Michael Cross

The Joseph Rowntree Reform Trust recently issued a report on Britain’s growing Database State. It had some sound points to make. Unfortunately, the government and others will probably be able to ignore them because it also made a number of basic errors, says Michael Cross.

In polite circles, it is well known that there are certain topics on which it is quite safe to voice firm opinions without having the faintest idea what you’re talking about.

The national curriculum is one. Healthcare informatics is another. To the parade of newspaper columnists and broadcast satirists who feel quite safe sounding off about the National Programme for IT in the NHS we can now add musicians. Last month, I heard the usually estimable Brian Eno berate the government for failing “even” to computerise the NHS – as if that were a self-evidently trivial task.

All entertaining stuff, to be sure. But when critics get things wrong, they give their targets an excuse to disregard the whole critical message. In its otherwise thought provoking and highly timely report on the Database State, the Joseph Rowntree Reform Trust comes dangerously close to falling into this trap.

Headline claims

The survey’s headline claim – well reported in all media last week – is that a quarter of a sample of major government databases apparently breaches privacy or data protection laws. The NHS is one of the biggest culprits.

Yet, as NHS Connecting for Health (and E-Health Insider readers) were quick to notice, the report’s NHS section is riddled with reasons for the government not to take it seriously.

Some errors, like the name of the Personal Demographics Service, are trivial. Likewise, it doesn’t really matter that NHS Direct is not being rebranded NHS Choices as some of their functions and web pages are shuffled around.

Others are more damaging: as CfH pointed out, the Rowntree report’s “red” verdict on the Secondary Uses Service ignores the consultation shortly to report on the wider uses of patient information. And some statements are simply science fiction. What is this “Radiology Information System” (note the singular) that today enables PACS images “to be viewed in multiple providers”?

Finally, there’s the noble, but Qixotic, suggestion that it would be “orders of magnitude cheaper” to throw the NHS to be open to all comers from around the world than to try to computerise it. To put it mildly, this suggestion is not close to the mainstream of current policy. In fact, I can’t think of one more guaranteed to have a minister chuck the whole report in the bin.

Important points

The tragedy is that the Rowntree report makes some highly relevant points. For example, it blows the whistle on the “Wikipedia” model of shared authorship (which it says is being used by the red-rated detailed care record). It is also right to raise the possibility of coerced access to records via HealthSpace.

The authors’ recommendations on the future direction of travel for government IT systems – that they should be either simple, or local – makes a lot of sense. They also have much to say on the malign impact of the public procurement process. And they are dead right about the need to appoint a government chief information officer at permanent secretary level.

These strengths, I suspect, reflect the expertise of the report’s authors, who come from the Foundation for Information Policy Research. They include national experts on security information, the government IT market and children’s rights. However, none appears to have up-to-date experience inside the NHS.

Lost in the nit-picking

OK, some of this criticism is nit-picking. And there’s an element of cheek when a newspaper journalist lambasts other writers for inaccuracies – my professional career is peppered with grovelling apologies for everything from confusing an ambassador’s wife with Raquel Welch to giving Sweden a land border with Russia. Almost certainly, something I have said in this very article will be open to challenge.

But when you’re producing an authoritative agenda-setting report that you intend to be taken seriously at the very top of government, you need to get things right. The Rowntree authors need to get working on a second edition, and quickly. As they so succinctly put it: “The sooner the government changes its approach, the less the inevitable changes will cost.”


About the author: Michael Cross is a freelance journalist specialising in healthcare informatics and e-government. He is an occasional contributor to E-Health Insider. He is also a member of the British Computer Society.


Database State report