Case study 2.2

  • Which local policies might you need to take into account when dealing with such matters over the phone?
  • How might you go about safely involving the sister in decisions about John’s care?
  • Can you imagine a scenario where this situation might need to be escalated; and to whom?

Speaking with people over the phone about patients in your care is fraught with dangers. It is very common for relatives to phone up inquiring about a person in their care, and to ask searching questions. Unless you have already met the person making the phone call, and so can identify them by their voice and demeanour, it may be impossible for you to establish their identity. Each Trust will have their own policy about what can and cannot be communicated over the phone, and you should only step away from that guidance when you are quite sure with whom you are speaking, or if the situation reasonably demands it.

In the scenario above, there are a number of cautionary hints. Elizabeth immediately tries to pull rank, and establish her authority, thereby seeking to undermine your capacity to say ‘I’m sorry, but I can’t discuss that over the phone’. The fact that she is a journalist also presents the potential for escalating the story into the public domain, if Elizabeth is unhappy with how she is treated. This is, of course, not relevant to John’s care, but would doubtless hang over any healthcare worker charged with dealing with this call.

Elizabeth goes to some lengths to describe the difficulties she has had before in these circumstances, and how that has proven detrimental to the care of her brother. This is a valid point. Having a blanket ban of discussing care over the phone can sometimes risk compromising care through providing a block to effective communication. This can potentially lead to misunderstandings, and may be detrimental to the patient’s recovery.  These situations are always weighed against issues of confidentiality, data protection, and protection of the patient’s rights (and on rare occasions, protection of members of staff).

In this case, for instance, there may be previous conflicts you are not aware of, and even safeguarding issues. Elizabeth may exercise a degree of control over her brother’s life, for instance, which is inappropriate. In a worst case scenario, this relationship may be abusive. You simply don’t know. So, there may potentially be a safeguarding issue to deal with here, although at this point it would be far too early to say.

The Mental Capacity Act (2005) includes the Deprivation of Liberty Safeguards (DoLS). This is a series of checks aiming to ensure that any care that restricts a person’s liberty is both appropriate and in their best interests. DoLS encompass the 2005 Act’s Code of Practice. In addition to assessing capacity, the Deprivation of Liberty Safeguards set out what steps a healthcare practitioner must take if they think that it is in someone’s best interests to be deprived of their liberty so they can receive the care and treatment they need in the relevant care environment.

It’s important to bear these issues in mind. However, let’s say that in this case Elizabeth’s desire to be involved in decisions about John’s care is entirely appropriate. The issue of distance could be bridged through the involvement of the hospital social worker, with due consideration about whether it is possible to establish a power of attorney (see NHS Choices 2015). Elizabeth might be invited to attend a multi-disciplinary meeting, facilitating a fruitful on-going, working relationship between herself and John’s carers.