Photography And Video Recordings Of Living Patients ... · Photography And Video Recordings Of Living Patients: Confidentiality, Consent, Copyright & Storage 9 Version 3 May 2011

Photography And Video Recordings Of Living Patients: Confidentiality, Consent, Copyright & Storage Version 3 May 2011

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PHOTOGRAPHY AND VIDEO RECORDINGS OF LIVING PATIENTS CONFIDENTIALITY, CONSENT, COPYRIGHT & STORAGE POLICY

Documentation Control

Reference GG/CM/013

Date approved 27 May 2011

Approving body Directors’ Group

Implementation date 27 May 2011

Version 3

Supersedes Photography and video recordings of patients: confidentiality, consent, copyright & storage Version 2, March 2007

Consultation undertaken Consent Committee Clinical Effectiveness Committee

Target audience All healthcare professionals

Distribution: Policy and Procedures Clinical Directors Heads of Service Clinical Leads Matrons All Consultant Staff

Supporting Procedures Information Security and Data Protection Policy and Procedures Department of Health ‘Good Practice in Consent’; Department of Health Confidentiality Code of Practice; GMC Making and Using Visual and Audio Recordings of Patients, 2011.

Review date May 2014

Lead Executive Medical Director

Author / Lead Manager Graham Love, Medical Photography Manager

Further Guidance / Information Medical Photography City 56493 Medical Photography QMC 63576


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CONTENTS

Paragraph Title Page

1 Policy Statement 4

2 Introduction 4

3 Roles and Responsibilities 6

4 Procedure and specific circumstances 7

5 Who can Consent to Visual Records 12

6 Visual Records for which consent is not required 14

7 Visual Records made without consent 14

8 Deceased patients, including bereavement photography for children

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9 Research 16

10 Consent for publication 16

11 Copyright 17

12 Historical collections of teaching material 18

13 Consent for Visual Records for Public Relations purposes

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14 Processing and reproduction 20

15 Logging and storage 20

16 Security of Visual Images 21

17 Internet Security / E-mail 21

18 Implementation and Monitoring Plans 22

19 Communication of Policy 22

20 Equality and Diversity Statement 22

21 Equality Impact Assessment Statement 23

22 Environmental Impact Assessment Statement 23

23 We are here for you mission statement 23

24 References 24

Appendix 1 Consent to Photography/VR 25

Appendix 2 VR Exceptional Circumstances Registration Form

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Appendix 3 Consent for the Publication of Visual Records 27

Appendix 4 Non-Clinical Visual Record Consent Form 28

Appendix 5 External Media Consent Form 29

Appendix 6 Special Photography Request 30

Appendix 7 NUH staff photographic registration form 31

Appendix 8 Guide to uploading patient images to Medical Photography Image Database

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Appendix 9 Equality Impact Assessment 35

Appendix 10 We are Here for You Assessment 38

Appendix 11 Certificate of Employee Awareness 41


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1. Policy Statement

1.1 The Trust has a responsibility to ensure that all Visual Records (VRs) are taken with the informed consent of the patient, are stored securely and are handled in accordance with current legislation and the Trust Consent to Examination and Treatment Policy.

1.2 The purpose of the Policy:-

To ensure good practice in protection of patient confidentiality and identity with the production of VRs

To define the process of consent

To enable recordings for teaching and research

To protect Trust staff from any complaints or legal proceedings

To raise staff awareness of their responsibilities regarding VRs

To ensure VRs are safeguarded and removed from site only with permission

To ensure that VRs form part of the patient’s confidential medical record

To ensure that anyone who makes a VR signs up to this policy as an authorised user. The Trust may take disciplinary action against anyone who does not follow this policy.

1.3 The scope of the policy covers all Visual Records of live patients and/or

body parts from which the patient can be identified namely:

Photographs

Video Recordings

Radiological Images (for teaching, publication and research purposes)

Artwork 2. Introduction This policy must be read with conjunction with the Trust Consent to

Examination and Treatment Policy


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2.1 Why are Visual Records taken?

For clinical purposes, therefore contributing to patient care by demonstrating features of disease, deformities etc and to follow the natural course or impact of treatment on the disease

For teaching both within NUH and externally

For research purposes and publications (the majority of recordings made for research purposes are usually for disease and/or treatment assessment and not publication)

Public relations

2.2 Who can make Visual Records?

a) Trust Medical Photographers.

b) A health care professional who has registered with the medical photography department and signed up to the Photography and Video Recordings of Patients Policy, and had training given by the medical photography department.

c) In emergency situations, any qualified health care professional,

preferably using a registered camera, who is competent to take a VR. If personal equipment is used in this situation, the image must be uploaded at the earliest opportunity onto the image database (fotostation) by a member of the Medical Photography staff and deleted from the device’s memory card by the responsible health care professional within one week of image being taken. Complete Appendix 2.

2.3 Storage and security of Visual Records

Any VR may need to be used for legal purposes and therefore its availability is essential. Storage may be:

In patient case notes, secure under the Hospital Case Note Management Policy

By Medical Photography using image uploader (fotostation) and safe storage facilities

By health care professionals who have registered a camera with medical photography and received training in image uploading and deletion of images from memory cards.


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Note - Copies of VRs securely stored at NUH may continue to be used by health care professionals who have left NUH (within the consent level obtained)

Copies of VRs made for research purposes and sent outside of the Trust to the research sponsor, to be utilised only according to the authorisation and consent obtained.

2.4 Asset Registers of Cameras and Video Recorders Each clinical area must: a) identify a named individual responsible for VR management within the

clinical area b) keep an asset register of all cameras and video recorders in use in the clinical area c) register each VR device with Medical Photography, who will provide training in image uploading and deletion of images from memory cards

2.5 Duty of Confidentiality

All VRs form part of the patient’s medical record and are governed by the duty of confidentiality.

Any VR may need to be used for legal purposes and therefore its availability is essential whether in the patient’s case notes or stored elsewhere.

3 Roles and Responsibilities 3.1 Clinical Directors and their Heads of Service are responsible for:

Ensuring that the requirements of this policy, specifically paragraphs 2.2 – 2.5) are included in local induction and training.

That all health care professionals in the specialty understand the principles of photography and video recording of patients outlined in this policy

That the policy is adhered to


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3.2 Individual Health Care Professionals

Must adhere to the principles outlined in the policy

Must explain to the patient the purpose of the recording and gain consent. Consent must be sought even if the patient is not identifiable in the VR.

Once the VR has been taken it is the responsibility of the health care professional taking the VR to ensure it is stored in an appropriate manner.

Failure to ensure correct use and storage will be considered a breach of confidentiality and may result in disciplinary action. A breach of the Data Protection Act may also have significant legal penalties.

4. Procedure and specific circumstances 4.1 Medical Photography provides a clinical photography / video service: Monday - Thursday 8.30 – 1pm and 2– 5pm Friday 8.30 – 1pm and 2 - 4.30pm City Hospital Tel: 54981 Bleep 780 7425 Queen’s Medical Centre Tel: 64685 Bleep 80 6198

Out of hours photography If you need to make your own visual records please use the following

guidelines: ** Only equipment belonging to NUH should be used to create a VR. The

use of personal equipment must be limited to exceptional circumstances only (eg. PACS failure) and in such circumstances the VR must be registered with Medical Photography by completing and submission of a VR registration form (Appendix 1).


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4.2 How do I request VRs?

Request consent from patients using the Consent to Photography / Video form (Appendix 2)

4.3 What do I do if the patient is not competent to consent? e.g. unplanned

intraoperative VRs when the patient is anaesthetised or patients who have been assessed as lacking capacity in accordance with the Mental Capacity Act Policy?

PLEASE REFER TO SECTION 7.2. 4.4 What do I do for planned intra-operative VRs?

Consent for recording VRs Consent to Photography / Video form (Appendix 2)

4.5 What about children and young people?

General guidance in relation to the treatment of children can be found in the GMC Guidance ‘0 – 18’ (http://www.gmc-uk.org/guidance/ethical_guidance/children_guidance_index.asp). See paragraphs 24 – 33 in relation to assessing capacity and what to do if a child/young person refuses treatment.

A young person aged 16 or over can consent to or refuse treatment.

A young person aged 16 – 18, who does not have capacity in accordance with the Mental Capacity Act 2005 must have decisions made in accordance with their best interests, in consultation with other appropriate adults involved in their care, please refer to Trust Consent to Examination and Treatment Policy.

For competent children under the age of 16 o see NUH’s Consent to Examination and Treatment Policy for

general guidance o Competent children can consent for themselves, but unless

the child specifically asks you not to, you should involve the parents or those with parental responsibility (PR), unless you are of the view that to seek such consent would place the child at risk of significant harm/not be in the public

http://www.gmc-uk.org/guidance/ethical_guidance/children_guidance_index.asp

http://www.gmc-uk.org/guidance/ethical_guidance/children_guidance_index.asp


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interest. Seeking advice from your manager in these circumstances is recommended.

o A competent child’s wishes can be overridden by a person

who holds parental responsibility for them but in these circumstances advice from your manager should be sought from the lead clinician overseeing the child’s care.

Where a child is not competent to make a decision in relation to the proposed photo/recording (i.e. they do not fully understand what is being asked for and what the purpose of the photo/VR is for) then someone with parental responsibility must give consent on their behalf. In the event that the person with parental responsibility will not consent, advice from your manager or the Trust Secretary should be sought. It is unlawful to remove a child from its parent or undertake and examination/treatment, without the parents consent, unless certain specified circumstances apply. This is where:

o The treatment is urgent and/or considered to be life saving.

o There is a lawful removal of the child (via the police using their 72

hour powers/a Local Authority Emergency Protection Order or Care Order or another relevant Order from the Court).

Where it is suspected that there has been a non-accidental injury - PLEASE FOLLOW THE SEPARATE NON-ACCIDENTAL INJURY PHOTOGRAPHY POLICY

If you feel a child genuinely does not want a VR to be taken this should be respected unless there is an overriding public interest in taking the photo/VR in urgent circumstances and/or there has been parental consent/another form of lawful authority to do so. See also the Trust’s Non Accidental Injury Photography Policy.

VRs of children should be taken only if there are specific features that need recording for a clinical purpose e.g. assessing the progression of a skin lesion, or recording an important clinical sign that might only be seen rarely for teaching purposes.


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VRs should only include the specific area of interest; whole body shots should only be taken if completely necessary.

It is acceptable for staff on the neonatal unit to take a picture using an instant polaroid camera at the request of parents if the image is not stored.

All photos/VRs should be destroyed in accordance with the NHS Records Management: Code of Practice. In the usual course this will be when the child reaches the age of 25 (unless their ongoing retention is justified) or eight years after their death.

4.6 What happens if the patient withdraws consent for VRs to be used?

As a patient has agreed to a VR being created/used in treatment and thereby a part of their clinical record then it must be retained as part of the record. It is to be noted that, on occasion, a patient who lacks capacity (or is not competent in the case of children under the age of 16 years) may not be able to provide sufficient authority to destroy the records and/or there may be safeguarding concerns in relation to them (however their views must be recorded and taken into account). In these circumstances, you should consult with the lead clinician. VRs already circulating for teaching may not be fully retrievable as collections move with staff but there should be no further use/processing/disclosure of the VR, once NUH is notified of the withdrawal of consent. VRs released for publication will not be fully retrievable (this risk is explained on the Consent to Publication form Appendix 3)

4.7 What if VRs are implicit and essential to the procedure - e.g. endoscopy

or key-hole surgery? Consent to the procedure provides explicit consent to record for clinical records only. Any further use of the VRs i.e. teaching / publication requires additional, specific consent.

4.8 What about VRs of post-mortems? VRs of post-mortems are outside of the scope of this policy, unless the deceased can be identified and then the general principles of good practice in this policy should be followed. Further information can be found in the Trust Consent to post mortem examination policy.

4.9 What about publication?


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Consent to Publication form (Appendix 3) signed by the patient and consultant. Case studies using radiographs (even though anonymised by removing the patient’s name / personal details), require patient consent.

4.9 What about research? Contact the Trust’s Research & Development Department (R&D) for advice before seeking the Research Ethics Committee (REC) and Trust R&D approval required to commence the project.

4.10 Can I use cameras integral to mobile telephones?

It is Trust policy that use of cameras integral to personal mobile telephones must be limited to exceptional circumstances only (eg. PACS failure) and these should be deleted once uploaded to a secure area of the Trust’s computer system. An incident form needs to be completed explaining the exceptional circumstances.

4.11 Can I e-mail VRs? Any emails sent should be in accordance with the Trust ’s Email Policy.

4.12 What about VRs for Public Relations purposes?

Patients - written consent is required for patients (store form with Medical Photography).

Staff - verbal consent is sufficient but it is advisable for a note to be taken of their consent where possible..

4.13 Visual Records for which patient consent is not required

Covert recording Refer to separate CCTV Policy before proceeding

Pathology slides - VRs of histology

Peri-operative - Tissue that has been removed from the

Radiology Radiographs, scans and other diagnostic images can be used for teaching without consent provided they are made anonymous by removing the patient’s name and other personal details.

4.14 Copyright

Employees of NUH - copyright vests in NUH (irrespective of who owns the recording equipment or in whose time the VRs were made).

External agencies commissioned by NUH - copyright vested in NUH.


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Freelance media working independently - copyright vests in the external agency unless assigned to NUH. NB. The Trust has NO control over their use.

4.15 Logging

VRs are subject to the Data Protection Act 1998 for patients who are alive and the Access to Health Records Act 1990 for deceased patients and must therefore be available for disclosure. If you are taking the VRs yourself please store the top copy of Consent to Photography / Video form (Appendix 2) in the case notes making sure that it includes details of who took the VRs, the date and where the original VRs have been archived. Second copy to be sent to Medical Photography.

5. Who can Consent to a VR?

Please refer to section 24 of the Consent to Treatment and Examination Policy and the Trust policy about specific consent requirements for health care professionals as they are equally appropriate to this policy.

Any qualified health care professional who is competent to take a

photograph within the scope of their professional practice is able to take consent for a VR. A full explanation and appropriate patient information must be given to the patient around uses and storage of VRs (described in this policy).

5.1 Why is it necessary to obtain consent for Visual Records (VRs)? The NHS policy on confidentiality is based on the principle that any

information held about a patient is provided in confidence only to be used to support their own individual healthcare. Patients have a right to object to the use and disclosure of confidential information. It is wrong to assume that a patient would agree to allow that information to be used for other purposes unconnected with their care and treatment, even when those other purposes are beneficial to society e.g. medical research. Additional efforts to gain their consent must be made to ensure that the extended use of patient identifiable information is lawful.


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‘Consent’, when used in the context of obtaining and using information about a patient, has the same meaning and principles as consent to examination and treatment.

5.2 Basic principles for consent for VRs Patients must be told the purpose, procedure, and all intended uses of

the recording which does/could/might identify them and provide their consent in writing (see patient consent forms Appendices 2 & 3).

The health care professional will make it clear to the patient that the VRs

will be used for their case notes and may be used for teaching purposes. It should also be made clear to the patient that they have a choice and if they do not want the VR to be used for teaching or publication purposes, they may withhold their consent and their decision will have no effect on their subsequent clinical care.

A patient’s refusal to permit any level of recording should be respected.

Such refusal to consent to photography should not prejudice future or current care.

Anonymising a patient’s VR does not preclude the need to obtain

consent. An exception is made for radiographs, scans and other diagnostic

images which may be used for teaching purposes provided they are anonymised by removing the patient’s name and any other details that might support identification

Where video recording or still photography is implicit to the procedure

e.g. endoscopy and laparoscopy, consent to the procedure only provides explicit consent to the recording for clinical documentation only. Any further use of the VRs i.e. teaching and publication requires additional, specific consent if the patient can be identified from the images.

When consent for publication is being obtained, it should be made

explicit that once the VRs are in the public domain there are no effective means of withdrawing them and the Trust would not be able to protect the patient’s interest by exercising control over further publication or use of that VR.


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Written consent must be obtained from both patient and consultant prior to providing copies of the VRs to any external third party for any other purpose e.g. to a solicitor under a Data Protection subject access application. Copies of VRs may be released within the trust with authorisation from the Consultant.

6. VRs for which consent is not required for notes or teaching

You do not need to seek permission to make the VRs listed below for notes or teaching purposes for NUH, providing that, before use, the VRs are effectively anonymised by the removal of any patient identifiers (including writing in the margins of an x-ray for example):

VRs taken from pathology slides

VRs of internal organs

Radiological VRs (Publication as case study requires consent) Such recordings are unlikely to raise issues about autonomy and will not

identify the patient. It may nonetheless be appropriate to explain to the patient, as part of the process of obtaining consent to the treatment or assessment procedure, that a recording will be made.

7. VRs made without Consent Circumstances in which a recording may occur without consent are

described below: 7.1 In legal terms, an adult cannot consent on behalf of another adult.

However, it is good practice and in accordance with the Mental Capacity Act to seek the views of someone close to an incompetent patient to help to determine what might be in the patient’s best interests. Care must be taken not to breach patient confidentiality in this situation.

7.2 VRs can be undertaken when a patient lacks capacity to consent,

including during emergency treatment or when unconscious, but only if it is judged by a health care professional to be in their best interests to do so. In these instances the consent form must be signed by the most senior health care professional involved. VRs must not be made in these circumstances if the patient has previously refused this procedure when competent and such a refusal clearly applies to the present circumstances. No further use should be made of that record e.g. for teaching or publication purposes without the doctor obtaining written


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consent and any material published or otherwise used should only be released if there is lawful authority to do so (for example a Court Order requiring such). In these circumstances, advice from the Trust Secretary should be sought.

7.3 When no VRs have been planned, but a record of an unexpected

development would make a valuable educational tool, you may record patients undergoing treatment. If you cannot get permission at the time because, for example, the patient is anaesthetised, you must ensure the patient is later told about the recording and gives consent to its use. No VRs may be released until the appropriate consent is given. If consent is refused the VR(s) must be destroyed/deleted. If the patient lacks capacity to consent to the VR being taken/retained/used then the opinion of an appropriate person involved in their care (for adults) or a person who holds PR (for children) must be obtained.

7.4 If you believe there is a case for covert VRs, please refer to the Trust’s

CCTV Policy.

8. Deceased Patients

If the patient dies before consent is obtained, VRs should be treated as a part of their medical records. However, if there is extraordinary teaching or research value in the use of the images, advice on contacting the bereaved relatives and obtaining consent can be obtained from the pathology specialist nursing and midwifery team ext 61726 or contact through the bereavement centre.

8.1 Bereavement photography for children

Bereavement photography may be requested by families where a child has died and no photograph of them is held by their parents/those with parental responsibility. This can be carried out for the parents/next of kin if they wish to have a photographic record of their child. Parental permission should be obtained using the special photographic request form, Appendix 6. These photographs arenot to be used as medical records, and are only for the parents’ use. The parents/holders of parental responsibility should be informed that the photos will only be retained for eight years. [


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These images must be stored in a secure area of the Trust’s network, using the photographic image uploader, which will only be accessible to authorised users.

9. Research VRs made solely for the purposes of research must have both Research

Ethics Committee (REC) and Trust Research & Development (R&D) approval prior to obtaining them. It may be necessary for an individualised research specific consent form to be used. Please seek advice from the R&D Department.

Consent to take VRs must follow the same principles outlined in this

policy. All research projects must be conducted according to the Research

Governance Framework for Health and Social Care (2005) and the Clinical Trial Regulations (2004) where applicable. (Patient information sheets and consent forms for research projects usually contain a statement advising participants of the use of their data and may specify publication. If this is the case then it clearly states that any material used for this purpose will be anonymised and the participant will not be able to be recognised. In research this is considered acceptable practice and would negate the need for a separate publication consent form)

10. Consent for Publication Patients’ wishes concerning the uses made of their VRs must be

respected. For example, consent to publication of a photograph in a scientific journal must be obtained before it is submitted to the journal.

Consent may be withdrawn by the patient (or someone with authority to

consent on their behalf) at any time prior to publication of the VR. Patients have the right to withdraw or alter the level of their consent at any time and this should be recorded in the notes. However it should be made clear to the patient that once a VR is in the public domain, it is not possible to effectively withdraw the material. In addition, it should be recognised that electronic dissemination of VRs on the internet or other insecure networks provides ample opportunity for illicit copying,


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modification and unauthorised use of the VR(s). All parties should be fully aware of the possible implications

Electronic dissemination must be approved by the Information Asset

Owner/Clinical Director for the specialty affected, taking into account the risks of misuse.

Caution must therefore be exercised by those submitting VRs of patients

to any form of publishing media. Before material may be submitted for publication, specific consent must

be obtained using the Consent to Publication form (Appendix 2). This form should be completed and signed by the patient or legal representative and the patient’s consultant. Specific consent for publication on each occasion.

Where possible, efforts should be made to preserve anonymity in

published VRs, for example, by excluding the face. However, such precautions do not preclude the need for consent.

Consent may only be valid for 12 months from the date of signing. If no

application has been made to publish the VRs within this time consent is no longer valid.

11. Copyright NUH holds the copyright for VRs taken of NUH patients in accordance

with paragraph 4.14 above. Staff may not use VRs for any personal use whatsoever and, unless

expressly agreed otherwise in advance in writing by the Directorate’s information asset owner, and shall only be permitted to use them for the purposes of performing their duties.

Any copyright (and any other intellectual property rights) residing in

VRs taken of NUH’s patients may not be assigned, transferred or sold to any third parties (including without limitation to any publishers).

Any agreements or arrangements entered into by NUH with third parties

must contain provisions which make it clear that any copyright and any other intellectual property rights residing in the VRs are owned by NUH


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and shall not be assigned to the relevant third party and that the third party obtains no other right, title or interest in the VRs.

Copyright (and any other intellectual property rights) residing in the VRs

may not be licensed (i.e. a permission to use granted) to third parties (including without limitation any publisher) without the express prior written approval of the Directorate’s information asset owner (or their appointed nominee for this purpose). Appropriate consent must also be obtained from the patient in accordance with Appendix 2. A fee may be payable for the granting of a licence in some instances. It is essential that staff obtain the express prior written approval of the Directorate’s information asset owner before signing the publication consent form or other agreement permitting a third party to use the VRs. It may also be appropriate to seek the guidance of the relevant innovations hub.

To protect copyright VR’s should be labelled ‘ Nottingham University Hospitals NHS Trust’ in a clear and prominent place.

Staff who leave NUH must promptly disclose to NUH and promptly

return any VRs obtained during their course of employment, appointment or other engagement with the Trust. Specialist staff may be permitted to retain anonymised VRs for non-commercial, medical teaching purposes, but this shall be subject to such specialist staff having obtained the express prior written approval of the Directorate’s information asset owner. If such approval is granted, the relevant specialist staff must, in addition to any additional terms that may be stipulated by NUH, undertake in writing only to use them within the terms of the original consent given by the patient. The patient’s name and hospital number and any other identifiable patient data must also be removed. The embedded patient metadata also needs to be erased. No other use may be made of such VRs. Copyright and reproduction rights at all times remain with the NUH.

Copies of VRs may only be made with the express prior written approval

of the clinician in charge and within the constraints of section 4 of this policy (consent).

12. Historical collections of Teaching Material Historical collections of identifiable clinical VRs used for teaching

purposes should be checked for consistency with the policies outlined in


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the present document. It should be assessed whether or not consent was obtained for VRs to be used for educational purposes. Where consent was not obtained any information that would identify the individual patient must be removed before the VRs can be further used. Where anonymisation is not possible consent must be obtained or the VR must be destroyed. (GMC 2002)

Retrospective compliance with this procedure is not possible but we

recommend that care is exercised in accordance with the spirit of this policy.

13. Consent for VRs for Public Relations Purposes See ‘Guidelines for handling media enquiries and maintaining patient

confidentiality.’ The main points in relation to VRs are: 13.1Freelance professional photographers / videographers may only be

introduced to the Trust by the Corporate Communications Team. Queen’s Medical Centre 61975 / 63562 13.2 Consent must be obtained before any VRs are produced, this can be

verbal although written is preferable as it can be kept in patient notes. (see Non-clinical Visual Record Consent form and External Media Consent form Appendices 3 & 4).

13.3 Accidental VRs of patients who have not given appropriate consent must

be avoided. VRs of a patient inadvertently included when recording another patient(s), who has not consented, must not be published under any circumstances. Unless deleterious to the care of the subject patient, they must be destroyed.

13.4 Consent from members of staff must not be assumed. It is not necessary

to obtain their written agreement but they must be given an opportunity to make a choice and any refusal should be upheld.

13.5 Re-use of VRs: Please be aware that NUH has no control over the use of material taken

by external agencies, such as newspapers and TV companies, either now or in the future. All copyright belongs to the external agency, which


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retains the right to re-use, broadcast, publish and re-distribute the material worldwide in the future, without seeking further consent.

14. Processing & Reproduction In the interests of confidentiality, the processing and reproduction of VRs

for the case notes must be carried out on Trust property. No external processing of VRs is permitted.

Patients have the right to obtain copies of their VRs for themselves

under the subject access provisions of the Data Protection Act 1998.

Patients can contact the Patient Records Services ext: 63975 to access this facility.

15. Logging and Storage 15.1 Since any VR may be available for disclosure (including subject access

applications), it is essential that a record is logged in the case notes with details of the VR; who made it, the date and its location.

The top copy of the consent form must be filed in the Investigations and

Results section of the notes. The second copy must be sent to Medical Photography.

15.2 In the case of a digital VR, the original file – with no manipulation or

compression applied - must be downloaded on to a secure storage facility as soon as possible. The Medical Photography department in conjunction with ICT provides a service where health care professionals can securely deposit VRs onto a secure server. In addition VR’s taken by Medical Photography can be accessed via a secure server by specific health care professionals for teaching (providing the correct level of consent has been given).

15.3 Once downloaded digital VRs must be deleted from the camera. 15.4 Each patient’s VR set should be assigned to a folder whose filename

must include the patient’s hospital number and the date of the recording.


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15.5 VR’s may be stored on NHS desk / laptop computers provided that adequate security protection is used (see ICT Information Security and Data Protection Policy and Procedures ).

15.6 Conventional photographic negatives/slides must be securely stored and

catalogued, irrespective of who took the photographs or owns the film. 15.7 Secure Disposal When no longer required CDs, DVDs, conventional slides and negatives

must be securely destroyed using the confidential waste bags. Material may be deposited with Medical Photography for destruction.

15.8 The existence of digital VRs clearly supports the move towards

electronic patient records incorporated within the proposed new national patient care record as part to the National Programme for IT (NPflT). As improved technology solutions are made available the policy will be updated.

16. Security of Digital Images The Trust’s ICT Information Security and Data Protection Policy and

Procedures apply to VRs. VRs on digital cameras, disc drives and other storage media should be kept in a secure location under lock and key when not in use. The location should be recorded in all appropriate records.

Access to VRs must be protected by individual passwords. Computers

must be located in such a way that the VRs of patients displayed on screen cannot be seen by passers-by.

17. Internet Security / E-mail The internet is not secure. VRs of patients must not be transmitted over

a public network, e,g, an electronic publication of a journal, without the explicit consent of the patient. It must be made clear to the patient that there is a risk of such VRs being seen or downloaded by someone other than the intended recipient, and that once such VRs are in the public domain there is no effective means of withdrawing them and the Trust would not be able to protect the patient’s interests by exercising control


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over further publication or use of that VR. This is made explicit in the Consent for the Publication of Visual Records Appendix 2.

VRs may ONLY be transmitted to colleagues via e-mail if ENCRYPTION

is used. Please contact the ICT Information Security Advisor in the event that encryption assistance is required.

18. Implementation and Monitoring Plans

The Medical Photography department is responsible for ensuring this policy is circulated and monitored and for recommending updates to the Consent Committee. A record must be kept of incidents breaching the policy and recommendations. The Medical Photography department will offer guidance and training to staff who need to take VR.

19. Communication of the Policy

The policy will be distributed to the target audience as an attachment via e-mail. It will also be available via the intranet and held in the policy library. Clinical Directors and their Heads of Service are responsible for all health care professionals and will be made aware of the policy.

20.0 Equality and Diversity Statement

All patients, employees and members of the public should be treated fairly and with respect, regardless of age, disability, gender, marital status, membership or non-membership of a trade union, race, religion, domestic circumstances, sexual orientation, ethnic or national origin, social & employment status, HIV status, or gender re-assignment. All Trust policies and Trust-wide procedures must comply with the relevant legislation (non exhaustive list) where applicable:

Equality Act 2010


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Employment Relations Act (1999)

Rehabilitation of Offenders Act (1974)

Human Rights Act (1998)

Trade Union and Labour Relations (Consolidation) Act 1999

Part Time Workers – Prevention of Less Favourable Treatment Regulations (2000)

Fixed Term Employees – Prevention of Less Favourable Treatment Regulations (2001)

Health and Safety at Work Act (1974) 21.0 Equality Impact Assessment Statement

NUH is committed to ensuring that none of its policies, procedures, services, projects or functions discriminate unlawfully. In order to ensure this commitment all policies, procedures, services, projects or functions will undergo an Equality Impact Assessment. A copy of the Equality Impact Assessment for this policy can be found in Appendix 4.

22.0 Environmental Impact Assessment Statement

The environmental impact of the policy has been considered and no further

action is required at this time.

23.0 We are Here for You Standard Mission Statement

This Trust is committed to providing the highest quality of care to our patients, so we can pledge to them that ‘we are here for you’. This Trustsupports a patient centred culture of continuous improvement delivered by our staff. The Trust established the Values and Behaviours programme to enable Nottingham University Hospitals to continue to improve patient safety, outcomes and experiences. The set of twelve agreed values and behaviours explicitly describe to employees the required way of working and behaving, both to patients and each other, which would enable patients to have clear expectations as to their experience of our services.

A copy of the full We Are Here For You Compliance Assessment Toolkit can be found in Appendix .


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24. References

BMA: Taking and using visual and audio images of patients: Guidance from the Medical Ethics Department, 2004 British Photographers’ Liaison Committee. The ABC of UK Photographic Copyright; BLPC 1994 The Medicines for Human Use (Clinical Trials) Regulations 2004 The Caldicott Report 1997 DOH Research Governance Framework for Health & Social Care 2005 DOH Good Practice in Consent 2009 DOH Protecting and Using Confidential Patient Information – A Strategy For The NHS DOH The Protection and the Use of Patient Information, 1996 DOH “For the Record” 1999 Protocol for Photographing Non-accidental Injuries. GMC: Making & Using Visual and Audio Recordings of Patients, April 2011 International Committee of Medical Journal Editors: Protection of Patient’s Rights to Privacy 1995 Institute of Medical Illustrators. A Code of Professional Conduct for Members, 2006 Royal College of General Practitioners. RGCP Statement on the Use of Video-recording of General Practice Consultations for Teaching, Learning and Assessment: The Importance of Ethical Considerations; RCGP 1993


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Appendix 1


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Appendix 2 VR Exceptional Circumstances Registration Form

Reason for having to use non registered NUH camera/including camera phone Has this reason been reported on Datix or incident form Yes / No Is this incident likely to be repeated? Have any preventative steps been put in place Where have the photographs been stored and where Have copies been placed in the patient notes Yes / No Method of data transfer Have photographs been removed from camera/camera phone Yes / No Please send this form to Medical Photography department, QMC campus


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NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST Appendix 3

CONSENT FOR THE PUBLICATION OF VISUAL RECORDS

Consultant: .......................................................... Department:......................................................... Date: ..................................

Copyright of all Visual Records remains with the Nottingham University Hospitals NHS Trust

Consent is only given for use in the specified publication(s) detailed below; Visual Records must not be used for any other purpose.

The Visual Records described to me have been taken with my permission for my case notes and for teaching. I understand that I may view my Visual Records before making a decision.

Following discussion / correspondence with: Name……………….......…Dept…………………..…. I understand that it may be helpful for these Visual Records to be published. Publication Media:

Hospital publication Poster Electronic (Internet)

Journal (print and website) Book Other (details) ........…………. Patient information leaflet DVD ..........................................…. Publication:……………………………………………………Publisher…………………........ Electronic publications may be available world wide on the Internet. As a result, I understand that the Visual Records may be seen by the general public. My name and details will remain confidential but I understand that I might be recognised from the Visual Records so full confidentiality is not guaranteed.

In view of the explanation given to me I give consent for these Visual Records to be published only in the form(s) I have indicated above.

I understand that no Visual Records will be submitted for publication within the next 14 days. During this time I may withdraw my consent by writing to my hospital consultant. I understand that should I wish to withdraw consent once Visual Records have been submitted for publication or published, it may not be possible to retrieve them. In this case the Trust would not be able to protect my interests by exercising control over their further use. I understand that consent is valid for 12 months from the date of signing. If my Visual Record is to be used for further publication after this date my permission will be sought for further consent.

Full name (print):…………………………………………………Date DD / MM./20YY…..

Relationship if not patient……………………………………

I confirm that I have parental responsibility for the child: (delete if not applicable)

Signature……………………………………………………………………………......

PRINT X3 – Copies to Patient, Medical Photography, Publisher

(Please also attach label to second sheet)

Surname……… ………..……………..

Forename……………...……………..…

Hospital No………………………..……..

DOB……………………………….

Address…………………………….….

……………………………………….…


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Appendix 4

NON-CLINICAL VISUAL RECORDS CONSENT FORM

I hereby give my consent to be photographed / videoed by Nottingham University Hospitals NHS Trust

Purpose of Visual Record: ……………………………………..………………….

Date of recording: ……………………………………………….......…….............. Expiry date of recording: Single purpose / 6 months / 12 months/18 months / perpetuity (please circle)

Do you also give consent for this material to be used for other hospital publicity purposes? This may include material seen by the general public such as brochures, reports, advertisements, leaflets and the hospital website (delete any which are not permitted).

Yes / No

Name of patient: ………………………………………………………….

Name of parent/guardian …………………………………………………………. (if patient aged under 16)

Home address: ………………………………………………………….

………………………………………………………….

………………………………………………………….

Daytime telephone number: ………………………………………………………….

Signature of patient/guardian: …………………………………………………..............……………………………………………………….

Date: ………………………………………….


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Appendix 5

EXTERNAL MEDIA CONSENT FORM

I hereby give my consent to be interviewed / photographed / filmed by external media e.g. local radio, TV (delete any which are not permitted.)

Name of publication/programme: ………………………………………………….

Date: ……………………………..…………………………..……………………...

Name of patient: ………………………..…………………………………………...

Name of guardian (if applicable): ………………………………………………….

Home address: ………………………………………………………………………

………………………………..……………………………………………………….

……………………………..………………………………………………………….

Daytime telephone number: ..…………………………………………………….

Signature of patient/guardian: …………………………………………………….

Date: …………………………………………………………………………..…….

IMPORTANT NOTE

Re-use of interviews/photographs/films: Please be aware that Nottingham University Hospitals NHS Trust has no control over the use of material taken by external agencies, such as newspapers, TV and radio companies, either now or in the future. All copyright belongs to the external agency, which retains the right to re-use, broadcast, publish and re-distribute the material worldwide in the future, without seeking further consent.


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Appendix 6

The image(s) will be destroyed after [insert the agreed time period – it is my suggestion that to ensure ease of document control this should be no more than say 6 months and where possible a copy of the photograph given to the parents immediately after the photo is taken]”.


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Appendix 7

NUH staff photographic registration form Name :______________________________________________________ Department:__________________________________________________ Contact email__________________@_____________________________ Contact phone no.____________________________ext:________________ Camera being used (Serial No.):__________________________________ Do you have Fotoweb access? Yes/No Do you have access to fotoweb up-loader? Yes/No Has training been given by medical photography? Yes/No Has the Photography And Video Recordings Of Patients: Confidentiality, Consent, Copyright & Storage been read.

Signature ____________________________

Date: ________________________________

Authorisation give Yes / No Signature of medical photographer ____________________________ Date:_________________________________________________________

Please send to medical photography once completed


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Appendix 8

Uploading patient images to the Medical Photography Image Database using Image Uploader

To assist the Medical Photography team in processing the images please ensure that the consent to photography form is completed in full and signed by the patient. The completed form needs to be photographed first, in full, before photographing the patient. This means any patient is identifiable. A photograph of the completed consent form should be uploaded along with the patient photographs. Before you follow the directions below you must ensure that the patient photographs that you wish to upload have been downloaded onto your NUH account and that you have them stored somewhere that you can find.

1) Open Image Uploader – a link can be found within FotoWeb if you have access or via the intranet using the following web address: http://cmedphoto/imageuploader/

2) The front page of Image Uploader will open. Enter the patient details of

the first patient whose images you wish to upload. You must enter as much information as possible. You will not be able to finish this part of the upload process if the required information fields are not completed. Please enter the data with care. If any of the information is not correct this may delay or prevent the photographs from being included in the patients records.

http://cmedphoto/imageuploader/


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3) Click ‘Submit’ once all of the information has been entered. 4) A new page will be opened in Image Uploader. The patient details that

you have just entered will be visible on the left side of the page. You now need to find the patient photographs that match the patient details showing on the left side of the page.

5) Click on the ‘My Computer’ button at the top of the page. This will open

up different folders that you can access on you PC. You need to navigate to the patient photographs that you saved before starting this process. You can navigate forwards and backwards through the folders using the arrow buttons next to ‘My Computer’ until you find them.

6) Once you have the photographs you require you need to check / tick

the box that you can see at the top left of each photograph. These will then be the photographs that you upload with the corresponding patient information you previously entered.


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7) Press ‘Send’ at the top right of the page. If the upload is successful a

box will appear that says ‘Upload complete’.

8) The photographs have now been uploaded to the Medical Photography

Image Database.

If you need further assistance please call Medical Photography on: City Campus x56493 QMC Campus x64685


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Appendix 9

Assessment Report Outline

Remember that your EIA report should demonstrate what you do (or will do) to make sure that your service/policy is accessible to different people and communities, not just that it can, in theory, be used by anyone.

1. Name of Policy or Service

Photography and video recordings of living patients: Confidentiality, consent, copyright & storage

2. Responsible Manager

Head of Medical Photography

3. Name of Person Completing Assessment

Graham Love

4. Date EIA Completed 23 August 2010

5. Description and Aims of Policy/Service (including relevance

to equalities) The Trust has a responsibility to ensure that all Visual Records (VRs) are taken with the consent of the patient, are stored securely and are handled in accordance with current legislation and the Trust’s consent to examination and treatment policy gives the Trust permission to consent to treatment.

6. Brief Summary of Research and Relevant Data

Acts of Parliament that have a direct bearing on visual photographs include: Regulation of Investigatory Powers Act (2000) The Human Rights Act 1998


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The Data Protection Acts (1984 and 1998) The Criminal Justice and Public Order Act (1994) The Children Act (1989) The Copyright, Design and Patents Act (1988) The Access to Personal Files Act (1987) The Video Photographs Act (1984) The Access to Health Records Act (1990) The Mental Health Act (1983)

7. Methods and Outcome of Consultation

Review by the Consent Committee and Medical Photography Department

Results of Initial Screening or Full Equality Impact Assessment:

Equality Group

Assessment of Impact

Age

No Impact Identified

Gender


Race


Sexual Orientation


Religion or belief


Disability


Dignity and Human Rights


Working Patterns


Social Deprivation



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9. Decisions and/or Recommendations (including supporting rationale)

This policy provides information to staff that may be involved in the photography of patients

11. Monitoring and Review Arrangements (including date of next full review)

This policy will be reviewed in-line with NUH guidelines by the NUH Medical Photography Department. Review date June 2013


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Appendix 10

We Are Here For You Policy and Trust-wide Procedure Compliance Toolkit The We Are Here For You service standards have been developed together with more than 1,000 staff and patients. They can help us to be more consistent in what we do and say to help people to feel cared for, safe and confident in their treatment. The standards apply to how we behave not only with patients and visitors, but with all of our colleagues too. They apply to all of us, every day, in everything that we do. Therefore, their inclusion in Policies and Trust-wide Procedures is essential to embed them in our organization. This toolkit has been designed for Policy Owners to assess the compliance of their Policy or Trust-wide Procedure in light of the We Are Here For You values. It is now mandatory for all Policies and Trust-wide Procedures to incorporate the We Are Here For You Values and undergo this compliance assessment. Please complete the grid below to assess your Policy or Trust-wide Procedure. The toolkit will then advise Policy-owners on the steps they need to take to become We Are Here For You compliant. To what extent is your Policy or Trust-wide Procedure affected by the following We Are Here For You values? Please rate each value from 1 – 3 (1 being not at all, 2 being affected and 3 being very affected)

1. Polite and Respectful

Whatever our role we are polite, welcoming and positive in the face of adversity, and are always respectful of people’s individuality, privacy and dignity.

3

2. Communicate and Listen We take the time to listen, asking open questions, to hear what people say; and keep people informed of what’s happening; providing smooth handovers.

3


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3. Helpful and Kind All of us keep our ‘eyes open’ for (and don’t ‘avoid’) people who need help; we take ownership of delivering the help and can be relied on.

1

4. Vigilant (patients are safe) Every one of us is vigilant across all aspects of safety, practices hand hygiene and demonstrates attention to detail for a clean and tidy environment everywhere.

3

5. On Stage (patients feel safe)

We imagine anywhere that patients could see or hear us as a ‘stage’. Whenever we are ‘on stage’ we look and behave professionally, acting as an ambassador for the Trust, so patients, families and carers feel safe, and are never unduly worried.

3

6. Speak Up (patients stay safe) We are confident to speak up if colleagues don’t meet these standards, we are appreciative when they do, and are open to ‘positive challenge’ by colleagues.

3

7. Informative We involve people as partners in their own care, helping them to be clear about their condition, choices, care plan and how they might feel. We answer their questions without jargon. We do the same when delivering services to colleagues.

3

8. Timely We appreciate that other people’s time is valuable, and offer a responsive service, to keep waiting to a minimum, with convenient appointments, helping patients get better quicker and spend only appropriate time in hospital.

2


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9. Compassionate We understand the important role that patients’ and family’s feelings play in helping them feel better. We are considerate of patients’ pain, and compassionate, gentle and reassuring with patients and colleagues.

1

10. Accountable Take responsibility for our own actions and results

1

11. Best Use of Time and Resources Simplify processes and eliminate waste, while improving quality

2

12. Improve Our best gets better. Working in teams to innovate and to solve patient frustrations

1

TOTAL

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CERTIFICATION OF EMPLOYEE AWARENESS

Document Title PHOTOGRAPHY AND VIDEO RECORDINGS OF LIVING PATIENTS CONFIDENTIALITY, CONSENT, COPYRIGHT & STORAGE POLICY

Version (number) 3

Version (date) 27 May 2011

I hereby certify that I have:

Identified (by reference to the document control sheet of the above

policy/ procedure) the staff groups within my area of responsibility to

whom this policy / procedure applies.

Made arrangements to ensure that such members of staff have the

opportunity to be aware of the existence of this document and have the

means to access, read and understand it.

Signature

Print name

Date

Directorate/ Department

The manager completing this certification should retain it for audit and/or other purposes for a period of six years (even if subsequent versions of the document are implemented). The suggested level of certification is;

Clinical directorates - general manager

Non clinical directorates - deputy director or equivalent. The manager may, at their discretion, also require that subordinate levels of their directorate / department utilize this form in a similar way, but this would always be an additional (not replacement) action.

Documents

Photography And Video Recordings Of Living Patients ... · Photography And Video Recordings Of Living Patients: Confidentiality, Consent, Copyright & Storage 9 Version 3 May 2011