UK: "guardians of patient confidentiality"

[Peter Marshall <techdiff@ix.netcom.com>]

BMJ 1999;318:284
( 30 January )

News extra

Guardians to protect
patient data

John Warden,
parliamentary
correspondent, BMJ

New watchdog figures, to
be called Caldicott
Guardians, will make
their appearance throughout the NHS from April. Their duty will be to
safeguard and protect the handling of confidential patient information as it
passes between computers.

The name derives from the Caldicott review which reported just over a year
ago (BMJ 1997;315:1562) in response to a threatened BMA boycott of the NHS
"net" because of the vulnerability of patient data flowing from clinical to
administrative settings. The review was led by Dame Fiona Caldicott, the
principal of Somerville College, Oxford, and a past president of the Royal
College of Psychiatrists.

The introduction of local guardians of patient confidentiality was a key
recommendation, and an executive circular has now ordered NHS frontline
units to have them appointed by 1 April. The network of Caldicott Guardians
will be appointed by each health authority, NHS trust, and primary care
group.

The circular says that ideally the guardians should be board members and
senior health professionals, with some responsibility for clinical
governance within the organisation. Their work should not be delegated. "It
is intended that Caldicott Guardians will be central to the development of a
new framework for handling patient information in the NHS," the circular
states. In support of the guardians, NHS boards are to develop protocols for
the disclosure of patient information to other organisations, restrict
access, review the uses of patient data, and improve database design, staff
training, and compliance.

Caldicott Guardians should have the authority to exercise the necessary
influence on policy and strategic planning. Candidates might include
directors of public health and clinical or nursing directors of trusts. Each
primary care group should have its guardian, and each practice should
nominate a liaison point for confidentiality issues. Preserving patient
confidentiality is a cornerstone of the NHS information strategy, the
circular states.

The NHS executive is contemplating a new national advisory body to set
uniform standards. Junior health minister Baroness Hayman said that the
Caldicott Guardians would have a vital role to play as the NHS learns to
harness the enormous potential of information technology.

Dr Ian Bogle, the chairman of council of the BMA, welcomed the initiative.
He said that the process has a long way to go and setting up a system of
guardians was a vital first step.

The health service circular Caldicott Guardians is available from the
Department of Health, PO Box 410, Wetherby, LS23 7LN, or on website:
http://www.open.gov.uk/doh/coinh.htm