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Access for Students


The NHS is investing substantial sums in information technology and making more patient records electronic through the implementation of a collection of computer systems and services. More and more NHS organisations are using a combination of these together with those that have been procured locally and independently.

Some of these are linked to the NHS Spine enabling a range of different NHS computer systems to collect, store and exchange patient information safely and securely. Many healthcare staff throughout the country now regularly access electronic systems and records as part of their work. At the same time the importance of effective identity assurance of all individuals providing services to the NHS is of increased importance (see the NHS Employment Check Standards).

To ensure that patient's records remain confidential, access is strictly controlled. To access some NHS computer systems, individuals need an NHS Smartcard. Systems that use a Smartcard can be more secure than other systems because a healthcare staff member’s Smartcard carries their ‘digital’ signature. This signature means that patient information is more safe and secure as it only allows healthcare staff to access appropriate records, and to the information they need to do their job. The process for obtaining a Smartcard involves proving identity beyond reasonable doubt, followed by the granting of appropriate access privileges based on an individual's role.

Why students?

Healthcare students are the workforce of the future and as such need appropriate access to NHS systems and electronic records as part of their training placements. This enables them to learn in much the same way as when they had access to paper records in the past.

How will students get access?

Such access will require the issue of a Smartcard and permission to view records appropriate to the training that is being provided. NHS organisations undertaking training therefore need to ensure that there are arrangements for Smartcard issue and the granting of appropriate access rights for students on placements. This must be based on verification of identity, just as for other NHS staff and contractors (footnote 1).

When should students be issued with Smartcards?

The first time students may need to be able to access records and systems is during their clinical placements, as part of their programme of undergraduate education. Undergraduate education has developed significantly over the past few years; students are undertaking an increasing number, and range, of clinical placements. Furthermore, some of these placements are occurring earlier in education programmes than may have previously been the case. Generally there is no typical placement pattern.

How can the process of verifying identity and issuing Smartcards be managed?

Each NHS organisation already has a structure and process in place to verify identity, based on the NHS Employment Check Standards. This usually occurs in HR departments for joiners, and in Registration Authorities for the issue of Smartcards to healthcare staff and others requiring   access to NHS systems that use them. In some cases these processes are already integrated. These standards include options for what documentation is acceptable in relation to young people who may not have established 'proof in the community' documents.

The Registration Authority in each organisation also manages the process of granting appropriate access rights to electronic systems and records, either at the same time as issuing a Smartcard or separately if the person, such as a student, already has a Smartcard, which should stay with that person even as they move between organisations.

At present only NHS organisations can set up a Registration Authority and therefore joint working with educational establishments will be needed. However NHS organisations can confer delegated responsibilities on individuals within educational establishments to manage the process of identity checking and issuing of Smartcards to students. Therefore two broad options are available:

  • NHS organisations include, as part of the induction process for students, appropriate identity checks and the issuing of a Smartcard (unless the student already has one from an earlier placement or NHS employment) followed by the granting of appropriate access rights.
  • NHS organisations delegate the verification of identity and issue of a Smartcard, within the Registration Authority governance framework, to educational establishments. The NHS organisations those students then attend will then need to grant appropriate access rights on commencement of placements.

The need to verify students' identities and issue Smartcards could be integrated into a single business process, coordinated between educational establishments and NHS organisations in an area. We suggest that NHS organisations, including the local education commissioner and their local educational establishments, enter into a dialogue to consider how students might be issued with Smartcards. We are aware that educational establishments work with a range of NHS organisations that provide clinical placements for their students so there may be lead employers within a 'circuit' with whom dialogue can commence and local solutions reached.

The issues the dialogue will need to consider include:

  • What pattern of students placements will there be in relation to each educational establishment? How many students will be joining an NHS organisation? Will it be their first placement or not? When is the best time to issue Smartcards?
  • How can the process of issuing Smartcards be integrated into the University or employers' normal identity checking process at the point of induction?
  • What processes does the NHS organisation already have in place to check the identity of students coming on placement to their organisation? This is a requirement under NHS Employers mandatory employment checks. Delegating responsibility of issuing Smartcards to educational establishments, with the associated identity checking may support NHS organisations in meeting this requirement. Because Smartcards are only issued on the basis that identity has been verified, the Smartcard could be used as one method of checking identity when an individual arrives in another organisation
  • Will students require access to NHS systems or other organisational processes that are Smartcard enabled during their clinical placements? Agreeing with NHS organisations the point during training when access to NHS systems is required may help to facilitate the planning process around issuing Smartcards and granting access rights
  • What processes does the NHS organisation(s) employ to issue Smartcards to staff?
  • What are the options locally that are available to issue Smartcards to students? (1)
  • What are the numbers of students involved and when?
  • How will the arrangements agreed locally ensure access privileges be removed once the student placement has finished? (2)

Endorsement of this approach

This statement is endorsed by DH Workforce Directorate, NHS Employers and HSCIC. In preparing the statement the following organisations were consulted in its preparation:
British Medical Association
Chartered Society of Physiotherapists
Royal College of Nursing
Royal College of Midwives
Universities UK
Council of Deans
SHA Education Commissioners
Medical Schools Council

1. Guidance is available on the Registration processes that could be used, either when the student arrives at their first placement, or Smartcards issued on a bureau basis at the educational establishment - however there are different resource implications attached to each of these which will need to be talked through between employers and the educational establishments. This document is available to NHS organisations at http://nww.hscic.gov.uk/iim/ra/governance (N3 connection required)

2. NHS staff are granted certain access privileges (an access profile) to allow them to do their job. If they move to another organisation this profile is removed but they retain their Smartcard. When they join a new organisation requiring access to NHSsystems they would be granted a new profile in that new organisation. This same system needs to apply to students.