Chaplain should be consulted first.
c) Where there is a persistent request for information, which appears to be unrelated to a claim, the
DSS or local authority should be asked to put the request in writing.
d) Where personnel are requested to confirm information on a service user claim that is known to be
incorrect, personnel will provide the correct information.

12. Police inquiries

a) Where police are investigating a criminal matter and are requesting assistance, information may be
provided.
b) Where more sensitive and personal information is asked for, the Chaplain may need to talk with a
Trustee.

13. Passing on information to other agencies

a) Personal information will be passed onto another agency without the client’s consent only in
exceptional circumstances, e.g. where the service user has AIDS or is HIV+, has Hepatitis C.
b) When The Shirley Community Chaplaincy (North East) is referring a service user to another agency
for assistance, e.g. with housing or for a particular help or support, the service user’s consent must
be sought before passing on personal information. Personnel must explain to the service user how

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 the information provided will be used by the referring agency, and what are the potential benefits to
them of providing such information.
c) In exceptional circumstances, where the health and safety of the individual or of other individuals is
at risk and it is not feasible to obtain the individual’s consent, information that would normally be
considered confidential may be passed onto appropriate agencies, e.g. relevant medical information
to medical personnel where an individual is unconscious.

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INFORMATION FOR SERVICE USERS IN THE COMMUNITY

1. Policy Statement

The Shirley Community Chaplaincy (North East) is committed to practices and procedures that ensure
confidentiality in respect of information relating to service users, staff, trustees, volunteers and
committee members, in accordance with the General Data Protection Regulation (GDPR) 25 May 2018.
2. Personal Information
Personal information will be kept on you as a service user. Information is held for the following purposes:
• To assess your suitability for involvement with the Chaplaincy.
• To enable the effective management of the Chaplaincy.
• To provide appropriate support for you, where required.
• To ensure your continued care, as in a care plan or resettlement plan, where required.
• To respond appropriately to accidents and emergencies, to ensure the health, safety and well-being
of others in the accommodation/facility.

Information is kept only if it is relevant and for as long as it continues to be so. The information is
available only to personnel who need to use it and to enable them to undertake their work.

Access to your personal information

You have the right to see information kept about you and to correct any mistakes on it. If you wish to
see it, please ask the Chaplain to make an appointment.

It is possible, though rare, that some information will not be shown to you. This will happen only in
particular circumstances, when:

• The information has been supplied by or identifies someone else who is not willing for you to
see it or be identified.
• The information may cause harm to you or others if it is shown to you.
• The information is legally protected.
• You will be told if documents are not shown to you.

3. Giving information to other agencies

The Shirley Community Chaplaincy (North East) will not give personal information to any other agency
without your agreement, except where it is legally obliged to do so, including the following cases:

• Routine information to DWP and local authority to assist in benefit claims.

• Routine information to the police investigating a criminal matter.
• In extreme situations where your health and safety or the health and safety of others is at risk.

4. Your responsibility

You are requested not to ask personnel for information on other service users, which they cannot give
you. You must also respect the confidentiality of any personal information you may have about someone
else receiving a service from The Shirley Community Chaplaincy (North East).

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5. Complaints

Any complaints you may have about the operation of this policy should be made through The Shirley
Community Chaplaincy (North East)’s Complaints Procedure.

6. Access to Records for former service users

Former service users must make their request in writing and also provide identification. On receiving a
request from a former service user (or relative) for access to personal information, the Chaplain needs to
retrieve it from the archives and carefully sort the relevant information that can be accessed by the former
service user.

Information will be withheld from an individual only for a specific reason. This may include information:
• about another person,
• written by a third party,
• which is subject to legal privilege.

See para. 4 p.4 – Information that can be withheld, and para. 5 p.5 – Disclosure to third parties

A suitable venue and time should be made for the former client to access the information and if s/he wishes
to make photocopies of the information it is acceptable as long as it meets with the requirements already
stated.

Disclosure to relatives or other persons will be made only when the following items are available:
• identification of the person making the request.
• evidence is produced justifying the reason for the request.
• authorisation for them to have the information.

At all times staff should show sensitivity and support to the former service user (relative) when accessing
information from the past, which could be traumatic to the receiver.

A full copy of the Confidentiality Policy, procedures and guidelines is available on request to the Chaplain.

Signed on behalf of the

Management Committee

Name of Trustee:

7 June 2018
Date of approval by the
Management Committee
Date of First Review 7 June 2018

June 2020
Date of Next Review

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