- Kable, Wednesday 29 April 2009 09.00 BST
In his speech to the Conservative spring conference last weekend, David Cameron gave three examples of government schemes that are "easy choices" for his party to cancel. Two were IT projects – identity cards and the children's database ContactPoint.
Perhaps surprisingly, the third was not the National Programme for IT. (It was regional assemblies, a Conservative bugbear.) Instead, Cameron – who looks increasingly likely to become prime minister in just over a year – had something constructive to say about health service computing.
This didn't stop him criticising NHS Connecting for Health. In a previous speech as leader, he suggested that the Conservatives wanted to scrap the "NHS supercomputer". As far as Kable is aware, no such device exists, and his repeated use of the term may be more of a rhetorical device than a serious policy.
Cameron's ideas have matured. While opposing the centralised electronic patient record system that CfH is slowly implementing, he suggested an intriguing alternative: personal electronic health records controlled by the patient, and managed online by the likes of Google or Microsoft, both of which have products of this nature.
It is reasonable to criticise this government's NHS IT policy as over-centralised – and Cameron did. Letting patients run their own records has some merit: it would greatly minimise complaints over privacy if patients controlled access, for example.
But Cameron's idea raises a number of questions. Firstly, who would pay – the patient or the government? If the latter, efficient procurement would be a challenge, particularly if the choice was up to individuals and vendors were not guaranteed levels of use.
Secondly, who would be allowed to provide such a service? The record providers would have to use common standards, or it would be impractical for medical professionals to update them. Would it just be IT giants – which are not universally trusted to look after sensitive data – or would smaller organisations be able to get involved, perhaps including voluntary groups, charities or unions? And what if patients simply want the NHS to do the job?
Thirdly, it might prove cheaper to provide electronic health records in this online personalised fashion, but Cameron's hope that they might "cost virtually nothing" sounds unlikely. Patient data will need to held with rigorous security but with high availability, accessibly to health professionals in a standardised form. This will not come free.
A market, even a virtual one where the state paid, for such records could help reduce prices. However, the most obvious way to make such services cost virtually nothing would be that used elsewhere for internet services – to exploit the data for advertising and other commercial purposes. This would be limited in the UK by the ban on advertising prescription medicines to patients, and any such use would raise significant privacy questions.
The Conservative Party is still working on its review of NHS IT. Cameron's speech suggests that the likely next government has gone beyond simply opposing the current situation to thinking about a replacement. But it still has a long way to go.
