NHS England - Transformation Directorate

Caldicott Principles and Caldicott Guardians are still relevant today

In this joint blog Simon Eccles, CCIO NHSX and Natasha Phillips, CNIO NHSX welcome the publication by the National Data Guardian, Dame Fiona Caldicott, of the revised Caldicott Principles and the confirmation of further work to support the role of Caldicott Guardians. They also outline the national role of NHSX in building staff confidence in sharing information and in opening a dialogue with patients and service users.

Simon Eccles and Natasha Phillips

The outcomes of a recent consultation found that even after 23 years since its inception, the Caldicott Principles and Caldicott Guardians (22,000 of them) were still considered valuable and useful today. That is a real testament to the quality of insight, commitment and leadership provided by Dame Fiona. 

The consultation provided an opportunity to revise the existing 7 principles as they had not been reviewed for 7 years and the introduction of an 8th one, which focuses on ensuring that expectations of patients and service users are considered and met when decisions about data sharing are made. The purpose is to ensure there are ‘no surprises’ about the handling or sharing of patient and service user data. 

COVID-19 has revealed how powerful access to the right information at the right time is. During the first wave of the pandemic, many NHS staff were redeployed, patients and service users were often seen virtually and/or by an unfamiliar health and care professional or in an unfamiliar setting. Whole health and care populations needed to work differently and shared information was absolutely key to the success of this. At the start of the pandemic just over 3 million people had an enhanced Summary Care Record. By the end of July over 54 million people had such a record and that figure has continued to creep up month by month ever since.

At a regional level, some really great conversations about the use of health and care data have moved the dialogue forward, like in the OneLondon research summarised in their report "understanding public expectations of the use of health and care data". This research found that the public had a strong expectation that their information should be available to clinicians at the point of their individual care, and were surprised to learn that this is not routinely the case. The digitisation of records and record sharing is happening so fast (as it needs to) that many people are left confused as to a) why this wasn’t happening before and b) how else this data might be used. 

Locally, the Caldicott Principles are an invaluable resource that can provide staff with a common sense approach. Playing an important part in embedding these principles into the work of their organisatons, Caldicott Guardians are often referred to as the conscience of their organisation. They have a deep understanding of how health and care data is different to other data, because in many cases they are clinicians and care providers themselves, and therefore are advocates for patients and service users. 

We recognise that there is also a national role for NHSX to build staff confidence in both sharing information and in opening a dialogue with patients and service users. We need to provide both the right tools and guidance, and lead by example. 

Our approach is to simplify guidance relating to information governance (IG) so that NHS and care staff are confident to make decisions about managing and sharing information. Our new one-stop shop IG portal brings simple advice and guidance together in place, so it is much easier to understand and apply at work. It also saves valuable time so staff can focus on what they do best - providing excellent care.