• The young person can independently seek, consent to and refuse medical treatment, provided the doctor or nurse feels the young person is competent and understands the nature and possible consequences of the advice and/or treatment, including contraception and termination of pregnancy - see Age of Legal Capacity (Scotland) Act 1991 sections 2(4).
• It is preferable for young people to have parental/carer support and the value of this should be discussed, recognising that in certain circumstances this may not be in the interest of the child.

• Parents have a right of custody until a young person is 16, but this right can only be exercised if it promotes the young person’s interests.
• There is no law requiring parental consent before advice/treatment is given to a young person and practitioners are not required to inform parents.

It is documented in the National Child Protection Guideline that all staff who work and/or come into contact with children and their families have a role to play in child protection.
Health care workers should:

• Give the young person the knowledge and skills to be responsible for their own sexual health.
• Aim to establish trust between the young person and the clinician to ensure the best care. The clinician is in a privileged position to talk about sex and sexuality, relationships and other relevant issues where there may be the opportunity for harm reduction (for example eating disorders, deliberate self-harm and drug and alcohol abuse).
• Positively promote that young person’s sense of worth and self-esteem, their health and development, so that they are able to make informed decisions.
• Facilitate harm minimisation through education and support, medical care including provision of emergency and ongoing contraception, pregnancy advice, and the testing and treatment of sexually transmitted infections.
• Provide confidential sexual health advice and treatment and to protect young people’s rights to confidentiality in all but the most exceptional cases.
• To recognise and facilitate timely information sharing with appropriate partners when a young person is at risk of harm.
• Encourage the young person to speak to their parents/carer where it is safe to do so.

GIRFEC should underpin all practice with children and young people. It is designed to be a uniform approach for all professionals working with children, young people and their families who need extra support. It ensures that services hold children and their families at the heart of decision making, and that agencies work together across service boundaries. Sexual health services should have knowledge of this approach and work towards its core components, values and principles.

All young people have a named person until they are 18 (or later if still at school). That named person is the first point of contact for a child or their families who have concerns or need extra support. Once a concern has been brought to their attention, the named person – who will be the first point of contact for the child and their family – will take action, help, or arrange for the right help in order to promote, support, and safeguard the child’s development and wellbeing.

GIRFEC also provides a framework for assessing children and young people with 8 wellbeing indicators – Safe, Healthy, Achieving, Nurtured, Active, Responsible, Respected and Included. This framework can be useful when recording significant events, observations and concerns to share with other professionals, especially in more vulnerable young people.

Young people worry about the confidentiality of the sexual health services, and this is one of the main reasons they fail to seek professional advice and may not disclose sexual activity or abuse. The confidentiality that is owed to a person less than 16 years of age is equal to that of an older person. Professionals working with young people must protect their right to confidentiality in all but the most exceptional cases. If it is felt that it is in the young person’s best interests to share information, then every effort should be made first to gain the consent of the person concerned. However, confidentiality does not prevent information sharing where there is risk of significant harm.

The decision to share information depends on an assessment of current or potential harm, and not on the person’s actual age. Health professionals can only disclose information if it is in the child’s best interest. They must also consider what information requires to be shared within their own and/ or with other agencies to ensure that a pattern of behaviour or a disclosure of potential risk is not being missed. Health professionals are required to share as much information as is necessary to protect a child.

The health care worker must be prepared to justify his/her decision to share information on the patient, to his/her colleagues and to their relevant professional association. Reasons for breaching confidentiality should be documented clearly.

Young people have the right to request a copy of their personal data under both the Data Protection Act 1998 and General Data Protection Regulation 2018. Young people can access their records by requesting a copy in writing. Both pieces of legislation state that parents are not permitted to see a young person’s health record unless the young person has given consent or the young person is deemed too young to understand how to make a request. Young people have the same rights as adults over their personal data and can access their records by requesting access in writing.

For young people who have concerns about how information has been shared or wish to complain about a “breach in their confidentiality”, the Scottish Child Law Centre (Advice Line Mon-Fri 9.30am-4.00pm 0131 667 6333 Freecall Under 21s (landlines) 0800 328 8970 (mobiles) 0300 3301421) can provide relevant advice and information.

1. Age of Legal Capacity (Scotland) Act 1991 (Sc) S 2(4). Available from: http://www.legislation.gov.uk/ukpga/1991/50/contents
2. National guidance for child protection in Scotland 2021 [Internet]. Scottish Government; 2022 Feb 22 [cited 2023 Jan 20]. Available from: https://www.gov.scot/publications/national-guidance-child-protection-scotland-2021/
3. Getting it right for every child (GIRFEC) [Internet]. Scottish Government; 2022 Sep [cited 2023 Jan 20]. Available from: https://www.gov.scot/policies/girfec/
4. Children and the UK GDPR [Internet]. Information Commissioner's Office (ICO) [Cited 2023 Jan 20]. Available from: https://ico.org.uk/for-organisations/guide-to-data-protection/guide-to-the-general-data-protection-regulation-gdpr/children-and-the-uk-gdpr/