Time to change the record?

The retiring chief executive of the NHS, David Nicholson, stated on Newsnight on Monday night that a health service that shares risk across the population is much more likely to be successful at delivering healthcare than one based on private insurance.  In other words, a National Health Service (or a system very much like it) is not only the fairest way of providing healthcare, it’s also the best way to do it.

Yet an insurance-based system is exactly what the system is being stealthily morphed into.  When we see companies like Serco Group profiting from delivering community nursing, NHS hospitals going into debt, damaging cuts to health services, and private healthcare companies keen to be  commissioning  services as well as delivering them, it’s hard not to see the insurance companies circling overhead.  So instead of being “by the people, for the people” (to borrow a phrase – but not a system – from over the pond) it’s looking rather as if our NHS is “by the people, for some of the people, for very few of the people’s bank balances”. Not a very good message for a system built on the right to equity of access.

Jeremy Hunt et al would probably be delighted if we all responded to this assault on our NHS by taking out health insurance premiums, but he’s not asked us to do that.  (Not yet, anyway.)  What he has done is proposed a new medical records database, Care.data,  to bring together all our medical records (hospital and GP) in one place. This is actually a good idea, but he’s bungled it, with the result that many people fear private healthcare organisations and insurance companies will not only be running the show, but profiting from the use of our personal health data too.

Hunt appears to have been assisted in bungling the establishment of Care.data  by NHS England, which is something of a pity. (Failing to send out information, or having it arrive with the junk mail isn’t a convincing message when you want people to trust what you are doing.)  Luckily Ben Goldacre, writing in the Guardian, has set out very clearly why Care.data is a good thing,  what the problems are that need resolving, and how some of these should be dealt with over the next couple of months.  Sadly, as Goldacre also noted, these problems appeared to get worse not better yesterday, when the body in charge (Health and Social Care Information Centre) appeared before the Health Select Committee and the full extent of the chaos was revealed.

However, even supposing all these problems are satisfactorily addressed, there remains a fairly fundamental lack of trust in Care.data which threatens to jeopardise the whole project.  The success of Care.data depends upon us, as citizens, supporting it; failing to address the lack of trust makes it more likely that more people will choose to opt out and exclude their personal records from the database.  We are, rightly, cautious about safeguarding our personal data. And here the data in question isn’t just our bank account details, or where we live – it’s highly sensitive information often arising from situations in which we are at our most vulnerable.  So the concerns are not just about trespass, theft and profit (valid though these are), they are also about protecting our emotional selves.

There’s a role for Hunt here, surely? It shouldn’t be left to commentators like Goldacre to reassure the public; isn’t that one of the functions of a Secretary of State?   He doesn’t do the ‘doing’, but he is responsible for the message.  He should be not only issuing supportive words, but also being seen to support the principles and delivery of the service.  This doesn’t just mean continuing to say that healthcare will be “free at the point of use” when an opportunity arises,  it also means recognising that all the bad press and all the cuts and reorganisation are leading to a fundamental mistrust of the system which needs to be addressed. (Stepping in to stop extreme and damaging cuts in local mental health services would be a good start, for example.) Despite Stafford, despite the deficit, despite the pressures of a growing and ageing population,  we still have one of the finest healthcare services in the world.  It’s about time he said so and didn’t rely on civil servants like David Nicholson to do that for him.  Perhaps he’s absented himself from the debate because it is so very clear that the public don’t trust him? If that’s the case, it’s time for him to put the interests of our health service first and resign. 

As things stand at the moment, I’m undecided about whether to stay in or opt out of Care.data.  I was all for staying in – staying in should be a no-brainer, as it’s in all our interests to have effective research and commissioning, and a national database will assist enormously with these. But  there are a lot of concerns – both practical and fundamental – which need answering.  Andy Burnham made it clear yesterday that Labour could assist with sorting out the mess, as the prize is too important to play politics with.  Over to you, Mr Hunt?

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