
It seems as though patience is wearing thin with the proposed national NHS database. The project, which plans to store electronic medical records for 50 million people in the UK, has been hit with lengthy delays amidst fears over the system’s confidentiality and bust-ups with providers. To make matters worse, there’s a new kid on the block for the Government to contend with. The innovative £40 ‘Health eCard’ provides an alternative to the less-than-reliable database scheme, and enables patients to carry their medical records with them at all times. The London-based company behind the card, Health e-Systems, says that once credit-card sized smart card is adopted by a GP, a securely encrypted copy of the patient’s records can be accessed, downloaded, updated, and checked. Not to mention storing test results and digital X-rays.
In almost sheepish comparison, the NHS database languishes four years behind schedule, and the National Audit Office now predicts a completion date ‘around 2014-15.’ The project is part of a £12.4bn government programme to upgrade NHS computer systems. That equates to £200 for every man, woman and child in the UK, a staggering amount of cash. Ministers claim the database, which will store information on mental illness, HIV status, pregnancy and alcoholism, will ‘drag the NHS kicking and screaming into the 21st century. Sure, there’s a risk of losing data (see recent data losses by various Whitehall departments), but paper records are also going astray. Doctors and nurses will carry chip and PIN cards to access more confidential information, although ominously, the danger with the system is that with no clear individual responsibility for the records, who’s going to protect the information that’s been collected?
The government’s decision that only the minimum information on each patient will be uploaded perhaps signals the lack of confidence in their own staff actually retaining this data, rather than misplacing it, as we’ve come to expect.
In fact, the Department for Health was forced to admit another blunder, announcing negotiations with Japanese giant Fujitsu had collapsed after the two failed to reach an agreement ahead of the first scheduled roll-out in Southern England. (As yet, only two NHS primary care trusts have piloted the scheme, describing the results as ‘clunky’). Fujitsu was one of the three main suppliers, holding a contract worth £895m, and overseeing activities from Kent all the way to Cornwall. Contractors involved in the deal are rumoured to have complained the DoH has been ‘inflexible in specifications in order to keep costs within budget’. In a statement, a Fujitsu spokesman said the company had withdrawn as it did not feel there was any prospect of an acceptable conclusion. It seems the government’s attempt to push a centralised, one-size-fits-all NHS system is starting to crack under the considerable pressure.
But nevertheless, ministers have brushed aside concerns over the project. Labour MP Kevin Baron accused the British Medical Association (BMA) of scaremongering with suggestions that the government will profit by selling health records to pharmaceutical and insurance companies. It’s clear that a central database would be very helpful when managing and monitoring patients – the benefits are obvious to all. Then again, so are the risks. The recent debacles in data management make it very difficult for patients to have any confidence in a system which cannot wholly guarantee the security of its data.
But what about the GPs? A survey conducted by BMA News revealed nine out of ten doctors had no confidence in the government’s ability to safeguard data either. More than 90% of respondents said they weren’t confident patient data on the centralized database would be secure. However, there could be more of a motive for doctors to turn their backs on the government’s plans. The company behind the Health eCard pays GPs £10 to download a patient’s records onto the card, a handy bonus to add to the coffers. If the card takes off, it could mean an extra £500m for doctors across England. Are GPs protesting against the threat of data loss and the potential effect on patients, or are they motivated by making a quick buck?
One reason for an affiliation to the eCard over the proposed database for doctors is the reduced risk and culpability involved from their perspective, with sensitive details carried in the wallet rather than smeared across the web. Of course, I can think of 500 million other reasons as well.
Already, twenty-one surgeries and three-hundred patients, mainly based in London, are using the card. Trust is so minimal in the database that even some NHS hospitals have bought alternative software; at extra expense might I add.
With the government's previous farcical handling of medical services contracts, it’s no surprise that the public is looking elsewhere for secure ways to protect sensitive information. Whether the Health eCard is the answer is uncertain, but the DoH will need to get its act together if it wants to regain the trust of doctors and patients across the country.
(Smartcard News Ltd, 2009)