Intended for healthcare professionals

Rapid response to:

This Week In The Bmj

Electronic health records reduce office visits

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7491.0-f (Published 10 March 2005) Cite this as: BMJ 2005;330:0-f

Rapid Response:

Will we need to take lawyers/advocates along to consultations in future?

There have been so many twists in the tale regarding the setting up of Electronic Systems in the UK that citizens can hardly put their trust in their information being handled competently or even that they will be properly informed in the first place. Few practices have informed people who use them, many healthworkers themselves are unaware or confused by the proposal, which changes by the week. There have been so many reversals of statements made regarding people's right to state how they wish their information to be handled - opt in or opt out? sealed envelopes to secrete information is one bizarre twist. It seems to be becoming more clear that there will be attempts to manipulate or even coerce citizens into sharing information by making the process as difficult as possible for the individual to make personal decisions about important areas of their lives - to decide to withhold information or not.

the NPflT's Caldicott Guardian stated in a letter to a GP Mark McCartney (e-health Insider) that:- 'The right of a patient to opt out of having information stored about them within the NHS CRS was covered by the Data Protection Act'.

'The right is separate to mechanisms by which people can request their details are held on the data base not available to health professionals other than their doctor. This permits a patient who feels they are suffering or may in future suffer significant damage or distress to ask for the processing of data to cease, including the holding of data'.

'The process by which a person may demonstrate that the required level of damage or distress is still being considered but will need to be in place prior to NCR's going live with clinical details included'.

Why should any citizen be put through this nonsense and especially when the system is being piloted already in some parts of the country, despite the above statement.The first paragraph is full of weasel words which can be interpreted differently by different healthworkers -as so often shown by BMJ rr's - with different values and attitudes, variable training and life experience, eg 'can request'; 'permits'; 'feels they are suffering...'; 'significant distress'; 'other than their doctor'. The next is full of paternalistic and arrogant statement which may allow or not, adults to make decisions about their lives. More people are likely to opt out of a system which treats them without genuine respect.

Other statements have proposed that citizens will not understand that opting out of sharing all information may lead to inferior care. Again this infantalising attitude does nothing to support the supposed partnership approach to healthcare promoted elsewhere by the DoH.

Once people begin to realise how they are being treated with regard to their rights to confidentiality in the NHS they are less likely to decide to disclose personal information to a healthworker in any case. Paradoxically at a time when more and more sensitive information is being requested in the push for healthworkers to monitor more aspects of private lives, citizens' rights to privacy and confidentiality and to disclose their information to a named person they have chosen to trust, are being eroded.

In order to negotiate the services people are paying for in the UK, citizens will soon need to take an advocate or lawyer to consultations. We already need knowledge of the DPA; Rights to Privacy re Common Law and Human Rights ACt; who a Caldicott Guardian may be; what a 'sealed envelope in the NHS means; GMC and and other regulatory guidelines. How the Sharing of Records as proposed is supposed to fit without breaching these is a mystery.

Competing interests: None declared

Competing interests: No competing interests

15 March 2005
susanne mccabe
retired
cf24 3pf