Martin Crook is Caldicott Guardian at University Hospital Lewisham and Greenwich (UHL), where he is a consultant chemical pathologist and metabolic physician. His multiple clinical responsibilities include holding four clinics a week in lipidology and metabolic medicine, two of which are held at Guy’s and St Thomas’ hospitals. He is involved in a hospital nutrition team and is head of department at Lewisham biochemistry laboratory. Martin is also a visiting professor in clinical biochemistry at two universities and has about 200 publications and seven medical textbooks to his name. To make it possible for him to discharge Caldicott Guardian responsibilities in addition to these other extensive duties, Martin has found it useful to work with a hospital ‘Caldicott team’ comprising colleagues expert in information governance, medicolegal matters, computing and administration.
Martin says: “One of my interests is medical ethics. I did an MA in ethics and law at Keele University, which included writing a dissertation discussing the risk of absolute medical con dentiality. Of course patient confidentiality is extremely important, but it needs to be wisely delivered to reduce third party harm or even detriment to the patient. This is particularly important for example when it comes to genetic information and inherited disease.”
This issue is of more than academic interest. Increasingly questions about the ownership and use of genetic information are posing practical dilemmas for the Caldicott Guardian. For example, what if a patient with a genetic lipid disorder e.g. familial hypercholesterolaemia doesn’t get on with other family members and thus doesn’t want to share information with them? If there is no sharing of information with the relations, they will not be made aware of the risk they may have of also having the condition. Careful and open discussion with patients on a case by case basis can sometimes help under such circumstances as well as applying the Caldicott principles
Martin says: “I have an interest in Caldicott issues raised about access to laboratory results. Should patients sometimes be denied access to their own results? When may the results be shared with others, e.g. HIV results? And how do we guarantee the confidentiality of patient results on IT systems?”
The Caldicott Guardian can help to devise robust systems to help staff deliver services in ways that are both efficient and compatible with Caldicott principles. Martin says: “I work in very busy hospitals serving an inner city deprived multicultural population. Doctors have lists of patients in their care, which can get lost if they are in paper format. I have been looking at the use of electronic means to try and avoid this problem. I have also worked on how we dispose of patient identifiable information, e.g. waste bins, shredders, and how we store such data in secure hospital patient records. Our innovations have included an ‘electronic new sheet’ to induct staff in Caldicott principles along with computer electronic screen savers. I also hold medical ethics educational sessions for junior doctors and other staff on issues of confidentiality. We are also regularly encouraging staff to complete Caldicott and information governance questionnaires and ‘quizzes’ to update them on patient confidentiality issues and to ensure that they know who their Caldicott Guardian is!”
Martin is thus trying to ‘up the profile’ of the Caldicott Guardian and elevate the importance of patient confidentiality within his hospital with the help of the ‘Caldicott team’.