Updated: Sep 23, 98
UK Review of Non-Clinical Use of Patient Information

This report was published in December 1997 giving 16 recommendations on the non-clinical use of patient identifiable information in the National Health Service (NHS). While generally supporting the purposes for which patient information is currently used, the report called for improvements to be made in the way such information is handled. Two major concerns arising from a review conducted under the leadership of Dame Fiona between December 1996 and June 1997 were:1.
A variable awareness throughout the NHS of confidentiality requirements outside the clinical setting, and 2.
A need to ensure that information which can readily identify individual patients is kept to a minimum. The report called on the UK Department of Health to work closely with all interested groups to ensure that action taken in response to the recommendations is given the widest possible support and make sure that a challenging yet realistic pace of change is maintained. The Caldicott Report recommendations were:

1. Every dataflow, current or proposed, should be tested against basic principles of good practice. Continuing flows should be re-tested regularly.
2. A programme of work should be established to reinforce awareness of confidentiality and information security requirements amongst all staff within the NHS.
3. A senior person, preferably a health professional, should be nominated in each health organisation to act as a guardian, responsible for safeguarding the confidentiality of patient information.
4. Clear guidance should be provided for those individuals/bodies responsible for approving uses of patient-identifiable information.
5. Protocols should be developed to protect the exchange of patient identifiable information between NHS and non-NHS bodies.
6. The identity of those responsible for monitoring the sharing and transfer of information within agreed local protocols should be clearly communicated.
7. An accreditation system which recognises those organisations following good practice with respect to confidentiality should be considered.
8. The NHS number should replace other identifiers wherever practicable, taking account of the consequences of errors and particular requirements for other specific identifiers.
9. Strict protocols should define who is authorised to gain access to patient identity where the NHS number or other coded identifier is used.
10. Where particularly sensitive information is transferred, privacy enhancing technologies (e.g. encrypting identifiers or Patient identifying information) must be explored.
11. Those involved in developing health information systems should ensure that best principles are incorporated during the design stage.
12. Where practicable, the internal structure and administration of databases holding patient identifiable information should reflect the principles developed in the Caldicott Report.
13. The NHS number should replace the patient's name on Items of Service Claims made by General Practitioners as soon as practically possible.
14. The design of new systems for the transfer of prescription data should incorporate the principles developed in the Caldicott Report.
15. Future negotiations on pay and conditions for General Practitioners should, where possible, avoid systems of payment which require patient identifying details to be transmitted.
16. Consideration should be given to procedures for General Practice claims and payments which do not require patient-identifying information to be transferred, which can then be piloted.

In the light of the report's recommendations, the Department of Health intends setting up a steering committee to direct implementation, forge links with other related work programmes and invite input from interested organisations. Full text of the report is available on the web -http://www.btwebworld.com/imt4nhs/general/caldico1.htm

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