The Caldicott Principles: Protecting Patient Privacy

clendar July 13, 2023

clendar 18 minutes

James Wilshiere

11581 Users

Caldicott Principles are the building blocks of patient confidentiality that must be respected throughout the process of care. Caldicott Principles addresses concerns about patient information and security. Keep reading to find out more about what are the Caldicott Principles.

What are the Caldicott Principles?

The Caldicott Principles refer to a set of rules that organisations like 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. Also, she served as the National Data Guardian for Health and Social Care.

Why were the Caldicott Principles Introduced?

Caldicott Principles were developed after following a review of how the NHS handled patient information. Before the 1997 review, patient records were easily accessible by the public. So there were often data breaches as. And these put people at risk of social discrimination and abuse 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. Moreover, there were increasing concerns about how patient information was used in the NHS. And the concerns were raised due to the development of information technology. So the review was commissioned by the Chief Medical Officer of England and Wales.

The introduction of the Caldicott Principles meant there was a total overhaul of indiscriminate access to patient information. This also meant that only the patient themselves or approved family members had access. Also, as per the Data Protection Act of 1998, it is unlawful to gain unauthorised access to a patient’s medical record, ensuring the privacy of all individuals.

Why do We Need Caldicott Principles?

The Caldicott Principles are essential for the following reasons:

First, to make the patients feel more in control of their personal information.
Protect the identities of the patients.
To make sure patients know how and when to object to the release of their confidential data.
Make patients feel confident that their information is in safe hands and not to worry.
Finally, ensure that healthcare personnel don’t use personal information for individual purposes.

The Caldicott report clearly defines that all pieces of data that pertain to a person must be protected to safeguard confidentiality. Therefore, it would not be possible to identify a patient, and this principle is crucial for anyone in a position of responsibility, such as a Designated Safeguarding Lead, to uphold.

The Caldicott Principles help lay down guidelines for medical practitioners to follow and limit patients’ personal information sharing. For example, the only time a patient’s records can be accessed without their consent is if they’re registered in public records. Moreover, only government officials can do that under an act of non-disclosure.

In brief, the Caldicott principles are a basis for sharing personal information between the patient and medical and government officials to safeguard their confidentiality. In addition, they help keep patient’s medical records and registers safe and secure.

Patient-Identifiable Information

It is important to know about patient identifiable information so that this information can be handled with care. So, here’s a list of some key patient-identifiable information –

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, symptoms, diagnoses, drug treatments or statistical analyses using very small sample sizes, which may allow individuals to be identified.

How Many Caldicott Principles are there in 2024?

There are eight Caldicott Principles to ensure that people’s information is kept confidential and used properly.

Initially, there were six Caldicott Principles until April 2013. Then 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. It is mainly for their safety and improved care. For example, if the patient had committed a crime.

A more recent review was conducted in December 2023, 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.

Who do the Caldicott Principles Apply To?

The Caldicott Principles apply to the use of confidential information within any health and social care organisation. These principles also apply when sharing such information with other organisations or individuals for individual care or other purposes.

And if you’re wondering whether Caldicott Principles apply to the deceased. Yes, Caldicott Principles apply to records and information regarding the deceased too. However, when making a novel or any complex judgment or decision regarding health and care, it is prudent to involve a Caldicott Guardian.

Keep reading to find out more about Caldicott Guardians.

What are the Eight Caldicott Principles in Health and Social Care?

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

The first Caldicott Principle states that all proposed use or transfer of any confidential information should be clearly defined, scrutinised, and documented. And any 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. And reasons for giving out personal information about a patient should be clearly stipulated. In addition, a Caldicott Guardian must review how documents are handled and ensure the patient’s privacy.

Principle 2: Use Confidential Information Only When it’s Necessary

The second Caldicott Principle is about using confidential information. Any confidential information should not be included unless it is absolutely necessary. And the reason for using or accessing information should be for the specified purposes only. Also, the need to identify individuals should be considered at each stage of satisfying the purpose(s) and alternatives used where possible.

More importantly, 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

Principle three of Caldicot aims to ensure minimal use of 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

The fourth principle states that only those people who need access to confidential information should have access to it. And access is limited 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.

Also, patient data should not be given out to any third party who is not permitted to have it. What is more, 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

The fifth Caldicott Principle emphasises the responsibility of the people who have access to sensitive data. So, 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.

If there is a need for personal information to be shared, it must be in the patient’s best interest to do so. And only authorised persons with rightful access should be allowed to view confidential data. Health or social workers must be aware of their obligations to protect and respect the confidentiality of the patient.

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 abide by 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.

Also, in some situations, the police may request to release full patient details and information. But remember that in such a case, they must have a court order.

But 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 the confidentiality, to keep people safe.

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Principle 8: Inform Patients and Service Users about How Their Confidential Information is Used

The eighth Caldicott Principle states that necessary steps should be taken to ensure there are no surprises for patients and service users, and they are well-informed. They should have a clear idea about how and why their personal information will be used and their choices about this.

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.

It is important to ensure that it is done by following these principles and not outside what the policies provide. In addition, they must oversee the flow of patient information, either for research or disclosure of information to the police.

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.

How can You Apply Caldicott Principles in Your Settings?

Caldicott Principles must be followed by all the social and healthcare personnel to ensure that there’s no breach of confidentiality.

But some people might still be confused about whether to share information about patients in certain situations. For instance, principle 7 states, ‘The duty to share personal information can be as important as the duty to have regard for patient confidentiality.’

However, principle 7 doesn’t give a clear boundary regarding when it’s okay to share information. Instead, it merely denotes that while protecting patients’ confidentiality is necessary, there are also exceptions in the case of a breach of duty of care. So when can you share confidential information? Find out in the section below.

Here is the Caldicott Principles’ mnemonic, a reminder of Dame Fiona Caldicott herself to help you remember the Caldicott Principles.

FIONA C

Formal justification of purpose.
Information is to be transferred only when absolutely necessary.
Only the minimum is required.
Need to know access controls.
All to understand their responsibilities.
Comply with and understand the law.

Hopefully, this will help you remember to concentrate on patient confidentiality in your healthcare work.

When can You Share Confidential Information?

To eliminate any room for confusion, here are some situations when you should share information about a patient.

The patient is being shifted to another hospital for treatment.
Someone is or might be at risk of harm and needs protection.
They are at risk of harming someone else.
A crime might be prevented if the information is shared.
A patient is dead, but a relative needs to be identified.
The court or any other legal authority has requested the information.
A serious crime has been committed, or a patient is wanted for a crime committed.
Lastly, when the law authorises it.

However, any member of the Executive, such as the police, does not have the right to request patient-identifiable information without a written order by the court. If there is a written order, but the information is still being withheld, the patient’s doctor could be held in contempt of court.

Who is a Caldicott Guardian?

A Caldicott Guardian is a person responsible for preserving the confidentiality of people’s health and care information. And the Caldicott Guardian is usually a board-level health professional or deputy.

Therefore, 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.

All NHS organisations and local authorities that provide social services need to have a Caldicott Guardian. The national body for Caldicott Guardians is the UK Caldicott Guardian Council (UKCGC).

The Role of a Caldicott Guardian

A Caldicott Guardian’s key responsibilities include championing confidentiality at the senior management level, internal information processing and information. But most importantly, they have excellent knowledge and expertise in confidentiality and data protection.

Caldicott Guardians are responsible for developing local protocols for information disclosure, restricting access to patient information by enforcing strict need-to-know principles, and regularly reviewing and justifying patient information use. In addition, Caldicott Guardians make sure that patient-identifiable information are used legally, ethically and appropriately.

The role of the Caldicott Guardian for both health and social care covers the wider aspects of information management, including the following laws:

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 following confidentiality model used by the NHS and Caldicott Guardian’s is also very beneficial in protecting patients’ confidentiality.

A Caldicott Guardian must approve of it before sharing information. And there is a Caldicott Guardian appointed to each hospital to ensure that every member of social and health care staff follows the Caldicott Principles. And the guardian reviews the procedures relating to person-identifiable health data and safeguards patients.

The guardian should also have a close relationship with the senior health professional responsible for promoting clinical governance or the equivalent of social care.

Download Free Poster of 8 Caldicott Principles

Summary of Caldicott Principles

Caldicott Principles are the rules that protect patient confidentiality in health and social care. There are eight Caldicott Principles in 2024, even though it started with only six principles in 1997.

Years later, the Caldicott Principles still govern our healthcare system to safeguard patient identity. They help protect patient information and respect their privacy.

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FAQs

1. How many caldicott principles are there?

There are a total of Eight Caldicott principles. These principles are essential guidelines for handling personal confidential information in the healthcare sector. They outline the necessary steps to ensure the privacy and security of sensitive data, promoting trust between patients and healthcare providers.

2. What are the caldicott principles?

The Eight Caldicott Principles in Health and Social Care are:

1. Justify use.
2. Necessary use only.
3. Minimum data use.
4. Limited access.
5. Responsible access.
6. Legal compliance.
7. Balance confidentiality with sharing.
8. Inform patients.

3. Does the caldicott principles apply to the deceased?

Yes, the Caldicott Principles also apply to the deceased. These principles aim to ensure that confidential information about individuals, including those who have passed away, is handled respectfully and securely.

4. Why was the caldicott review commissioned?

The Caldicott Review was commissioned to address concerns about the use of patient data in the NHS and to establish principles for handling sensitive information securely.

5. Who does the caldicott principles apply to?

The Caldicott Principles apply to all individuals working within health and social care organizations in the UK who have access to patient information.

6. What is the 7 caldicott principles?

The seven Caldicott Principles are a set of guidelines established to ensure the confidential handling of personal information within the healthcare sector in the UK. These principles emphasize the importance of respecting patient confidentiality, limiting access to personal data, and ensuring secure storage and transmission of sensitive information. They provide a framework for healthcare organizations to uphold the privacy rights of patients while delivering quality care.