Efforts to integrate care and improve services with better use of patient data could be hindered by proposals in the government-commissioned Caldicott review, it has been warned.

Recommendations in Dame Fiona Caldicott’s report on information governance, if implemented, could “tilt the balance” too far towards restricting the flow of patient identifiable data and the need for explicit consent for it to be used, HSJ was told.

Dame Fiona’s report said it was “wrong [for commissioners] to assume [patients] have given their implied consent to sharing” of personal information, if efforts had not been made to explain how it would be used.

She recommended regulators agree on conditions under which commissioners can rely on implied consent, in the 26 April report.

One senior commissioning figure said: “The report raises some important issues and makes some good recommendations but it does not seem to sufficiently recognise the financial and demand pressures which face commissioners and providers.

“Important tools like urgent care dashboards would not be viable without patient identifiable data that could be reliably linked and securely published to local care teams.”

The source also raised concerns about the impact on integrated care that suggestions in the review around limitations on the use of implied consent could have. 

“Integrated care records like those built on interoperable systems would not be able to work practicably without implied informed consent, rather than explicit consent as the review appears to suggest,” he added.

Anthony McKeever, chief executive of NHS business intelligence company MedeAnalytics, and previously Bexley Care Trust chief executive, told HSJ he supported much of Dame Fiona’s report but warned a lack of access to identifiable data would create financial and contract risks for commissioners.

“We need to make a clear and justifiable case for patient identifiable data to be used by commissioners. One issue is that without it, it is very hard to check the bills sent through by hospitals,” he said.

Mr McKeever said commissioners did not need patients’ names but sometimes needed information on a “live human being” to check bills had not been miscoded.

The effect of Dame Fiona’s recommendations on commissioners will depend on how ministers interpret and act on them. This is expected to be decided in the summer.

The review report recommended a new duty to promote information sharing, but also highlighted both cultural and practical challenges faced by the NHS in sharing records.

It said there was “a lack of consensus” on information sharing and that “a culture of anxiety permeates many organisations from the boardroom to front line staff”.

It rejected a proposal by NHS England that commissioners’ use of personal confidential data was legitimate as part of a “consent deal” between the NHS and service users.