How we use your personal information

Supplementary privacy note on Covid-19 for LAS Patients and Staff

This notice describes how we may use your information to protect you and others during the Covid-19 outbreak. It supplements our main Privacy Notice which is available here.

The health and social care system is facing significant pressures due to the Covid-19 outbreak. Health and care information is essential to deliver care to individuals, to support health and social care services and to protect public health. Information will also be vital in researching, monitoring, tracking and managing the outbreak. In the current emergency it has become even more important to share health and care information across relevant organisations.

Existing law which allows confidential person identifiable information to be used and shared appropriately and lawfully in a public health emergency is being used during this outbreak. Using this law the Secretary of State has required NHS Digital; NHS England and Improvement; Arms Length Bodies (such as Public Health England); local authorities; health organisations and GPs to share confidential person identifiable information to respond to the Covid-19 outbreak. Any information used or shared during the Covid-19 outbreak will be limited to the period of the outbreak unless there is another legal basis to use the data.  Further information is available on gov.uk and some FAQs on this law are available on the NHSx website.

During this period of emergency, opt-outs will not generally apply to the data used to support the Covid-19 outbreak, due to the public interest in sharing information.  This includes National Data Opt-outs.  However in relation to the Summary Care Record, existing choices will be respected. Where data is used and shared under these laws your right to have personal data erased will also not apply.  It may also take us longer to respond to Subject Access requests, Freedom of Information requests and new opt-out requests whilst we focus our efforts on responding to the outbreak.

In order to look after your health and / or care needs we may share your confidential person identifiable information including health and care records with clinical and non clinical staff in other health and care providers, for example neighbouring GP practices, hospitals and NHS 111. We may also use the details we have to send public health messages to you, either by phone, text, email or any other means available at our disposal.

During this period of emergency we may offer you a consultation via telephone or video-conferencing. By accepting the invitation and entering the consultation you are consenting to this. Confidential person identifiable information will be safeguarded in the same way it would with any other consultation.

We will also be required to share confidential person identifiable information with health and care organisations and other bodies engaged in disease surveillance for the purposes of protecting public health, providing healthcare services to the public, monitoring and managing the outbreak.  Further information about how health and care data is being used and shared by other NHS and social care organisations in a variety of ways to support the Covid-19 response can be found on the NHSx website.

NHS England and Improvement and NHSX have developed a single, secure store to gather data from across the health and care system to inform the Covid-19 response. This includes data already collected by NHS England, NHS Improvement, Public Health England and NHS Digital. New data will include 999 call data, data about hospital occupancy and A&E capacity data as well as data provided by patients or staff themselves.  All the data held in the platform is subject to strict controls that meet the requirements of data protection legislation.

During this outbreak, the London Ambulance Service will also work with other public and private organisations as part of the Covid-19 response.

In such circumstances where you tell us you’re experiencing Covid-19 symptoms we may need to collect specific health data about you.  Where we or our partners need to do so, we will not collect more information than we require and we will ensure that any information collected is treated with the appropriate safeguards.

We may amend this privacy notice at any time so please review it frequently. The date at the top of this page will be amended each time this notice is updated.

Under the UK General Data Protection Regulation and the Data Protection Act 2018, the legal basis for the processing of your data is:

• the NHS is an official authority with a public duty to care for its patients, as guided by the Department of Health
• Data protection legislation states that it is appropriate to do so for the health and social care treatment of patients, and the management of health or social care systems and services.

If we need to use your personal information for any reason beyond those stated above and below, we will discuss this with you. You have the right to ask us not to use your information for certain purposes but there are exceptions to this which are listed below under ‘Disclosure to third parties’.

With the onset of GDPR the professionals involved in your individual care (or direct care) will be using implied consent from you to see your shared medical records. In order for the sharing of Personal Data to comply with Article 5 of the General Data Protection Regulation it must be fair and lawful and one of the Article 6 conditions must be met. Article 9 conditions must also be met if Sensitive Personal Data or special category data is being shared. The following articles are the ones that apply for sharing of data for the professionals involved in your care:

• A) Article 6 condition – The sharing of Personal Data is permitted under Article 6 paragraph (c) (processing for legal obligation); paragraph (d) (processing for vital interests of data subject); and/or paragraph (e) (public interest or in the exercise of official authority).
• B) Article 9 condition – The sharing of Sensitive Personal Data or Special Category Data is permitted under Article 9 (h) (processing for medical purposes); and/or paragraph (i) (public interest in the area of public health). For the vast majority of sharing we will be relying on article (h) with an implied consent model for direct individual care (more detail below where we talk about the Common Law Duty of Confidentiality). In certain instances, however, we may also rely on paragraph (a) (explicit consent) or paragraph (c) (vital interests) but these will be specified in any sharing agreements or data processing contracts related to those special cases.

Common Law Duty Of Confidentiality

We log details electronically when we receive a call for help at our emergency control centres or 111 service, or book a non-emergency transport service that we operate.

If one of our ambulances attends you, or you are transferred between hospitals by ambulance, we will collect information about you to help us identify and treat you. This will be written on a patient clinical record along with details of your symptoms, condition, and any treatment we give you. We are also required to record details of your ethnicity and other information to help us monitor the equality of the services we provide.

If you speak to one of our 111 call handlers or clinical advisors we will record your details and access your clinical information in order to provide the advice or care you need, which may include transferring you to the out-of-hours service, requesting an ambulance or, if it is in hours, putting you in touch with your dentist or GP.

If you receive non-emergency transport services, we will record details about where you live, where we will be taking you and some details about your circumstances.

If you make a complaint or an enquiry about the service we have provided, or have contact with us on another matter, we will keep a record of all the relevant details in a file for case management purposes. In some cases, we may need to obtain information from the hospital we took you to in order to investigate a complaint or deal with an enquiry.

Update: In conjunction with London’s Air Ambulance we are exploring the use of a facility to obtain a secure live-stream video from callers’ mobile phones at certain incidents, to help our control room clinicians more accurately and rapidly assess patient injuries. This will only be done when clinically necessary with patient and caller consent, or when a patient is unable to consent it will be done in a patient’s best interests. No footage is stored and privacy controls and protocols are in place in connection with this tool.

The London Ambulance Service utilises surveillance cameras (Static/Vehicle based CCTV and Body Worn Cameras) in and around the Trust’s sites, on our emergency vehicles, as well as body worn cameras used by operational crews which has been rolled out nationally following a successful local pilot.

Please note: Our surveillance cameras inside our vehicles and our body worn cameras are only activated by the crew when they feel there may be a risk to safety. Should these systems be activated, the crew will advise you and/or an audio message will be played inside the vehicle with a recording flashing light on the body worn cameras.

If an ambulance takes you to hospital, we will share an electronic copy of the patient clinical record so that they have details of your condition and the treatment we have provided.

In addition to sharing your data with other clinicians, we can access your data from other health and care organisations across London to ensure we are providing you with the best possible care.

Where necessary, we use a limited number of private contractors to supplement our emergency and non-emergency transport services. In these cases, they are under contract to us and must comply with data protection legislation in the same way we do. Their performance is monitored and all the information they collect about you is transferred securely to us.

Other health and social care professionals involved in your treatment or care may ask us for information about your use of our services or the treatment you received. Provided we are satisfied that they need this information for your care, or you have given your permission, we will provide this to them.

In some circumstances we may share information or clinical records with other healthcare professionals – most commonly your GP but also specialist healthcare teams such as social service – even if we have not taken you to hospital or provided 111 advice. We do this to help them assess whether they can offer you support that may help to prevent a similar situation arising again.

We are sometimes also asked by the Clinical Commissioning Groups (CCGs) that fund our services to provide information about incidents attended so they can identify and provide more appropriate care pathways for patients. The information we provide will not identify you.

Where another NHS organisation is funding a non-emergency transport service journey, we have to confirm personal information – although we will provide only the details that are needed.

Clinicians may need a copy of the patient clinical records they have completed for their training, but they will blank out information which could identify you before they do this. London Ambulance Service Paramedics may receive clinical feedback on the outcomes and associated treatments of the patients they have attended, to support their learning and development to improve the care they provide.

Sometimes, our staff and other third parties listen to calls for training and learning purposes. All requests for third parties will be approved by the Caldicott Guardian who is the Chief Medical Officer and who will consider the application of Caldicott Principles in such cases.

Anonymised information from patient clinical records is used for internal audit purposes and details of the emergency treatment and care we provide is sometimes used for research. We make sure ethical approval has been obtained in accordance with NHS guidelines before we release any information outside the organisation for research purposes and do not release information that could identify patients unless there is a legal basis for doing so.

On occasion we may need to view records that contain personal information and use this information to link records to allow us to get a full picture of the care provided to you.  If you do not wish for us to use your data for research in this way please contact the Clinical Audit & Research Unit at [email protected]

We pass information to other NHS organisations as part of national initiatives to monitor the standard of care provided within the NHS as a whole. In all cases, we supply only the details that are needed for these purposes and, wherever possible, the information will be anonymised.

 

We will not disclose your information to third parties outside the NHS without your permission unless it is required for your direct care or there are exceptional circumstances, such as when it is justified in the public interest; for example:

• When a serious crime has been committed

• if there are risks to the public or NHS staff

• to protect vulnerable children or adults who are not able to decide for themselves whether their information should be shared.

• We have a legal duty, for example reporting some infectious diseases, wounding by firearms and court orders
• We need to use the information for medical research. We have to ask permission from the Confidentiality Advisory Group (appointed by the NHS Health Research Authority)

or where the law requires information to be passed on; for example-

• Where a formal court order has been issued.

We will seek your consent before we release information that identifies you to any third party for any other reason than direct patient care and those set out in this guidance and the regulations.

Your information is never collected for direct marketing purposes, and is not sold on to any other third parties. Your information is not processed overseas.

Please note, anonymised or redacted information shall be shared to third parties such as, but not limited to, research bodies and media outlets. To ensure anonymity and possibilities of re-identification, the London Ambulance Service NHS Trust undertakes relevant appropriate privacy and security assessments before any disclosure.

All NHS organisations have a legal duty of confidence to their patients and Data Protection legislation further defines how we can collect and handle personal information. The NHS also has an additional set of guidelines, known as the Caldicott principles, which apply to the use of patient information. All NHS organisations are required to appoint a Caldicott Guardian to ensure patient information is handled in accordance with legal and NHS regulations and the Caldicott Guardian for the London Ambulance Service is the Medical Director.

When we pass on any information we will ensure that the recipient is aware that it must be kept confidential and secure.

Information is held for specified periods of time as set out in the Records Management Code of Practice for Health and Social Care 2016.

We retain medical records for 25 years and clinical details of 999 and 111 calls made by adults for 10 years. Other records that may contain information about you are kept for varying lengths of time, up to ten years.

Data Protection legislation gives individuals rights in respect of the personal information that we hold about you. These are:

1. Right of access – you have the right to request a copy of the information that we hold about you.
2. Right of rectification – you have a right to correct data that we hold about you that is inaccurate or incomplete.
3. Right to erasure (does not apply to medical records) or restriction of processing, such as for research purposes.
4. Right of portability – you have the right to have the data we hold about you transferred from one IT system to another in a safe and secure way, without impacting the quality of the information.
5. To ask us to restrict the use of your information.
6. To ask us to copy or transfer your information from one IT system to another in a safe and secure way, without impacting the quality of the information.
7. Right to object – you have the right to object to certain types of processing such as direct marketing.
8. Right to object to any decisions made without human intervention (automated decision making).

The sharing of information has always happened (to a lesser degree) with paper processes but electronic systems are allowing us to share more relevant information about you amongst your Direct Care Team helping them to be more efficient and support theirs and your decision making on your care.

All of the people accessing and sharing your information (your Direct Care Team) will have some form of direct interaction with you otherwise they will not be accessing your information.

The reason they want to access your information is that this can improve the quality of care that you receive from them. Imagine the information or data that is held about you are pieces of a jigsaw and these pieces are held on different systems by the providers of your care.

If one of your Direct Care Team wants to make a decision on the best course of action for you, the more pieces of the jigsaw they have, the more they can know about you and your history of care and therefore they can make the most appropriate decision based on you and your needs.

The local organisations involved in your Direct Care Team include any clinician across London with a legitimate relationship to you and the right level of access to view your record.

How it works

Data sharing securely connects different medical and care computer systems together. When your record is requested by an authorised system user, the system collects the information from different systems and shows the information to the requestor. None of the information it collects is stored and none of it can be changed. Because it collects the information only when it is needed, the information is always accurate and as up to date as possible.

Before any information is collected or displayed to a care professional, they must be involved in your individual or direct care. Not everyone can see your shared data, nor should they. It will only be accessed by the people involved in looking after you directly. The Fair Processing Programme uses the secure NHS network to retrieve the information that has been approved to be shared with that care setting and displays a read only view for the care professional to use to support the delivery of care at that specific point in time.

No information is stored or saved within the or the care setting from where it is accessed so there is no need to worry about what could happen to your information without your knowledge or permission. There are two major ways that Data Sharing is taking place in London.

1. The Summary Care Record – The Summary Care Record contains information about your allergies, medications and reactions you have to medications, so that in an emergency or when your GP practice is closed this information is available so that you can be cared for. This is a national programme for sharing your information. For more information please go to www.nhscarerecords.nhs.uk.

2. OneLondon Care Record – This is a London wide programme which shares information about you to better support your direct care. All organisations involved in your direct will be able to access only those areas of your record that are relevant to the particular aspect of your care. These will include your GP, Acute Hospital, Local Authorities and others. A comprehensive list of these organisations is provided at www.england.nhs.uk/london/our-work/

Why do you need to share my information?

Data sharing will provide health and social care professionals directly involved in your care access to the most up-to-date information about you.

This allows the professionals caring for you to more fully understand your needs. Information is already shared by phone and paper records, data sharing simply allows this to happen more efficiently. It does this by sharing appropriate information from your medical and care records between health and social care services involved in your care.

Can anybody see my records?

Definitely not. Only care professionals directly involved in your care will see your personal care information through data sharing.

How do I know my records are secure?

All staff must respect your privacy and keep your information safe. Your information is stored on secure computer systems connected on a private health and social care network.

Can I access my records?

Yes. Under the GDPR you can request access to all information that organisations hold about you. Please contact the organisations directly to request the information.

Can I object to my records being shared?

You can object to your information being shared by talking to your providers of care. For direct care the people viewing your records are the people directly looking after you and are doing so to give you the best quality care they can.

If you do however still want to object please contact the organisation who holds the records you do not want to be shared. It is worth noting that not sharing vital information about you with other organisations involved in your care could affect the quality of care that you receive and there may be circumstances where your objection may not be upheld.

For example:

• If it is in the public interest for data to still be shared. For example if there is a safeguarding issue, or in the case of a mental health patient who might be at risk from harming themselves or a member of the public;
• If clinical care cannot be provided. For example in referring a patient to hospital and data needs to be shared for the hospital clinician to do their job properly. In this instance obviously the patient can then choose not to have the treatment and therefore not have their data shared.
• If systems are not well developed enough to not share the information. For example GP Systems are relatively well developed and can handle objections a lot more easily than other providers but they still may be asked not to share something which the system cannot do. In this instance points 1 and 2 above would apply.

What information will be shared?

Your shared record will contain a summary of your most up-to-date, relevant health information which includes things such as:

• Your recent diagnosis and test results;
• What allergies you have; what medications and treatment you currently receive;
• Any Current or Past (and significant) illnesses Encounters and Referrals.

Can everybody see everything on my medical and care records?

No. We are working very carefully, supported by health and social care professionals, to make sure only relevant information is shared into specific care settings.

Can my records be accessed by health and social care professionals outside of my borough?

Yes they can but only with other professionals who are caring for you directly. On top of the programmes mentioned above there is also the Summary Care Record which is a national programme and as such means that it is available to care organisations outside of these boroughs (but again only for direct care purposes).

The Summary Care Record contains important health information such as:

• Any prescription medication a patient is taking
• Any allergies a patient may have
• Any bad reaction to any medication a patient may have previously had

More information about the Summary Care Record can be found at www.nhscarerecords.nhs.uk. If you have any queries or want to know more about data sharing or our fair processing please contact your local provider that holds the information you wish to discuss.

NHS Digital has developed a new system to support the national data opt-out which will give you more control over how your patient information is used. The system will offer you the opportunity to make an informed choice about whether you wish your confidential patient information to be used just for your individual care and treatment or also used for research and planning purposes. This new system was launched in May 2018.

To find out more please follow this link www.nhs.uk/your-nhs-data-matters

Any questions, comments or complaints about the use of your personal information, please contact our Information Governance Team:

Information Governance team
London Ambulance Service NHS Trust
220 Waterloo Road
London SE1 8SD

Email: [email protected]

If you are still unhappy with the outcome of your enquiry you can write to:  The Information Commissioner, Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF – Telephone: 01625 545700.

Fleetwave is a cloud based solution used by the London Ambulance Service fleet team for the day-to-day management of our fleet, from acquisition to disposal  – including regulatory compliance and auditing. Key features include asset management, maintenance management, incident reporting, and management of Road Traffic Collision (RTC)/insurance claims.

The solution holds some personal information of our staff and third party information being processed as part of a RTC. Information is stored in the cloud on UK based servers and not transported anywhere outside of the EEA. Personal data on the system are accessible by the fleet admin for the purposes of insurance claims. The legal basis for the processing of this information is subject to the requirements of the General Data Protection Regulation “GDPR” under, Article 6(1)(e), Article 6(1)(f).

• Categories of personal data – Name, address, email address, date of birth, staff payroll number and driving licence
• Recipients, sources or categories of recipients of the data – any sharing or transfers of the data (including to other countries) data will be shared with our third   party insurers; QBC, Turnamms. No data will be ported outside of the UK.
• Any automated decision making – no automated individual decision-making and profiling will be made as a result
• Retention period for the personal data – data will be kept throughout the cycle of the claim, after such time, all the information collected and processed for the purposes of claims, will be destroyed after the expiration of the data retention period .

Existence of data subject rights, including access to their data and/or withdrawal of consent and data portability – access to data is accessible through a subject access request, details on how to contact the team can be found here:  https://www.londonambulance.nhs.uk/talking-with-us/