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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Caldicott Principles and Patient Information Policy

1. Purpose

The purpose of this policy is to ensure that all patient-identifiable information is handled with the highest level of confidentiality, security, and compliance with legal and regulatory standards. This policy outlines how {{org_field_name}} adheres to the Caldicott Principles to manage patient information efficiently while balancing the need for effective care delivery and information governance.

2. Scope

This policy applies to all employees, volunteers, contractors, and any third-party partners who have access to patient-identifiable information within {{org_field_name}}. It includes electronic, paper-based, and verbal information shared within and outside the organisation.

3. Legal and Regulatory Framework

{{org_field_name}} complies with the following laws and regulations to ensure that patient information is handled legally and ethically:

• The Data Protection Act 2018 (UK GDPR) – Provides the legal framework for processing personal and health data, ensuring transparency, accountability, and lawful handling.
• The Health and Social Care Act 2012 – Mandates the proper handling and use of patient data within healthcare and social care settings.
• The Caldicott Principles – The fundamental guidelines governing the use and sharing of patient-identifiable information to uphold confidentiality.
• The Freedom of Information Act 2000 – Establishes rights to access non-personal healthcare information while maintaining patient privacy.
• The NHS Code of Confidentiality – Ensures all patient information is handled with care, only disclosed when necessary, and in compliance with laws.
• Common Law Duty of Confidentiality – Requires that patient information is kept confidential unless there is a lawful reason to disclose it.

By adhering to these frameworks, {{org_field_name}} ensures compliance with regulatory obligations, promoting a culture of trust and security regarding patient information.

4. The Caldicott Principles

{{org_field_name}} rigorously follows the seven Caldicott Principles to ensure patient information is used and shared responsibly:

1. Justify the purpose – Every instance of using patient-identifiable information must have a clear, documented justification that is reviewed regularly.
2. Only use it when necessary – We ensure patient information is used only where absolutely required to deliver care, research, or operational functions.
3. Use the minimum necessary information – {{org_field_name}} limits the amount of identifiable data processed to only what is needed to complete a task.
4. Restrict access on a need-to-know basis – Access controls are implemented so only authorised personnel can access specific patient information.
5. Ensure all staff understand their responsibilities – We provide continuous education and training to all employees regarding their responsibility to handle patient data appropriately.
6. Comply with legal obligations – All handling, storage, and sharing of patient information align with relevant legislation and regulatory requirements.
7. Balance the duty to share with confidentiality – While confidentiality is paramount, patient data is shared where necessary for direct care, safeguarding, and legal purposes in a lawful and proportionate manner.

5. Roles and Responsibilities

To maintain data security and integrity, specific roles within the organisation have been designated with defined responsibilities:

• Data Protection Officer (DPO)/ Caldicott Guardian ({{org_field_data_protection_officer_first_name}} {{org_field_data_protection_officer_last_name}}): Ensures compliance with data protection regulations, provides guidance on legal aspects of data handling, and oversees data breach response measures.
• All Employees and Contractors: Every individual handling patient data is responsible for maintaining confidentiality, complying with legal requirements, and reporting any concerns or breaches immediately.

6. Data Security and Confidentiality Measures

To protect patient information, {{org_field_name}} implements the following security measures:

• Access Control: Patient records are accessible only to authorised personnel with a legitimate reason.
• Encryption and Secure Storage: Electronic patient records are stored on encrypted servers with restricted access, and physical records are kept in secure, locked cabinets.
• Secure Transmission: Emails and data transfers involving patient-identifiable information are encrypted and use approved secure channels.
• Confidentiality Agreements: Employees, contractors, and third-party service providers must sign confidentiality agreements before handling patient data.
• Monitoring and Audit Logs: Regular system audits track access and use of patient information to detect and prevent unauthorised access.

7. Data Sharing and Third-Party Access

There are circumstances where patient information must be shared securely and lawfully, including:

• For direct care – Patient information is shared with authorised healthcare providers involved in their treatment.
• For legal obligations – Information is disclosed to regulatory bodies such as the Care Quality Commission (CQC) where required by law.
• For safeguarding purposes – Where necessary, information is shared to protect individuals from harm or abuse, following appropriate legal protocols.
• With third-party providers – Contractors and service providers must comply with data-sharing agreements, ensuring confidentiality and compliance with regulations.

Before any information is shared, a risk assessment is conducted to ensure that the sharing aligns with legal, ethical, and organisational policies.

8. Training and Awareness

To ensure compliance with this policy and relevant legislation, {{org_field_name}} provides:

• Mandatory training for all staff covering data protection, patient confidentiality, and information governance.
• Regular refresher courses and updates on policy changes and best practices.
• Role-specific training for employees who handle patient information more frequently.
• Awareness campaigns to reinforce the importance of data security and confidentiality among staff and stakeholders.

All employees are required to complete training upon induction and on an annual basis.

9. Managing Data Breaches

In the event of a data breach, {{org_field_name}} follows a strict incident management process:

1. Immediate containment – The breach is assessed, and immediate actions are taken to minimise further risk.
2. Impact assessment – The severity and potential impact of the breach on individuals and the organisation are evaluated.
3. Reporting internally – The Data Protection Officer (DPO) and Caldicott Guardian are notified immediately.
4. Notification of affected individuals – If necessary, affected individuals will be informed about the breach and any remedial actions taken.
5. Regulatory reporting – Where applicable, the Information Commissioner’s Office (ICO) is notified within 72 hours.
6. Corrective actions – Preventative measures are implemented to avoid similar breaches in the future.

10. Compliance and Monitoring

To ensure continuous compliance, {{org_field_name}} employs the following monitoring methods:

• Regular internal audits to assess adherence to data protection standards.
• Random checks and system access reviews to detect any potential misuse of patient data.
• Feedback mechanisms where staff and service users can report concerns related to information security.
• Policy reviews and updates to align with regulatory changes and emerging data security threats.

11. Review and Updates

This policy will be reviewed annually or whenever significant legal or procedural changes occur. Any updates will be communicated to all staff, and training materials will be revised accordingly.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.