Health Service Focus

29.07.16

Caldicott Review: Third time lucky

Dr Mark Davies photoDr Mark Davies, former medical director of the Health and Social Care Information Centre and GP of 20 years, reflects on the recent Caldicott review. 

This month saw the publication of Dame Fiona Caldicott’s long-awaited review into data security in the NHS. This is the third time Dame Fiona has been asked to produce some recommendations on the subject and comes in the context of a fervent debate on the subject of health information. 

It’s well-timed, much needed and built around a single notion – that of trust. People will trust what happens with their information when they can see what’s happening to it and when they control it. Dame Fiona’s paper is a powerful call for the introduction of a little more democracy in our clinical records. 

It is not that data sharing has been tried and found wanting, it’s more that data sharing has been tried and found hard. I think we are all familiar with the backdrop to this publication, which includes a number of well-publicised data breaches and the public unease around the now scrapped Care.Data project

The Five Year Forward View has set out the case for making the NHS sustainable by integrating care and moving to population-based healthcare systems – both of which require data sharing. 

The people trying to deliver effective and safe care, either planning services or encouraging data sharing to co-ordinate our fragmented system, are crying out for a more pragmatic approach to information sharing. There are frightening levels of clinical risk in NHS Systems because of the lack of information sharing in different care settings.  Ambulance drivers don’t know the GP thoughts on the patient’s condition, ED doctors aren’t aware of what the patient’s consultant is treating them with, and the poor patient hasn’t any visibility of what everyone else is saying about them. In a world of 21st century healthcare our communication can feel almost medieval. 

Confidentiality key 

Dame Fiona reminds us that the very foundation of the social contract of healthcare is confidentiality and we cannot afford to suggest that as a care system we don’t be see this as a basic tenet of how we work. 

Thankfully one of her key themes is that the vast majority of people who work in the NHS take confidentiality very seriously. There is much said of training, audit, assurance and penalties which are ways of demonstrating how seriously this is taken. To quote the UK Council of Caldicott Guardians: “Information Governance should be as much as possible integrated into the broader governance of an organisation, and regarded as being as important as financial and clinical governance in organisational culture.”  

There is a nagging suspicion among the general public that they don’t really know how the information in their clinical record is used. To address this, Dame Fiona talks of raising the public awareness and giving control with an opportunity to object to information being used for purposes other than their direct care

This emphasis is both sensible and necessary but it is hard to achieve in the world of Big Brother suspicions of central government and financial institutions. There are two distinct purposes of information in addition to direct care – research and health planning. Whether there are separate objections to these two uses or they are bundled together in a single question is yet to be decided. We recently had experience of trying to reduce a complex social issue into a single question in the EU debate and I think we all recognise what was required was a more nuanced a granular assessment of views. 

Interestingly, the proposed opt outs don’t apply to the flow of personal confidential data out of a GP surgery into NHS Digital. This is a highly contentious point and in many ways what did for Care.Data. The overwhelming majority of GPs take extremely seriously their responsibilities as a data controller of the cradle-to-grave-record that is the primary care clinical record. It will be interesting to see how that pans out – but I suspect it will be one of the more difficult areas of the recommendations. 

Dame Fiona also puts to bed some myths – and this must be welcomed. For example, the fact that the majority of health service planning and management such as population health management, regulation or commissioning, can be done using data from which personal identifiers have been removed is well argued. The only exception is where bills have to be checked against particular patients. The work in East and North Hertfordshire CCG, which the report references, has shown that even here, confidential data is not required. The issue of invoice validation will be subject to further consideration by the Department of Health. 

Dame Fiona calls for the adoption of modern technology standards around cyber security, training and software updates – “about time too!” I hear you cry. There is a clear acknowledgment that the information systems in a modern health system are as intrinsic as those in the operating theatres or the medication pipeline, and need to be treated with the same level of rigour and assurance. 

But to return to the theme of trust, which may hold the key to effective information sharing – in the last year I have heard too often about the barrier that is IG and how the publication of Dame Fiona’s report is going to solve this. How much is this an excuse not to share? The report is here. I don’t think government departments are in a position to build trust in the current climate. That means it is up to those involved in commissioning, planning and delivering care. This is going to have to be done from the bottom up. Are you ready?

Have you got a story to tell? Would you like to become an NHE columnist? If so, click here.

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

Three CCGs slapped with NHS England legal directions

18/08/2017Three CCGs slapped with NHS England legal directions

Three CCGs have been slapped with NHS England legal directions requiring them to produce urgent improvement and financial plans, as well as hire ... more >
Numbers placed into nursing courses drops by 8% since 2016

18/08/2017Numbers placed into nursing courses drops by 8% since 2016

Nurses have today warned that there are not enough new workers being trained to keep pace with demand as UCAS figures showed that there had been ... more >
London trust told to improve for third time in three years

17/08/2017London trust told to improve for third time in three years

A major London NHS trust has been told by inspectors that it needs to urgently improve after it received its third ‘Requires Improvement&rs... more >

editor's comment

13/06/2017Tackling the major challenges facing the NHS

As you will have gathered from the front cover, a theme that runs throughout this edition of NHE is about empowering and involving the workforce in order to deliver innovative change across the system.  Professor Jane Dacre, president of the Royal College of Physicians, highlights on page 16 the importance of sustainability and trans... read more >

last word

Your personality, your leadership

Your personality, your leadership

Deirdre Wallace, clinical skills manager at UCL Medical School, discusses the importance of learning about leadership and self while at medical school. Approximately five years ago, I was ch... more > more last word articles >
681 149x260 NHE Subscribe button

the scalpel's daily blog

Turbo-boosting STPs? It’s time we got serious about ‘partnership’

27/07/2017Turbo-boosting STPs? It’s time we got serious about ‘partnership’

Merron Simpson, chief executive New NHS Alliance, argues we’re missing the point of what ‘partnership working’ truly means if we refuse to recruit help from those outside the health service. Jeremy Hunt and Simon Steven’s recent announcement to ‘turbo-boost’ sustainability and transformation partnerships (STPs) provides a welcome shot-in-the-arm for those across the system who are ... more >
read more blog posts from 'the scalpel' >

comment

Changing our digital culture and safeguarding patient data

08/08/2017Changing our digital culture and safeguarding patient data

Joanna Smith, chief information officer at Royal Brompton & Harefield NHS FT (RBHT), says that as the NHS becomes more digital it has to get ... more >
A centre for medicines optimisation research and education

04/08/2017A centre for medicines optimisation research and education

Dr Yogini Jani, a consultant pharmacist at University College London Hospitals NHS FT (UCLH), discusses a collaboration with UCL School of Pharma... more >
Unlocking the benefits of age-friendly cities

04/08/2017Unlocking the benefits of age-friendly cities

Stefanie Buckner, Calum Mattocks and Louise Lafortune from the Cambridge Institute of Public Health, alongside Melanie Rimmer from the School of ... more >
A community service

04/08/2017A community service

Louise Watson, NHS England director of the New Care Models programme, discusses the emerging success stories from the vanguard areas across the c... more >
Diabetes Professional Care launches 2017 Conference programme

03/08/2017Diabetes Professional Care launches 2017 Conference programme

An outstanding line-up of practitioners and thought leaders will share their expertise and knowledge with healthcare professionals from across th... more >

interviews

Improving care at the touch of a screen

08/08/2017Improving care at the touch of a screen

When it comes to dementia, having a calm and safe environment can have a substantial impact on a patient’s quality of life. NHE’s Jos... more >
A new approach to talent management

25/07/2017A new approach to talent management

Martin Hancock, national lead for talent management at NHS Leadership Academy, and Gill Rooke, the organisation’s senior operations manager... more >
Enabling greater integration through ACSs

25/07/2017Enabling greater integration through ACSs

At this year’s NHS Confed, Simon Stevens revealed the first wave of accountable care systems (ACSs). NHE speaks to Ian Dodge, the director ... more >
How NHS organisations can protect themselves against cyber crime

25/07/2017How NHS organisations can protect themselves against cyber crime

On 12 May, a global cyber-attack occurred on an unprecedented scale. It affected organisations across the globe and, though it did not specifical... more >
Working collectively to improve cancer outcomes for patients

20/06/2017Working collectively to improve cancer outcomes for patients

Last year, the cancer vanguard established the Pharma Challenge. Rob Duncombe, pharmacy director at the Christie NHS FT, gives NHE an update on t... more >