SL62-Caldicott Principles and Patient Information Policy

Registration Number: {{org_field_registration_no}}

Caldicott Principles and Patient Information Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} effectively and securely manages patient information in line with the Caldicott Principles, General Data Protection Regulation (GDPR) 2018, Data Protection Act 2018, and Care Quality Commission (CQC) regulations. This policy aims to protect service users’ confidentiality, ensure lawful information sharing, and support the highest standard of care through secure and appropriate data management.

This policy applies to all forms of patient information, including electronic records, paper documentation, verbal communications, and digital transmissions. By implementing this policy, {{org_field_name}} ensures compliance with national standards while maintaining transparency, accountability, and trust between service users, staff, and external agencies.

2. Scope

This policy applies to all staff, volunteers, contractors, agency workers, and external service providers who have access to patient information within {{org_field_name}}. It governs:

Collection, storage, and sharing of patient information
Compliance with the Caldicott Principles
Legal and ethical considerations in data handling
Roles and responsibilities in managing confidential information
Procedures for handling data breaches
Training, monitoring, and compliance

3. Legal and Regulatory Compliance

3.1 CQC Regulations

Regulation 17 – Good Governance: Requires providers to maintain accurate, complete, and contemporaneous records for service users and ensure secure information sharing.
Regulation 10 – Dignity and Respect: Ensures that personal data is handled respectfully, maintaining service user confidentiality.
Regulation 13 – Safeguarding: Stresses the importance of appropriate information sharing to protect vulnerable individuals from harm.

3.2 Data Protection Legislation

GDPR 2018 and Data Protection Act 2018: Establishes legal requirements for processing personal and sensitive information, ensuring that data is handled lawfully, fairly, and transparently.
Freedom of Information Act 2000: Outlines rules for public access to certain types of information while protecting service user confidentiality.
Human Rights Act 1998: Ensures respect for an individual’s private and family life, directly impacting how patient information is managed.

4. Understanding the Caldicott Principles

The Caldicott Principles were developed to ensure that personal information is handled appropriately in health and social care settings. {{org_field_name}} adheres to these principles as follows:

4.1 Principle 1: Justify the Purpose for Using Confidential Information Every instance of patient information use must be justified. Staff must:

Clearly define why data is needed before accessing or sharing it.
Ensure that all data-sharing activities align with service user care and safety.
Conduct regular audits to assess the necessity of ongoing data processing.

4.2 Principle 2: Use Patient Identifiable Information Only When Necessary Wherever possible, anonymised or pseudonymised data should be used instead of personally identifiable information. Staff must:

Evaluate if identifiable data is essential before sharing information.
Use reference codes or initials where full disclosure is unnecessary.
Ensure that only relevant team members have access to identifiable information.

4.3 Principle 3: Use the Minimum Necessary Patient Identifiable Information Staff must:

Share only the minimum amount of data required to achieve the intended purpose.
Avoid excessive or irrelevant data collection and sharing.
Regularly review data retention and remove unnecessary records in line with GDPR requirements.

4.4 Principle 4: Access to Patient Identifiable Information Should Be on a Strict Need-to-Know Basis

Access is restricted to authorised personnel only.
Information is shared within a secure, controlled environment.
Access logs and permissions are reviewed regularly to prevent unauthorised use.

4.5 Principle 5: Everyone with Access to Patient Identifiable Information Should Be Aware of Their Responsibilities

All staff handling patient data must undergo mandatory data protection training.
Clear policies and guidelines are provided to ensure staff understand their responsibilities.
Breach of confidentiality is treated as a serious offence and may result in disciplinary action.

4.6 Principle 6: Understand and Comply with the Law

Staff must be familiar with legal requirements surrounding data protection and sharing.
Policies are reviewed to ensure ongoing compliance with GDPR, CQC, and NHS Digital guidance.
Data Protection Officers (DPOs) oversee compliance and provide guidance on legal issues.

4.7 Principle 7: The Duty to Share Information Can Be as Important as the Duty to Protect Confidentiality

In cases where information sharing is essential for safeguarding, protection from harm, or public interest, staff must disclose necessary information in line with legal requirements.
Justifications for sharing data without consent must be clearly documented.
All disclosures must align with local safeguarding procedures and national laws.

5. Managing Patient Information Efficiently

5.1 Secure Data Collection and Storage

Electronic records are stored on encrypted and password-protected systems.
Paper records are kept in locked cabinets, accessible only to authorised staff.
Data retention policies ensure information is not kept longer than necessary.

5.2 Information Sharing Procedures

Information is shared only through secure communication channels, such as encrypted emails or NHS-approved portals.
Service users and legal representatives are informed how their data is used and shared.
A formal agreement is in place with external agencies regarding information sharing.

5.3 Consent Management

Explicit consent must be obtained from service users before sharing personal data unless a legal or safeguarding exception applies.
Service users are informed of their rights to access, correct, or restrict processing of their data.
If a service user lacks capacity, decisions must align with the Mental Capacity Act 2005 and best interest principles.

5.4 Handling Data Breaches

All breaches must be reported immediately to the Data Protection Officer (DPO).
Investigations are conducted to determine the cause and impact of the breach.
Service users affected by data breaches are informed as per legal obligations.
Corrective measures are implemented to prevent future incidents.

6. Training and Staff Responsibilities

6.1 Training Requirements

All staff must complete annual GDPR and data protection training.
Specialised training is provided for staff handling sensitive or high-risk data.
Staff receive regular updates on policy changes and best practices.

6.2 Monitoring and Compliance

Regular audits assess data security and policy adherence.
Non-compliance with data security measures is addressed through corrective actions and disciplinary procedures.
Lessons learned from compliance checks inform continuous improvement strategies.

7. Related Policies

This policy should be read in conjunction with:

SL02 – Confidentiality and Data Protection Policy
SL07 – Safeguarding Policy
SL13 – Incident Reporting and Risk Assessment Policy
SL19 – IT and Cybersecurity Policy
SL25 – Complaints and Whistleblowing Policy

8. Policy Review

This policy will be reviewed annually or sooner if required by legislative changes, regulatory updates, or organisational needs.

Date of Next Review: [Insert Date]

By implementing this Caldicott Principles and Patient Information Policy, {{org_field_name}} ensures that patient data is handled with integrity, security, and compliance, while balancing confidentiality with the duty to share information when necessary for safe and effective care.

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.