It is a reflexive tic among libertarian types to describe Britain’s NHS as ‘Stalinist’, in reference to its vast monolithic structure and institutional preference for central state planning. Now some indications that the parallels run a little deeper.
The Department of Health’s first reaction to the campaign for people to opt out of the “Spine” medical records database, that I mentioned a couple of days ago, is not to attack it as ‘irresponsible’ as I was expecting. It is to demand that doctors report any patients who try to the authorities. “Let us deal with them,” it appears to be saying.
The Guardian reported yesterday:
The Department of Health provoked uproar among doctors yesterday by asking GPs in England to send in correspondence from objectors who do not want their confidential medical records placed on the Spine, a national NHS database.
Sir Liam Donaldson, the chief medical officer, said letters from patients who want to keep their private medical details out of the government’s reach should be sent to Patricia Hewitt, the health secretary, for “full consideration”.
You will recall that such suggested letters were personal communications with doctors, asking them personally to do something: to code patients records so that they would not be uploaded to the Spine. That’s something that can only (as I understand it) be done locally. “Consideration” by the Secretary of State defeats it.
It also seems to me that it would be a fundamental breach of confidentiality, and if the letter were posted, possibly a criminal offence contrary to the Postal Services Act 2000, for the letter to be forwarded to the Secretary of State without patient consent.
But neither law nor morals may stand in the way of the great plan.
…
BBC Radio 4 had another example this evening. Its File on 4 programme considered endemic MRSA and other antibiotic resistant bacteria in NHS hospitals. It interviewed a couple of epidemiological specialists who said with the current control regime slow progress was to be expected and the government target of 50% reduction in MRSA infections by 2008 is unrealistic. Andy Burnham MP, usually characterised as one of the brightest and best of the Primrose Hill group of New Labour heirs presumptive, was asked to comment. He said the complacency and defeatism of the clinical scientists was unacceptable: there was a target and the Health Service would meet it.
Maybe we can forward two letters. One to the GP with our name and another, anon, that can be forwarded as to WHY. Surely Dirty Patricia only needs to know WHY we do not want to, not WHO, right?
Then it may be an opportunity to fill said letter with all the reasons why. Make them have to read it over and over and over again.
Wouldn’t it be great if she had 60,000,000 letters to “consider”. I’ll start. I’ve printed and signed mine and will be hand delivering it to my Doctors tomorrow. I’ve also written to my MP (for as much good as that will ever do me) asking how it can possibly be considered to be in the interest of national health that people like me are driven to refuse to see their Doctor for fear that our personal details are published. I also noted that even if the stazi were to back out of this proposal I still won’t visit a GP for fear that this decision will be reversed at some time in he future. Fucking fuckwit lefties.
Oh yeah…drafy opt out letters are available Here
It looks to me that it could turn out a lot harder to keep one’s details off the “Spine” than some seem to imagine — that is if one wants to retain the right to use the NHS.
However, I look forward to seeing the outcome when the likes of Hewett and Blair realise the implications for their own records. Somehow I don’t see, for example, the controversial record of vaccinations for Blair’s youngest child remaining private when it becomes available to thousands of NHS staff. So, maybe there’s hope yet.
There are considerably darker things in some politician’s families than hypocrisy about vaccination. Out of consideration for the people involved they do not find their way out of the Westminster village, even these days. Politicians are relatively less protected than their children and spouses, but they are still protected. Quite right too.
But that rare oasis of gentility in modern public life is unlikely to survive potential access by the half-million, whatever the sanction. Charles Kennedy’s alcoholism only really got into the public realm when it affected his work badly. Would Chris Smith have got to announce his HIV infection only after his retirement as a popular minister? Or would he even have been considered for office?
Freeman – It looks to me that it could turn out a lot harder to keep one’s details off the “Spine” than some seem to imagine — that is if one wants to retain the right to use the NHS.
Then they should refund the taxes used to pay for it and to permit tax-exempt heathcare.
The Spine does not need to be a monolith. There is no reason why a hospital need access a single database of all pepole to get hold of information about all people. There is no reason why Hospitals and consultants could not access a single gateway to all people just as we dial a single number to accesss people regardless of the network they are on.
I want the spine to be like my VISA card – I want to get a statement to say who looked at what, when and why. We need multiple, private, independent companies who can hold our medical records for us and our GP and, upon our consent, other people on a case by case basis.
Thank you, Guy, and Samizdata, for bringing this to our attention. I am not a committed libertarian, but here you remind us why we need more, not less of such creatures.
You say that if GPs accede to Sir Liam’s request, they may be committing an offence contrary to the Postal Services Act 2000. If so (and I think it is a big ‘if’) then Donaldson himself commits the offence of incitement.
I checked the Postal Services Act, and see nothing to indicate that it is in fact a crime–please correct me if I am wrong. However, I think it is likely that a GP would commit the tort of breach of confidence, and that Sir Liam could be named a co-defendent.
On the subject of medical authoritarianism.
I note Samizdata has Melanie Phillips on its blogroll. She’s a bit of a mixed blessing, isn’t she. Yes, she can usually be heard opposing New Labour ideology (notwithstanding that she began her career on the left). But the culprit in her view is often “individualism”, implying she would perhaps like to see a return to good old-fashioned values such as birching and caning.
In today’s Daily Mail, she demands that new government proposals to make medical treatment compulsory for those diagnosed as “at risk” (no crime yet committed) not be resisted just because they represent an abuse of civil liberties. “What about the rights of victims”, she cries, sounding (to my mind) rather like David Blunkett or Jack Straw.
Lindsay,
I was thinking of Schedule VII to the The Postal Services Act, which is there to stop anyone opening or forwarding mail without proper authority. It is not clear whether or not it has application, but I think officials and ministers should definitely not be permitted to get away with crimes committed in order to promote policy. So the question of whether a crime has been committed ought to be looked into.
Having now opted out (hurrah!) a young lady I know who works for the cradle-to-grave-control-ocrats mentioned that this will make it nigh on impossible to change GP, as they won’t be able to transfer records in any other way other than via the spine(less Statist way).
Having changed GP before, upon leaving the country of my birth, I find this hard to believe. But will this be a stick they will use to beat us? I don’t mind opting out, if they refund the taxes I pay that go towards it…
I have never – not once – in my adult life moved doctor without my notes going missing. Believe me, you can move doctor without. In the NHS you may be required to, since there seem to be rigid rules about where their catchment areas run.
Will we see doctors who believe in patient privacy affecting house prices like good schools do, I wonder?
Guy,
I certainly agree with you on the principle, namely that “officials and ministers should definitely not be permitted to get away with crimes committed in order to promote policy”. Any court would agree with you too.
Schedule VII applies to “information if-
(a) it was obtained by virtue of this Act (other than section 62 or 118), and
(b) it relates to the affairs of an individual or to a particular business.”
I would be the first to admit that I am guessing, but I think the following interpretation is probably the correct one: information “obtained by virtue of this act” means information obtained by the Post Office or the Postal Services Commission in the course of their business, for example concerning the delivery of mail to person X. I would not think it makes it a crime for me to forward a piece of mail that I recieve, even in confidence (though that remains a tort).
On the general point, I think my intention was to bolster what you said, by pointing to an alternative remedy, namely an action in tort law. Another useful possibility is an action for judicial review. I won’t go into details here, but anyone bringing an action must have standing, or be a “victim” under the Human Rights Act. Cearly an individual who had their details forwarded by a GP following Sir Liam’s request would qualify. So too would a GP who wished to decline to honour that request. An application by the BMA or similar body would probably be permitted as a representative application, but possibly not under the Human Rights Act. But I am rambling now…
“They won’t be able to transfer records in any other way other than via the spine(less Statist way).”
Considering that 51% GPs responded to the Medix poll as saying that they oppose the Government’s centralization plan, hopefully it should be possible to find one who is sympathetic to our concerns.
One other thing you can do is to view and get copies of your records under the Data Protection Act 1998. You might be charged up to £50 to get the copies, but once you have them you will be able to take these along to the new surgery that you are hoping to register at (they may or may not accept that information as sufficient – but it’s worth doing anyway before they take that right away too).
Liberty guide to accessing your records