Medicopolitical Digest

BMA writes to NHS trusts about confidentialitySupraregional services have new advisersBMA is worried about reserve forces' trainingGPs to have guidance on care in the communityBMA updates its briefing on private finance initiative

BMJ 1996; 312 doi: (Published 03 February 1996) Cite this as: BMJ 1996;312:316
  1. Linda Beecham

    BMA writes to NHS trusts about confidentiality

    Until the NHS adopts a comprehensive and security policy for protecting the confidentiality of identifiable health information the BMA is advising doctors to defer considering links to the NHS wide network. The BMA has published its own security policy document (13 January, p 109) but after the Department of Health refused to amend its proposals the chairman of the BMA council, Dr Sandy Macara, wrote to chief executives of NHS trusts, executive directors of health authorities and family health services authorities, and directors of public health warning them that the current proposals for the NHS wide network would “permanently destroy the individual's right to privacy and radically alter the nature of the doctor/patient relationship.”

    Dr Macara says that widespread concerns about the risks are shared by patient and health care professional organisations alike. He explains that the BMA, whose members are bound by the General Medical Council to protect patient confidentiality, has actively pursued its concerns by developing a security policy, which lays down a series of principles applicable to both paper and computer based information systems.

    As we went to press a confidentiality bill was due to have its first reading in the House of Lords on 30 January. The Disclosure and Use of Personal Health Information Bill, which will be introduced by Lord Walton of Detchant, a former president of the BMA, was drafted by the association to clarify the law in England and Wales relating to the collection, use, and disclosure of personal health information. Nothing in the bill prevents the disclosure of information with the express consent of the person to whom it relates; it deals primarily with those exceptional circumstances where the individual's consent cannot and need not be sought.

    Supraregional services have new advisers

    The Department of Health is allocating pounds sterling68.6m for supraregional health services in 1996-7 as well as setting up a new advisory group on the funding and purchase of specialised treatments. The new budget, an increase of pounds sterling1.1m over the current year, will fund eight specialised services at 26 centres across England. Of the total, pounds sterling51.1m is for transplant services and will allow a modest expansion.

    Supraregional centres provide specialised services ranging from heart and liver transplants and craniofacial services to eye and bone cancer treatments. Each serves a population larger than any single NHS region.

    Following a review by the chief medical officer, Sir Kenneth Calman, a new expert group will advise on purchasing. The National Specialist Commissioning Advisory Group will take over from the existing Supraregional Services Advisory Group. Its 16 members, made up of senior NHS executives and medical representatives nominated by the Joint Consultants Committee, include Mr Chris Spry, NHS executive director for South Thames, who is acing chairman of the outgoing advisory group. The group's remit will cover guidelines for purchasing consortiums and the funding of specialised services not qualifying for supraregional designation.

    BMA is worried about reserve forces' training

    The BMA has asked the health secretary to support the principle that NHS trusts should continue to permit employees to join the reserves and to fulfil the subsequent training and deployment obligations. In his letter to Mr Stephen Dorrell the chairman of the BMA council, Dr Sandy Macara, says that the association is worried that the Reserve Forces Bill, currently going through parliament, does not make it a statutory requirement for employers to permit employees to join the reserves and to fulfil their obligations. The BMA is supporting an amendment to the bill which would cover its concerns.

    Despite previous assurances that most trusts make provision for staff to take part in volunteer reserve forces training, the BMA is aware that there are hospitals which are reluctant to allow key medical personnel to do so. Dr Macara says that some trusts had issued contracts which did not permit medical staff to join the reserves.

    As the regular element of the defence medical services continues to be reduced the BMA believes that the medical reserves will become increasingly important—and that the reservists will need regular training.

    GPs to have guidance on care in the community

    In 1994 the Department of Health issued guidance on the discharge of mentally disordered people and their continuing care in the community. The department asked family health services authorities to bring this to the attention of local medical committees (LMCs) and suggested that general practitioners should become involved in the planning and supervision of the care of these patients. The General Medical Services Committee will shortly be issuing guidance on general practitioners' role in the assessment and continuing care of mentally disordered people in the community and would welcome information from LMCs about any problems they have encountered.

    BMA updates its briefing on private finance initiative

    In its update on the private finance initiative in the NHS the BMA's health policy and economic research unit points out that the cost of using private finance in capital investment schemes must ultimately be greater in terms of interest charges, but says that it is difficult to compare this cost with that of waiting for desperately needed facilities when public money is not forthcoming.

    The unit first prepared a paper on the use of private capital in the NHS in 1994. Since then some privately funded schemes have been completed and more are planned. The importance of the private finance initiative to the future funding of the NHS was emphasised in the November 1995 budget, in which the chancellor of the exchequer announced that although the NHS budget would increase by pounds sterling1.3bn government spending on the health service capital programme would fall by 16.9%, with the expectation that some of the shortfall would be met through obtaining funding from private sources. This will mean that the NHS will be expected to obtain pounds sterling165m worth of funding from the private sector in 1996-7.

    The health secretary, Mr Stephen Dorrell, is committed to the development of the private finance initiative in the NHS and in November 1995 announced the first private sector funded hospital building scheme with the approval of a contract for pounds sterling35m for the redevelopment of the South Buckinghamshire NHS Trust. In a recent speech Mr Dorrell emphasised that in such projects there would remain a distinction between privately owned support services and clinical services. Trusts would continue to be the direct employer of clinical staff in most cases. This is not the case in Scotland, where the successful bidder for the Stonehaven hospital will be expected to provide specialists. Nurses, other professional posts, and support staff will also be employed by the successful bidder.


    The BMA's health policy unit says that one of the main practical problems is the delay due to the contracting process and the expense of tendering. The government argues that the delays are outweighed by efficiency savings. There is a concern, however, that a profit making company might be tempted to cut costs by reducing the quality of the service. There may also be financial pressure on clinical decisions.

    The briefing paper suggests that private sector involvement in the NHS is bound to affect its ethos. There will no longer be a national health service but a fragmented and competitive market. The willingness of the private sector to become involved in a new building project will increasingly influence whether the project goes ahead. This raises the prospect of the siting of hospitals and the type of provision being determined by commercial considerations rather than planned on the basis of local health need.

    Private Finance Initiative in the NHS: An Update is available from the BMA's health police and economic research unit, BMA House, Tavistock Square, London WC1H 9JP.

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