Carey Bloomer is Registered Manager and Nursing Director of a large nursing home in Shropshire. It has 81 beds and of those 20 are for people staying short term for assessment and rehabilitation after discharge from hospital. This post-discharge activity produces a high turnover of residents and so a large volume of data flows between the home, the NHS and social care.
Carey realised that the transfers of information would become more secure and efficient if the home could get an NHS email account. It became one of the first in England to do so. To qualify, she had to complete the NHS Information Governance Toolkit, which advises every health and care organisation to have a Caldicott Guardian. Carey took on this additional role in 2014 and went on a training course in London. This made her aware that procedures at her care home required root and branch reform. She recalls: "Becoming the CG was something of a learning curve. All of our policies and procedures had to be reviewed and altered. More in-depth training had to be made available to the staff who are now confident in what can be shared and what can't be shared."
Carey finds it alarming that the Caldicott principles are not well enough understood in many organisations in her sector. "Information should be shared among the multi-disciplinary teams caring for an individual. But what we see is extremes of behaviour. On some occasions intimate personal details about an individual's condition are inappropriately shared with all the care homes county wide. In other cases a hospital may refuse to tell any care home anything. This is quite worrying."
For Carey, sharing information among multi-disciplinary care teams should be the easy part. Sharing with family members can be more challenging. "We have an electronic care recording system that allows families to log in remotely and contribute to their family member's care plan. This has proved to be very effective. For example, it has allowed one family member, who has looked after her husband with severe dementia for several years, to go on holiday for the first time."
But which family members should have access to this personal information? The answer brings into play the Caldicott Guardian's role as ethical arbiter. Carey says: "I recall one particular incident when estranged family members demanded medical information about a resident who sadly was close to the end of life and lacked capacity to make any decisions. I was able to weigh up who exactly was going to benefit from divulging this medical information and it certainly wasn't the resident. During a careful conversation about protecting residents' rights, I reiterated that the family members were welcome to visit their relative, but could not see confidential material."
"My training as a Caldicott Guardian has helped me to organise data flows on a need-to-know basis. For example our finance department has no need to know medical details and likewise care staff do not need to know financial information.
"I had to make a decision recently about how to respond to a bank that would not close a joint account for a resident without being told why that resident could not go to the bank in person. In fact the resident needed to have the account moved as there was a safeguarding investigation into financial abuse. I divulged the bare minimum amount of information to enable the bank to close the account. I have found that making a judgement call on a daily basis with the knowledge that I now have is easier by far."