Julian Mark is Caldicott Guardian for the Yorkshire Ambulance Service, where he has been executive medical director since 2013. On issues of information governance, he seesa big difference between the ambulance service and other organisations in health and social care. The nature of the work is such that it is rarely appropriate to seek the patient’s explicit consent for their personal data to be collected and passed on to other members of the direct care team. When paramedics respond to a 999 call, they operate on the basis of implied consent. When they attend to a severely injured person, they do so to look after their best interests without the need for formal consent.
In the day-to-day work of the service, staff do not need to consult the Caldicott Guardian before sharing medical information with other healthcare professionals who need it to provide safe care. However, that does not mean that the role of the Caldicott Guardian lacks interesting challenges.
The issues that come up to Julian often involve requests from other organisations for information that may include personal medical data. For example, police officers often walk into an emergency operations centre and ask for call logs or incident data to assist an investigation into a possible crime. However, files containing personal medical material cannot be handed over there and then unless certain thresholds are reached. The police can make a request for such information under section 29 of the Data Protection Act 1998, but the Yorkshire Ambulance Service will not hand over records until they have been redacted to comply with Caldicott principles. Julian wrote the guidance on this subject that the UKCGC has made available to help others through this delicate process.
Julian’s previous clinical career was as an anaesthetist with an interest in trauma and critical care. At the Yorkshire Ambulance Service headquarters in Wakefield his role as executive medical director is concerned with clinical governance and development, improving the quality of the service and assuring patient safety. He says that the role of Caldicott Guardian fits in well with this because it is also about “acting as the patients’ champion.”
The information governance manager has ready access to Julian who can advise from a Caldicott perspective when issues arise. They meet formally once a month to examine all cases that have been logged as breaches of the rules on protection of patient identifiable data, such as when information about an individual is sent to the wrong GP. Other case work is sporadic. He might look at two issues one week and then none for the next two months. The more significant workload is when agreeing information sharing agreements. For example he spent a fortnight working on the agreement to share information with the Rotherham child abuse inquiry.
Julian has a deputy Caldicott Guardian, who is the deputy medical director. As they never take leave at the same time it makes sense for his deputy to cover both roles. If a member of the public wants to get in touch with the Caldicott Guardian they can find out who it is on the Yorkshire ambulance service website and contact Julian through his PA. He says: “I prefer people to approach me directly rather than going through a somewhat protracted process.” Cases are logged on the service’s incident reports system and are regularly reported to the board.