bombs) the psychiatrist himself disclosed the report to the medical director of the
secure unit. In turn the hospital forwarded the report to the Secretary of State. The
Court of Appeal stated that whilst mental patients should be free to seek advice and
assistance from independent doctors, nonetheless given the wider public interest
in public safety, this form of disclosure by the psychiatrist was thought not to be in
breach of any duty of confidentiality. /See also the interesting case ofWoolgarv.
Chief Constable of Sussex Police/1999) in which the Court allowed that the police
could pass information about a nurse to the UKCC where public safety so
required.)
Thus, although it might be possible to argue that disclosure of patient related
information serves wider public interest in highlighting the decline in the standard
of care, this is by no means obvious. Where possible, particular patients should not
be identified, or if this is inevitable, then the nurse should seek the permission of
that patient to refer to the particular case. Note that the public interest in ensuring
that patients are not inhibited from seeking treatment may mean that con-
fidentiality can attach even to non-identifying information concerning medical
treatment /seeRv.Department of Health ex parte Source Informatics Ltd/1999).
Nurses may also be troubled that voicing opinions on the regime of care may
lead to disciplinary action by the employer. Indeed the fear of such disclosures led
to the introduction into contracts of employment of express requirements prohi-
biting disclosure to the media of matters relating to the working responsibilities of
employer and employee. In certain instances, it could be argued that, even in the
absence of an express clause, implied duties of fidelity might dictate that any
public disclosure would amount to a breach of the employment contract. Prior to
1999 there were well documented incidents in which health service employees
have faced disciplinary proceedings or dismissal, apparently as a result of
complaints concerning shortfalls in the standard of care. Where this led to the
dismissal of an employee, that employee could consider redress by an industrial
tribunal. However this was unlikely to lead to reinstatement, even where the tri-
bunal found in favour of the dismissed nurse.
This situation changed radically in 1999 following the passage of the Public
Interest Disclosure Act 1998. This allows employees to make protected dis- closures' without victimisation or dismissal. All NHS employees are protected by these provisions, and there is no ceiling on the compensation that may be awarded if victimisation is proven. Among the categories of protected disclosure are the failure to comply with legal obligations, and the endangering of the health and safety of any individual. This may cover past as well as ongoing malpractice. However the Act also governs the manner of disclosure, encouraging initial internal disclosure if thewhistleblower' is to receive the protection of the Act. Here
anurse may have a number of options if wishing in good faith to make a
disclosure. It may be possible/appropriate for the nurse to speak directly to the
persons retaining responsibility for the malpractice in question, or to his/her
employer, to the Department of Health or some other relevant government
department /if working in the NHS), or to an appropriate /prescribed) regulatory
body ± such as the Health and Safety Executive.
Disclosure outside these categories will only gain the protection of the Act in
limited circumstances. For example, disclosure for personal gain /e.g. a payment
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