What's happened?
The NHS's ill fated computer project has made the news again, this time over the government's climbdown from putting medical records on a national database.
With public confidence in the ongoing £20bn upgrade of NHS computer systems right down there with the government's handling of Iraq, the news that electronic medical records would not, as originally planned, be automatically uploaded to a central computer “spine” was mothers' milk to British newspapers.
The security of the sinister sounding “spine” was the main focus of press concern. Do people want to risk others finding out they were a teenage bed wetter, or once had anal warts?
Under the initial proposals, summary patient records—including medicines taken, adverse reactions, and allergies—were to be made available for access nationally by GPs and hospitals. Under pressure, health minister Lord Warner produced a report the week before Christmas, promising patients an opt out. This softened approach would also allow patients to access and amend online records before they are sent to the national database.
What the papers say
The Guardian, which had been running a campaign against a compulsory national database of medical records, showed admirable self restraint on hearing of the climbdown. Instead of going with “it was the Guardian wot won it” headlines, it was almost downcast.
In a comment article, Ross Anderson, professor of security engineering at Cambridge University, warned that a lot more was at stake: “Don't break out the champagne yet. The [Warner] report was cleverly spun; hidden in an appendix is confirmation that you can opt out of the summary care record, but not the detailed care record.”
Over the next few years, detailed care records (the whole medical record, which will replace GP and hospital records) will be uploaded to a regional hosting centre run by a government contractor. The chief medical officer will eventually be in control of the lot. The government is not offering such an easy opt-out here, Anderson warned, and there will be plenty of opportunity to breach patients' privacy.
He said: “Once the records of millions of people are on one system, to which a court will give access without GPs' knowledge, the police will be sorely tempted. They already collect all sorts of operationally useful data: they have had access to opiate prescriptions for years, and there's been a steady rise in their requests for journey data from London's Oyster card [electronic ticketing] system.”
Christina Odone, in the Telegraph, continued with the “thin end of the wedge” theme. She urged readers to write to their GP in order to opt out of “the latest and maddest drive to centralisation.”
“Otherwise, our medical records—the sexually transmitted disease we kept a secret, the addiction to sleeping pills we overcame 10 years ago, the mental breakdown at university—will be loaded on one mammoth, central database.”
In Odone's opinion, centrally available electronic patient records would “spell an end to privacy.” What about all those millions of NHS employees who would have access to your data? And this is before we get started on the hackers. “As one NHS worker who emailed the Today programme confirmed, the NHS ‘is as leaky as a sieve.' Something as big as the NHS centralised system is just the kind of headline-grabbing target hackers love to tackle,” she wrote.
The Times found ample grist for the columnist's mill. Alice Miles, in an article ominously titled “Sending a shiver down my spine”, was almost nostalgic that patients' experiences of “disappearing notes” could soon be a thing of the past.
“It has always been part of the NHS experience: turn up for long awaited outpatient appointment; consultant doesn't know your name, no one has given him your notes. Somewhere in the bowels of the hospital a porter is wheeling them around, spilling from bulging envelopes, with dozens of other patient records packed on to a trolley. They might get there, they might not,” she wrote.
A little patience, please, said a Guardian leader. At least the government has shown some signs of having listened. When the first information is uploaded in trials next year there will be clear, clinical advantages, but much more needed to be done to quell fears. The “sealed envelope” technology, for example, which allows patients to restrict access to parts of their record, is still at the planning and development stage, according to the Department of Health.
Seeking to look at both sides of the story, the Independent ran a Q and A: “The big question: should we fear plans to put medical records on a national database?”
“Ministers think these risks have been overplayed. They believe that the interests of the majority of elderly vulnerable patients who have most to gain from the new system are being drowned out by a vocal minority worried about the privacy aspects and the threat to confidentiality,” it said.
What happened next
Chancellor Gordon Brown will soon have to decide the fate of the NHS computer system. Don't make it your Waterloo, warned the Guardian in a comment article. “The system is showing all the classic symptoms of turning into a software project disaster. The convoy is heading for the rocks. Gordon Brown will have to decide soon whether to scrap the central database and build safe systems that will work. If he calls it wrong—as with Blair and Iraq—it may well be the decision for which he is remembered,” it declared.
Something as big as the NHS centralised system is just the kind of headline-grabbing target hackers love to tackle
Christina Odone, Daily Telegraph