Yorick Wilks

Recent proposals to consider Google or Microsoft as possible holders of citizens’ health records produced a predictable range of comments in the Times blog: from “yes, yes, anything to get away from another centralized state database” to “Ah ha, there are the Tories handing over public money to a company they are connected to, and which is not even British”.

Behind the games are very serious issues, some of them technical, most not. Even among those who agree that the NHS IT policy over the years has been an unmitigated disaster, some think Britain should now stick with the long term database plan because of the investment made and that it will eventually be delivered, however late and however much over budget. It is good to remember here that the NHS took decades to provide email to staff, because a special NHS-relevant email system had to be designed and implemented, even though off-the-shelf email from any supplier could have been provided to the whole system within weeks or months, as it was to virtually all companies. Who could possibly have believed there was special NHS email? I personally gave up on NHS administration when I heard they had simply failed to claim the Microsoft discount, for quantity of installations, of £50 million to which they were entitled! These failings are not casual but endemic, as everyone can now see after the huge fall in NHS productivity since Gordon Brown doubled its tax-take.

All that health records require is:

* reasonable levels of reliability and confidentiality
* access by the “owner” of the records and some recourse in case of error
* ease of updating the records by those entitled to do so
* access anywhere to the records, preferably world-wide

If this list has a certain familiarity, it is because many kinds of big companies now offer this kind of service to anyone and compete for their custom: banks are the obvious case. Your access to your financial records can be from an ATM anywhere in the world, is up to date, pretty reliable and you more or less trust the bank to keep your records safe and confidential, probably more than you trust civil servants who leave data sticks regularly in taxis. Vodafone, which is British like most of the banks, also offers customers large scale mail storage, which is not really different in kind from medical records, so if the UK were to go along this route there are plenty of competing British providers; patriotism need not be an issue, though competition certainly is—if one did not like one’s health record Guardian one could always go elsewhere, just as banks must now transfer your standing orders intact to a new bank within days, whether they want to or not.

Most Internet usage surveys show the public trust companies more than the Government these days, on data as much as anything else. Google has the advantage that they have, in the last years, been transferring masses of printed material into digital form-the Google books project. This is relevant because one of the great scandals in the NHS is the shameful rate of the move to digitised patient records: in some hospitals consultants still have a fat folder of written notes for each patient, but the fifteen minutes allowed each one does not permit reading such a mass of material, so each consultation starts from scratch, usually with the patient describing their own condition! Digitised records could be summarised and absorbed in minutes.

The arguments for Cameron’s suggestion go way beyond cost saving and avoiding another giant state database of the kind so dear to Old and New Labour: they offer choice to the citizen, access to one’s own content with some control over it and, above all, deployment of a proven technology that would not need to be much specialised to the NHS at all, but just piggy-backed on years of competent management of vast data bases. The good news is that many kinds of companies have this experience, not just Google.