The Secretary of State for Health is reacting to the success of the BMA's campaign against the NHS wide network by focussing health IT spending on precisely the objectionable components of the IM&T strategy (the NHS wide network, the new NHS number, the NHS wide Clearing service) at the expense of clinical systems [20]. This is strange for a conservative minister presumably alert to the dangers of centralisation and aware that the market in health systems is perfectly capably of matching willing buyers with willing sellers without the need for a central civil service department to set up national monopolies in service sectors which already have competitive provision.
We have advanced a possible explanation for the urgency. The government is building a series of linkable databases --- Clearing, HES, PPA, registers for HIV, diabetes and other expensive diseases, and future databases covering primary and community care. These will eventually aggregate under central control all personal health information of significance. Although they are represented as being `anonymised', they are nothing of the kind. The project may be justified internally as `creating an electronic patient record shared throughout the NHS', but externally the picture is different. Officials are so sensitive about it that they have systematically obfuscated and delayed; it has taken over a year for us to dig down through successive layers to the heart of the problem.
But it is not necessary for these databases to contain identifiable information. In fact, as we have shown, replacing the current primary database key of postcode and date of birth with a one-way hash function of name and date of birth would bring tangible safety and accuracy gains.
If the database building project proceeds without controls of this kind, it can only be construed as a political attempt to centralise personal health information for state purposes. If that comes to pass, we may expect that health privacy in Britain will go the way of America. The papers in this volume by observers of the American scene give us some idea what to expect then.
