Intended for healthcare professionals

Rapid response to:


Undermining data privacy in health information

BMJ 2001; 322 doi: (Published 24 February 2001) Cite this as: BMJ 2001;322:442

Rapid Response:

Clause 67: A Question of Balance

In his editorial on data privacy1, Dr. Anderson rightly points out
that “the compromise that has emerged over the years balances patient
privacy, professional autonomy, public health effectiveness, and the needs
of scientific research”.

It is the demand for universal consent to disclosure that threatens
to upset this balance. Clause 67 provides one (albeit imperfect) means of
maintaining the balance by legitimising special cases for temporary
periods. If we depend upon informed consent to disclosure in every sphere
of the NHS, we risk introducing bias (for which it is very difficult to
adjust) into population data used to protect the public’s health, and
impeding essential functions like clinical and financial audit. An
interim, unpublished report from Sheffield University suggests that we
might expect over 20% of individuals to refuse such uses of their data.
This suggests that informed consent to disclosure matters to people and
matters to data quality.

Dr. Anderson’s assertion that Clause 67 “will remove the remaining
effective legal constraints that protect patients and doctors from
detailed surveillance by central government” is both melodramatic and
inaccurate. The Information Commissioner supports the inherent safeguards
written into clause 67, and has made clear2 that it can not undermine
powers within the Data Protection Act 1998. The issue here is not one of
defending the rights of doctors and patients against the over-weaning
authority of government. It is about balancing the claims of individuals
to privacy against the claims of the whole community to protection against
ill health.

As a past student of economics, I am aware that each extra pound we
spend moving closer and closer to perfect confidentiality and total
security, the less additional value we gain. It also means that there is
one less pound available to be spent on other ways of achieving better and
fairer health care. As a student of health care ethics, I am aware that
absolute patient confidentiality is the wrong goal. We must weigh up the
good to the individual to be gained from ensuring confidence against the
public good we can derive in certain circumstances from using identifiable
patient information. As a patient and citizen, I look to the NHS to
demonstrate balanced judgement in these matters. Dr. Anderson’s advice to
the BMA and its members lacks this balance.

1 Anderson R. Undermining data privacy in health information. BMJ
2000;322:422-3. (24 February 2001.)

2 The Information Commissioner's response is at:

Competing interests: No competing interests

07 March 2001
Malcolm Oswald
post-graduate student
University of Manchester