A review was commissioned in 1997 by the Chief Medical Officer of England "owing to increasing concern about the ways in which patient information is being used in the NHS in England and Wales and the need to ensure that confidentiality is not undermined. Such concern was largely due to the development of information technology in the service, and its capacity to disseminate information about patients rapidly and extensively".
A committee was established under the chairmanship of Dame Fiona Caldicott, Principal of Somerville College, Oxford, and previously President of the Royal College of Psychiatrists. Its findings were published in December 1997. The report highlighted six key principles,, listed below:
- Justify the purpose(s)
Every proposed use or transfer of patient identifiable information within or from an organisation should be clearly defined and scrutinised, with continuing uses regularly reviewed, by an appropriate guardian.
- Don't use patient identifiable information unless it is absolutely necessary
Patient identifiable information items should not be included unless it is essential for the specified purpose(s) of that flow. The need for patients to be identified should be considered at each stage of satisfying the purpose(s).
- Use the minimum necessary patient-identifiable information
Where use of patient identifiable information is considered to be essential, the inclusion of each individual item of information should be considered and justified so that the minimum amount of identifiable information is transferred or accessible as is necessary for a given function to be carried out.
- Access to patient identifiable information should be on a strict need-to-know basis
Only those individuals who need access to patient identifiable information should have access to it, and they should only have access to the information items that they need to see. This may mean introducing access controls or splitting information flows where one information flow is used for several purposes.
- Everyone with access to patient identifiable information should be aware of their responsibilities
Action should be taken to ensure that those handling patient identifiable information - both clinical and non-clinical staff - are made fully aware of their responsibilities and obligations to respect patient confidentiality.
- Understand and comply with the law
Every use of patient identifiable information must be lawful. Someone in each organisation handling patient information should be responsible for ensuring that the organisation complies with legal requirements.