Caldicott Principles are the building blocks of patient confidentiality that must be respected throughout the process of care. Keep reading to find out more about Caldicott Principles.
Table of Contents
What is Caldicott Principle?
The Caldicott Principles refer to a set of rules that organisations such as the NHS must follow to protect any patient information that could identify them, such as their name or medical records. This ensures that sensitive information is only used and shared when it is appropriate to do so.
The Caldicott Principles are named so because Dame Fiona Caldicott originally developed them in 1997. Dame Fiona Caldicott was a British psychiatrist and psychotherapist who also served as the National Data Guardian for Health and Social Care. Caldicott principles were developed after following a review of how the NHS handled patient information.
There were increasing concerns about how patient information was used in the NHS due to the development of information technology. So the review was commissioned by the Chief Medical Officer of England and Wales.
There were initially six Caldicott Principles until April 2013, when Dame Fiona Caldicott further reviewed these principles and added a seventh principle. The review involved a small panel of experts who recognised that it was sometimes appropriate to share information about a patient, mainly for their safety and improved care. For example, if the patient had committed a crime.
A more recent review was conducted in December 2020 when an eighth principle was added. The purpose of the new principle was that there should be no surprises for service users about how their personal information is processed.
The Caldicott report clearly defines that all pieces of data that pertain to a person must be protected to safeguard confidentiality, so it would not be possible to identify a patient.
It is important to know about patient identifiable information so that those information can be handled with care. Some common patient-identifiable information includes:
- The patient’s name, address, full postcode and date of birth
- Any pictures, photographs, videos, audio recordings or other images of patients
- The patient’s NHS number and local patient-identifiable codes
- Anything else that may be used to identify a patient, directly or indirectly. For example – rare diseases, drug treatments or statistical analyses using very small sample sizes, which may allow individuals to be identified.
What are the Eight Caldicott Principles?
The eight Caldicott Principles that govern and protect patient confidentiality are as follows:
- Principle 1: Justify the purpose(s) for using confidential information
- Principle 2: Use confidential information only when it’s necessary
- Principle 3: Use the minimum necessary confidential information
- Principle 4: Access to confidential information should be on a strictly need-to-know basis
- Principle 5: Everyone with access to confidential information should be aware of their responsibilities
- Principle 6: Comply with the law
- Principle 7: The duty to share information for individual care is as important as the duty to protect patient confidentiality
- Principle 8: Inform patients and service users about how their confidential information is used
Principle 1: Justify the purpose(s) for using confidential information
All proposed use or transfer of any confidential information should be clearly defined, scrutinised, and documented. And continuing uses must be regularly reviewed by an appropriate guardian.
This means that no patient’s confidential information should be shared if it is not in the patient’s best interest. Reasons for giving out personal information about a patient should be clearly stipulated. A Caldicott guardian must review how documents are handled and ensure the privacy of the patient.
Principle 2: Use confidential information only when it’s necessary
Any confidential information should not be included unless it is absolutely necessary for the specified purposes for which the information is used or being accessed. And the need to identify individuals should be considered at each stage of satisfying the purpose(s) and alternatives used where possible.
In other words, staff must be aware that giving out personal information can be a safety issue for the patient. Therefore, if the information is not needed to protect the patient, then it should not be given out.
Principle 3: Use the minimum necessary confidential information
Where the use of confidential information is necessary, all the information shared must be justified. And only the minimum amount of confidential information is included as necessary for a given function.
This means that only the least identifiable data should be shared in order to protect patient confidentiality.
Principle 4: Access to confidential information should be on a strictly need-to-know basis
This principle states that only those people who need access to the confidential information should have access to it and only to the items that they need to see. This may require introducing access controls or splitting information flows where one flow is used for several purposes.
Patient data should not be given out to any third party who is not permitted to have it. All kinds of personal and confidential information must be protected at all costs. If a non-recognised individual or organisation should request to share patient data, it is the responsibility of the health worker to deny unauthorised access.
Principle 5: Everyone with access to confidential information should be aware of their responsibilities
Necessary action should be taken to ensure that all those handling confidential information understand their responsibilities and obligations to respect the confidentiality of patients and service users.
Only a select few should have access to personal patient data. Health or social workers must be aware of their obligations to protect and respect the confidentiality of the patient.
If there is a need for personal information to be shared, it must be in the patient’s best interest to do so. Only authorised persons with rightful access should be allowed to view confidential data.
Principle 6: Comply with the law
Every use of confidential information must be lawful. All those parties handling confidential information are responsible for complying with the law. Therefore, they need to ensure that their use of and access to that information adheres to the legal requirements. And they must comply with rules set out in the statute and under the common law.
The sixth Caldicott Principle states that any use of personally identifiable data must be lawful. Every organisation must have a guardian in charge of ensuring all legal requirements are followed. This means that it is the responsibility of the guardian to ensure the organisation keeps personal data confidential.
Principle 7: The duty to share information for individual care is as important as the duty to protect patient confidentiality
All health and social care professionals should share confidential information in the best interests of patients and service users. And it must be within the framework set out by these Caldicott principles. They must also be supported by the policies of their employers, regulators, and professional bodies.
There are occasions when it is permitted to share data about a patient. For example, information may be required by government bodies or research agencies, in which case any data provided must be anonymous with no identifying factors.
Some situations involve the police requesting information, in which case it might be court-ordered so that full patient details may be released.
Principle 8: Inform patients and service users about how their confidential information is used
Necessary steps must be taken to ensure there are no surprises for patients and service users. To ensure that they can have clear expectations about how and why their private information is used and what choices they have in this regard.
These steps may vary depending on the usage. As a minimum, this will include providing accessible, relevant, and appropriate information, and in some cases, greater engagement might be required.
Further Explanation of the seventh Caldicott Principle
The Caldicott Principles must be followed by all health organisations, including public and private hospitals, clinics, and health or social care institutions. These principles serve as an ethical basis for staff to handle data and follow best practices. However, the seventh principle can cause confusion with defining when it is vital to share information.
In certain circumstances, the duty of confidentiality needs to be overridden. This is the purpose of principle seven, to show that sometimes sharing information can be as important as protecting confidentiality, to keep people safe.
When should Confidential Information be Shared?
A staff member should share information about a patient when:
- Someone is or might be at risk of harm.
- They are at risk of harming someone else.
- A crime might be prevented if the information is shared.
- A court order or any legal authority has requested the information.
- A serious crime has been committed.
What Type of Confidential Information can be Shared?
A Caldicott Guardian must approve of it before sharing information. There is a Caldicott Guardian appointed to each hospital to ensure that every member of staff in social and health care follows the Caldicott Principles. And this guardian reviews the procedures relating to person-identifiable health data.
The role of the Caldicott Guardian for both health and social care covers the wider aspects of information management, including:
- Data Protection Act 2018
- NHS Act 2006 (section 251)
- Freedom of Information Act 2000
- Human Rights Act 1998
- Computer Misuse Act 1990
- NHS Constitution (January 2009, updated February 2015)
- NHS Information Governance
The Caldicott Guardian should be as follows, in order of priority –
- A member of the management board or senior management team of the health or social care organisation.
- A senior health or social care professional.
- A member of staff who has the responsibility for promoting clinical governance or equivalent in the organisation.
The guardian should also have a close relationship with the senior health professional responsible for promoting clinical governance or the equivalent of social care.
What would we do without Caldicott Principles?
Prior to the 1997 review, there were often data breaches as patient records were easily accessible by the public. This put people at risk of social discrimination in the workplace or socially. There were widespread stories about patient data being abused by political rivals or even used to contest business leadership positions.
The introduction of the Caldicott Principles meant there was a total overhaul of indiscriminate access to patient information, meaning only the patient themselves or approved family members had access. Also, the Data Protection Act of 1998 means it is unlawful to gain unauthorised access to a patient’s medical record, ensuring the privacy of all individuals.
Years later, the Caldicott Principles still govern our healthcare system. They help protect patient information and respect their privacy. Learn about confidentiality in a medical environment, maintaining workplace safety and more with this Diploma in Medical Secretary course.
Ensure proper implementation of Caldicott Principles for a secure and reliable healthcare environment.
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