Many people will know the term Caldicott Guardian but perhaps not quite know what it means. In our latest blog, George Fernie, Senior Medical Reviewer with our organisation, outlines the role and what it means for respecting the rights of patients.

The term Caldicott Guardian is one that many people will have heard of, but perhaps not entirely know what it means or where it comes from. Even within my own organisation, Healthcare Improvement Scotland, I’m likely known as our Senior Medical Reviewer, working largely on our Death Certification responsibilities, but many may not know how the role of Caldicott Guardian is vital in protecting the rights of patients.

What the role is and where it came from

So, let’s answer that question right up front. The generally accepted definition of what constitutes the role of the Caldicott Guardian is set out within the UK Caldicott Guardian’s Manual. It describes the role as:

“… a senior person within a health or social care organisation who makes sure that the personal information about those who use its services is used legally, ethically and appropriately, and that confidentiality is maintained. Caldicott Guardians should be able to provide leadership and informed guidance on complex matters involving confidentiality and information sharing”. Caldicott Guardians

The term is named after Dame Fiona Caldicott who died earlier this year having worked with some distinction as an NHS psychiatrist. The Government Review of Patient-Identifiable Information, chaired by Dame Fiona Caldicott, which reported in December 1997, recommended that “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.” At that time, the report also set out principles for determining when confidential information might be used and when it should not. These six Caldicott principles have since helped Caldicott Guardians to make balanced judgements for their organisations, with a seventh being added in 2013 and an eighth in 2020.

From law graduate to legal guardian

Describing the role of Caldicott Guardian is easier to explain, however, than the journey I took to become one!

In Healthcare Improvement Scotland, the role of Caldicott Guardian has been devolved to me because of my long-term interest in medical law and ethics. Although I started my professional career as a ‘proper doctor’ by being a general practitioner, I discovered something even better in forensic and legal medicine. Having commenced work as a medicolegal adviser in 1996, I then had a complete mental aberration by going to law school where I graduated Bachelor of Laws at the University of Strathclyde, in addition to already having a Masters in Law & Ethics in Medicine from the University of Glasgow.

A further opportunity to combine law, ethics and healthcare arose when I was appointed the first Senior Medical Reviewer for Scotland in 2013, which is a statutory role conferred by the Certification of Death (Scotland) Act 2011. The reform of death certification had been a long-term aim of mine when I was the inaugural Registrar and third President of the Faculty of Forensic and Legal Medicine. Scottish Government took the enlightened decision to base the Death Certification Review Service in an independent NHS quality improvement organisation, Healthcare Improvement Scotland. This has allowed me to provide an additional contribution to other organisational workstreams, making use of my knowledge in information governance and the 17 years of practical skills I had gained in supporting doctors in the UK, South Africa and the Republic of Ireland as a medicolegal adviser.

The role of guardian at Healthcare Improvement Scotland

At Healthcare Improvement Scotland, the Caldicott Guardian works as part of a team within the Information Governance Group. In 2021, I was nominated as the Scottish representative on the United Kingdom’s Caldicott Guardian Council (UKCGC). The areas in which the Caldicott Guardian is expected to influence include: strategy and governance; confidentiality and data protection expertise; internal information processing, and information sharing.

It is quite a responsibility to be a Caldicott Guardian, as well as being a great honour. I’m fortunate to work within an organisation that places significant value on the role and its importance for protecting the rights of patients. When I’m asked what I enjoy most about being a Caldicott Guardian, the answers are actually pretty straightforward. It is facilitating the access of people to records to which they are entitled, helping avoid the release of information which is considered confidential and utilising the immense amount of data we possess within our diverse organisation to improve the health and social care of the patients of Scotland.

George Fernie is Senior Medical Reviewer with Healthcare Improvement Scotland.