Caldicott Review – The Ugly

(This is part 3 of a 4 part series looking at the future. If you are concerned about the privacy of your health data now, our advice remains unchanged)

The expectation of the Review was that it would create new opt out wording for the public – had many false starts as “mistakes” kept being discovered.

The new patient choice suggested on page 41 of the Review is: “information about me can only be used by the people directly providing my care.” That meets the promise in the Conservative’s election Manifesto, and it is a promise that is capable of being kept.

But what may happen in practice? Everything below is covered in the consultation that we discuss link to – it is not yet certain, it is just a proposal that can be changed. It may turn out the way you want, or the way you don’t – it depends on whether you make your views heard. For now, nothing changes, but it may in the future, and how it changes, is something you can help with.


Will Parliament be involved?

You may have already told your GP that you don’t want your data to leave their practice. But the Department of Health believes it alone can decide to ignore what you have told your Doctor… What happens when “too many” people opt out again?

The only safe way to “improve” past arrangements is for Parliament to put the opt-out into law. That should include how to get to the new model from where we are – topics that were outside the Terms of Reference of the Review.

1.2m people have explicitly ticked a box and personally delivered a form into their GP that says to their doctor “don’t pass on my records”. NHS managers want to instruct doctors to ignore it. For the medical profession, this is an ethical question, not a data protection question. Parliament therefore has to be involved.

Resolving this must be done democratically, with debate, if it is done at all. Otherwise trust in the NHS will be fundamentally damaged. What will stop a future Secretary of State changing the rules underneath patients and doctors, yet again?

This issue goes to a patient and professional trust — will the public have reason to believe the system will do what it says it will do?


Proposal: Your data will still leave your GP…

The Review suggests removing your existing opt out for GP data going to the HSCIC (page 31). Information you share with only your GP, will be copied into the HSCIC against any wishes you have already expressed.

This is the removal of an option that pre-dates – and breaches many promises of confidentiality that GPs have made to patients in the past. Currently, these promises are being kept by the GPs, but the new proposal is that GPs will be required to break them.

We have seen no compelling case for this to be necessary.


…and then data about you will leave the HSCIC…

Back in 2014, you may have opted out of “data about you leaving the HSCIC for purposes beyond your direct care”. If you did, data about you is still included in the hospital data sold for commercial reuse. The review proposes this continues (page 34).

As we showed in part 2, de-identification is not anonymisation. The Government continues to pretend that it is, so they can continue to sell your medical data and ignore the opt out you used to prevent that. While the Government say “marketing” is banned, use for “market access” is not – as the latest data release register shows.

When it was announced that opt outs were being respected, they kept the exclusions secret. It was not announced that the scope of the opt out had been slashed to exclude the data that was the primary source of patient concern. This is half the basis of our complaint to the ICO: the opt out does not do currently everything you (and we) were told it would do.


…and you may have to opt out again

If the “two box” model discussed in the second blog post is implemented, the Government will require you to opt out again. It will ignore your past choices, and you will have to fill in another form. That was the intent of those who didn’t want you to be able to opt out in the first place.

Question 15 of the consultation shows whether the Government has thought about how to do what it is consulting on: it hasn’t. Which is a recipe for the repeat of

No one can know the problems with what is proposed until the Government is clear on what it wishes to do. If they respect your   wishes, that’s pretty easy to tell patients… If they choose to ignore them, the chances of them telling you are somewhat lower.

The question the consultation should ask, is what will give you confidence that your wishes were honoured?

How will the outcome of this consultation help when the next data project gets mishandled, with a high price of patient trust,

Nothing has changed yet, but it will in the future; how it changes, is something you can help with.

The proposal in the review: “Information about me can only be used by the people directly providing my care” is strong, simple, and deliverable. You can help it become reality.


All parts can change – Here’s how you can help:

You can respond to the consultation online. You don’t need to answer every question, and can only answer question 15 if you wish.

You might want to mention some of these points in your own words:

  • Why is what you tell your GP private for you?
  • Why must the NHS keep the promises it makes to you?
  • Is this promise clear: “information about me can only be used by the people directly providing my care”?
    • Do you want that promise to be given and kept?

You can say as much or as little as you like.  

You may also want to tell your friends…

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See part 4 of the series