The Health Secretary has told his friends that the first part of his “Single Patient Record” will be rolled out by the end of the year. 

We expect this rollout will be a “pilot” of the now-merged Department of Health in England (i.e. DH and the “abolished” NHS England) using government powers to impose decisions on the NHS frontline – not a pilot of a real ‘patient record’, nor real patient choice.

The stated policy intent; a politically-controlled centralised database of everyone’s medical notes with the catchy title “Single Patient Record”, potentially could be consensual, safe, and transparent. But given the approach being taken – using a single incumbent tech supplier (which makes political donations) – any political promises made may be no more reliable than their Trumpian equivalents.

This politically-controlled centralised database of medical notes will consolidate all of your medical notes from across the NHS, to be made available wherever the NHS logo is seen (and some government buildings that don’t have such signs).

This could be done well; it could be done badly. 

It could be done in such a way that you can see everywhere your record has been accessed from day one; it could equally replicate the secrecy-by-design of today, where Department of Health in England officials know exactly when and where your GP notes have been read by people other than your GP… but refuse to tell you. 

(If you were to ask the data controller, NHS England, for this information they would simply refuse to confirm that they know when and where your record has been accessed – instead sending you back to your GP, who won’t necessarily know because NHS England is the only one who runs all of those systems.)

You could be offered the option to decline such a risky service – for some, the known risks will definitely outweigh the known benefits – but that would involve consideration of patients, and this Department of Health in England thinks it knows better. This most certainly won’t be a pilot of patient interests.

We asked the Department of Health in England some questions back in April. Five months later, we have had no answers.

This “pilot” announcement appears to confirm supplier suspicions that the pre-contractual “Request For Information“ published earlier this year was a sham, and that Mr Streeting has already picked whatever winner he wanted from the existing NHS England suppliers. (As everyone should by now be aware, NHS England’s existing monopoly supplier for such technology is Palantir.) 

When Mr Streeting decides your medical records will be processed by his AI to determine your priority at A&E, you won’t have a choice. And when your local surgery gets closed and your GP is moved into a neighbourhood health centre, your GP will be required to use the new database – and will have no discretion over the way in which the information they are required to record will be used. (Mr Streeting has already announced that all consultations in all of his new centres will be recorded – and his new database will hold the summaries, the transcripts, and the audio recordings. 

We shall see what Mr Streeting announces, and how it compares to what his Department delivers over his time in office. It is becoming increasingly perverse that Wes Streeting is entirely dependent for delivery on a company whose corporate leadership is actively hostile to the success of his mission. Unfortunately, as ever, patients are caught in the middle.

ID Cards are back

Simultaneously to all this, the Government will try to reintroduce ID cards – starting with a stated policy intent that every employer must treat their British workers with the same assumption of criminality that the Home Office imposes on their colleagues born elsewhere.

There may be additional as-yet-unstated policy intents – or at least, as with the last attempt, further policy intents that won’t be briefed out fully until it’s clear people aren’t buying the previous one. Even before the formal announcement at Labour Conference, people are speaking out.

Digital ID cards policy will run into further trouble when other parts of government assume they are dealing with a “worker” and demand to see their ID. Will police officers have powers to demand you show them your ID by handing over your unlocked phone? Will train ticket inspectors insist on seeing it? How about bouncers outside bars or hotels? 

At this point, the Government seems more interested in grabbing headlines than answering questions. Let’s hope they listen sooner this time as well.

There’ll be more on ID soon, both here and at https://www.no2id.uk/

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