IT underpins NHS reform in Queen’s speech

03 Dec 2008

The government is planning to introduce a health bill to Parliament that will require further investment in IT and new information services for the public, the Queen’s speech has confirmed.

The National Health Service Reform Bill will give the NHS its first, ever written constitution, drive forward the government’s quality and choice agendas, and strengthen primary care trusts’ commissioning powers, while requiring them to become more responsive to their communities.

A draft NHS constitution was published alongside the final report of Lord Darzi’s Next Stage Review of the NHS this summer. It sets out the principles and values of the NHS and sets out rights and responsibilities for the public.

The proposed rights include “access to your own health records” and that these “will always be used to manage your treatment in your best interests.” They also include a right to choose a GP and to make choices about further treatment.

The latter rights are backed up by a number of pledges; that the NHS will “strive” to give patients information about the choices open to them, that it will “include information on the quality of clinical services where there is robust and accurate information” and that it will share letters with patients.

Some of the rights and pledges in the constitution appear to depend on initiatives on which slow progress has been made to date. A commitment to copy clinical letters to patients was first made in the NHS Plan in 2000.

Just four primary care trusts are running pilots of the NHS Summary Care Record, which can be viewed through the Health Space online organiser. And figures released by the Department of Health this week show that recollection of a choice of hospital remains stuck at around 50%.

However, Lord Darzi’s report and the Health Informatics Review that followed it outlined plans for a number of new patient and clinician information services; and a business case for a revamp of Health Space is with the Treasury.

Other proposed rights in the constitution include being able to seek treatment in Europe in response to an EU directive on which the Department of Health is consulting. This would also require new patient information portals - and possibly patient records - to be created.

More controversially, although the constitution includes a new right to privacy and confidentiality, it would also make it easier for researchers to access patient information in order to recruit patients to trials. This was attacked by the new chair of the National Information Governance Board for Health and Social Care, Harry Cayton, last month.

A bill to give a wide range of public bodies, including health authorities, access to information about personal internet use did not appear in the Queen’s speech. However, Home Secretary Jacqui Smith has indicated that the Data and Communications Bill could still proceed after a three month consultation announced in October.

Other bills in the Queen’s speech to have some impact on health include the Policing and Crime Bill, which will criminalise paying for sex with trafficked women and introduce new measures to tackle binge-drinking, the Child Poverty Bill, which reaffirms the government’s target of ending child poverty by 2010, and the Coroners and Justice Bill, which will reform the inquest system.

Lyn Whitfield

Reader's Comments

Access

03 Dec 08 15:20

Patients already have the right to access their own health records under the DPA.

more Horlicks?

04 Dec 08 04:25

With all due respect to the Queen, has she too been seduced by the dream of health it, an expression of reality so cleverly phrased by Shadow Health Minister O'Brien.

Hypocrisy

04 Dec 08 10:11

The NHS Constitution declares that everyone has the right to privacy and confidentiality.

But in the same Queen's Speech, we have the Coroners and Justice Bill which will give ministers the right to allow all public bodies to exchange sensitive data with each other simply with ministerial approval. This includes NHS trusts and the data that they hold on their databases, and of course the NHS Database. Without any consent, data could be sent from the summary care record to the DVLA, Home Office, Ministry of Justice etc etc. Secondary legislation (i.e. without a full vote of MPs) would allow data to be transferred to private bodies.

re: more Horlicks?

04 Dec 08 12:18

I don't think that we're meant to believe that Mrs Windsor writes the speech herself.

That would be about as wise as paying much regard to what the shadow cabinet are saying about the subject...

re: hypocrisy

05 Dec 08 12:06

No, just common sense.

There is a lot of information which needs to be shared between public bodies (health, social services, police) which can't be done easily because of the Data Protection Act and the need to obtain explicit consent.

The baby P story can't highlight this problem enough - if you are an abusive parent, are you really going to give explict consent for these agencies to share information about your child?

Just sharing simple things like the same identifier (e.g. NHS Number) will make a huge difference for operational services in these areas, as the biggest danger faced by these services is often actually knowing they are all working with the same individual - if only immigration could be included too, particularly for children who arrive from abroad.

Hypocrisy versus Common Sense

07 Dec 08 23:32

It really is not "common sense" to let government departments,agencies or whoever else might think it useful to be able exchange information without explicit permission. Especially personal medical records unless there is a criminal investigation. Saving a child like Baby P depends more on making proper observations such as not being misled by chocolate covering injuries (If the newspaper reports are accurate) rather than relying on information exchange between databases. If the data is not accurate it won't help. Just think about the Pandora's box that you are opening if your medical records are accessible to any government department that wants to know. Once you do this you can't go back and incompetence and inaccuracy apart are you really sure that all future governments will be benign? History is not reassuring.

Professionals help children - not databases

08 Dec 08 12:18

Recent episodes highlight...

1. Failure of worker(s) to recognise child abuse

2. Failure of worker(s), having recognised child abuse, to take the correct action

Databases neither recognise child abuse nor take action against it. This is a human process / organisational issue! Computers are not going to fix this - get over it!

While it may be helpful to see if other agencies/workers have encountered incidents with a child before - there are risks associated with such databases.

Previous data can prejudice a worker's assessment of a case (be that data correct or incorrect).

Databases can make it even more seductively easy to tick the boxes on your form, 'cover' yourself and do nothing - it is always up to someone else or another agency to take decisive action.

Databases indeed may serve as the ultimate buck passing option: one which can be 'blamed' without any named professional held answerable. I wonder sometimes if that is not the very intention of such proposals.

Dr Malcolm H Duncan

Consent

Neil.Bhatia@nhs.net

08 Dec 08 12:41

You don't have to seek explicit consent from an abusive parent to share data about a vulnerable child, to give information to the police or to social services. GPs like myself don't need (or seek) consent in such cases, we have a duty to share such concerns. Don't jump on the bandwagon of those claiming that free access to all our medical records would have prevented Baby P's death - it wouldn't; what would have would be those seeing the baby to have recognised the signs, stated their concerns, and passed relevant info to the right authorities (no consent required) - and for the relevant authorities to have listened and intervened.