Jenny Belza is the Caldicott Guardian for one of England’s largest Clinical Commissioning Groups. NHS Birmingham CrossCity CCG has an annual budget of £1 billion and commissions services for 710,000 people.
Jenny has been its chief nurse and quality officer since it came into being in April 2013. That makes her responsible for ensuring quality of service among providers including primary care, acute trusts and mental health. She also manages safeguarding of children and adults, equality and diversity, continuing healthcare and transforming care for people with learning disabilities. She is a member of the CCG’s governing body.
With all these responsibilities, it is perhaps unsurprising that being Caldicott Guardian is a small part of Jenny’s workload. She says: “Some weeks I don’t spend any time on my Caldicott Guardian role. Some weeks it will take a couple of hours.”
The CCG does not itself provide direct patient care and so does not routinely handle patients’ confidential personal information. Issues that require the attention of the Caldicott Guardian often involve resolving problems that stand in the way of organisations sharing information appropriately.
A recent example came when NHS England was implementing its policy of moving people with learning disabilities from special hospitals to more personalised care in the community. Jenny worked with two other CCGs, the local authority and NHSE to put in place services for 70 individuals in the Birmingham area. Each had different individual needs and so the commissioning work required detailed knowledge of their personal circumstances.
To make the transfer of responsibility safe and to provide a quality service, all the organisations involved in their care needed to share this information. As Caldicott Guardian, Jenny led the work of drawing up an information sharing agreement.
The purpose was to assist the direct care of the individuals and there was no breach of Caldicott principles. But in Jenny’s experience there is often difficulty in achieving appropriate sharing across institutional boundaries. People struggle to overcome an over-cautious instinct not to share, even when sharing is in the best interests of the individual. Those judgement calls are part of the work of the Caldicott Guardian.
Jenny has been a nurse for 36 years and so has extensive professional knowledge of the importance of patient con dentiality, but before coming to the CCG she had no previous experience of being a Caldicott Guardian. She works closely with Dr Masood Nazir, the CCG’s Senior Information Risk Owner (SIRO), who also sits on the governing body.
When the CCG was set up, they organised training for themselves in information governance and spent time reading up Caldicott material. They set up an information governance steering group in the CCG to look at policies on training and staffing.
The CCG employs an information governance manager who refers issues to the Caldicott Guardian or SIRO as appropriate. They all sit near each other in the corporate office.
Jenny logs all her Caldicott Guardian decisions on a database, which includes all the information sharing agreements that involve the CCG. The information governance manager has access to the log.
There are 110 GP practices in the CCG and sometimes they may call Jenny for advice. She attended the UK Council of Caldicott Guardians’ annual conference last year, at which Dame Fiona Caldicott spoke about the importance of appropriate data sharing.