Identifiable data should no longer be freely available within the NHS

“Banks access computer records, foreclose on cancer patients.”1 This emotive headline from America in 1993 demonstrated the risks to confidentiality posed by electronic patient records—which are easy to inspect, copy, and transmit without anyone knowing. In Britain, attempts by the medical profession to ensure that such headlines should never be seen here led to fundamental disagreements with the Department of Health. These in turn stalled the already slow development of electronic data handling in the NHS. Only now, with the publication in December of the Caldicott report, is a way forward beginning to emerge.

Shortly after this American headline, the BMA and the Department of Health first discussed confidentiality within the NHS information strategy. The Department of Health (and the NHS Executive) believed all electronically held clinical data should be shared through “the wider NHS family” to facilitate NHS management,2 but the wider family turned out to be almost anyone in contract with or relating to the NHS, whether clinically involved or not. The BMA felt that patient confidentiality would be so threatened that the only ethical solution was to keep all identifiable clinical data within the clinical domain.3

After failing to reach any …