All that glitters can’t be sold
Civitas, 6 July 2009
By Daniel Isenberg
Every policy has costs and benefits alike, and in today’s world of tight purse strings, worth is often determined on the basis of financial outcome. The political narrative is dominated by debates over ‘spend or cut’, ‘waste or value’. Whilst the Conservatives are placing themselves firmly in the corner of financial prudence with a policy of fiscal retrenchment, this raises two concurrent questions about the latest rumours escaping CCHQ about Tory policy on electronic health records:
Are these proposed plans to use Microsoft Health Vault and/or Google Health a genuine alternative to the NHS ‘Connecting for Health’ electronic records programme, or was David Cameron merely utilising this theoretical (as opposed to practical) substitute as another method of Brown-bashing?
Equally, what lies at the root of this Conservative plan: would this turn to the private sector just be another method of limiting public spending, or is it more indicative of a Conservative vision of a public-run health system that needs yet further rationalisation and restraint?
Today’s reports seem to imply that this is a viable piece of policy for a future Conservative government, with logistical decisions not yet made between Google Health, Microsoft Health Vault and the other service providers that exist. However, it is interesting to look at how this policy appears in David Cameron’s ‘Age of Austerity’ speech in Cheltenham from April of this year. Whilst in other areas of health policy, Cameron firmly asserts “we’ll scrap those bureaucratic process targets,” and “we will pay these new providers by the results they achieve,” in the context of electronic patient records there is a distinctive conditional flavour of “now I want you to imagine how we’d have gone about it, if we’d had the chance.” This non-committal tone intimates a less positive devotion to private providers of patient record databases, and more the use of another opportunity to score points against the government, based on the usual allegations of wasteful spending.
Both Conservatives and the government are committed to the benefits of an online database of patients’ records; the difference between the two policies thus focuses more on ownership, than on content. Indeed, the two systems could operate in a relatively similar fashion: yet, whilst the Conservatives’ plan is crucially focused on patient ownership of their own records, the Department of Health’s intended database may be able to be amended by patients, but is intended to be available for “available to authorised clinicians…on a 24 hour basis”. A similar system already operating in Alberta, Canada (the Netcare EHR) is more limited in scope and works on a basis akin to only the SCR (Summary Care Record) element of the eagerly-awaited NHS programme. Yet, it is already providing benefits for patients and health care providers alike.
Only time (and potentially also election results) will show whether or not private provision of electronic patient records will become a central part of Conservative health policy; nevertheless it is important to examine the basis of this potential policy move and its possible ramifications. There are two strands to Conservative rhetoric on the potential replacement of the centralised database with the use of private providers. Firstly, the usual language of careless spending emerges, as the Tory plan would save half of the £1.65 million annual spending on IT; especially as the National Audit Office progress report on the NHS project has predicted a four-year delay in implementation to 2014. Yet, what is of more significance than this savings-based rhetoric that has become customary of Conservative policy, is the concurrent narrative of patients “owning” their own records: “they’re in control, not the state”. Notions of small government are nothing new to the Conservative Party, but there is a crucial danger here that moves toward financial efficacy can be construed as a lack of belief in the NHS’s ability to perform. There is a fine balance to be maintained between a marketisation of the NHS that improves efficiency and value, and the preservation of faith in the ability of the NHS to provide effective healthcare, itself.
It is important in the current environment of restraint that the Conservatives are looking for a fiscally tight solution to problems in the NHS; and of course, there needs to be a more efficient alternative to the current interminable project of database building. However, in seeking a more productive and cost-efficient NHS, we must not cause the ultimate damage of neglecting to maintain what is central to it: the people’s faith in the system’s confidentiality, which is the basis of the doctor/patient relationship.