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Reaction: Conservative plans for the future of NHS IT

The Conservative party's plans for the future of NHS IT, published earlier this week, have drawn a mixed reaction from those likely to be affected. Here's a sample of comments on the plans.

Full details of the plans are outlined in the original news story, and in the document detailing the Conservatives' proposals.

Dr Vivienne Nathanson, head of science and ethics at the BMA

'There have been major problems with the national NHS I.T. programme and we support the principle of greater local decision-making.'

'However, it is unclear where the funds would come from to ensure the smooth integration of new online patient records with the systems currently used by hospitals and GPs. Many trusts in England are waiting for new electronic systems to replace paper-based processes. This review does not provide a solution to that problem.'

'The BMA strongly supports the principle of patients controlling their own medical records. However, we have concerns about the security of web-based systems, and the implications of data being held by the private sector. There would need to be very strong safeguards and an accurate audit trail making it clear what changes or deletions had been made to records and by whom. All NHS IT systems must reach the highest possible standards for privacy, accuracy, security, and useability.'

'We are concerned by the suggestion that healthcare staff could be restricted from accessing important clinical information. Clinicians need access to records in order to do their jobs. If the information they have is incomplete - for example because pathologists have been prevented from entering test results - there could be implications for patient safety, as well as a negative impact on valuable health research. In a situation where a child was at risk of abuse, we would be very concerned about information being removed from their records by a family-member.'

Dr Neil Bhatia, a GP in Yateley, Hampshire

'I think the localized vision is what most doctors have wanted and asked for, the ability to "push" information – selective information, when required and if properly consented – from GP to secondary care (and vice versa), or to allow access to information when required (as EMIS Web allows).'

'I think that there is quite a lot of misunderstanding about the Google/MS proposals, and the Conservatives really need to clarify matters if they are not going to be roundly criticized for this (as they are being already). My understanding is that Google wouldn't (and couldn't) replace EMIS for example as the sole repository of GP records. No GP is going to login to Google Health for every patient in his/her surgery.'

'What I think is being suggested is that patients – or their GP with the patient's explicit consent – would upload certain information to Google Health – a very selective Summary Care Record of sorts. This then could be added to by hospitals (e.g. procedures performed), and it remains under the control of patients as to how much information is available in this way. The GP retains the GP record, as before, the hospital retain their own record. A shareable one – Google Health - is available, at the patient's discretion, to others (worldwide for that matter) who can only access it with a login/password.'

'Various permutations of this already exist in the UK in the online medical record market, ZapTag, Health-Ecard. Patient held records already exist too, USB bracelets, sticks, cards. And of course, EMIS Access.'

'There is always a risk when patients can edit their own records and selectively leave out information, but arguably that is no different to taking a history from a patient in A&E and the patient not mentioning the fact that he/she is HIV positive for example. Nearly always hospitals (or GPs seeing temporary residents) will contact the patient's usual GP for more detailed information when feasible.'

Dr Paul Thornton, a GP in Kingsbury, Warwickshire

'This expert review confirms that the CfH concept of a single electronic record for each patient across all health & social care settings is not going to work, even if it had been otherwise desirable, ethical or lawful.'

'The report demands a clear move towards small independent databases in each care setting. These must not only meet the diverse needs of the clinicians in each of the radically different health care settings but be able to securely "push" relevant, necessary and not excessive data to other care settings where it is genuinely needed, or very likely to be needed, with valid consent.'

Steve Barnett, chief executive of the NHS Confederation

'This report is a useful contribution to the debate about the use of information technology in the NHS and highlights how communications advances are changing both what the NHS is able to offer and the expectations of patients.'

'Better use of information and IT in the NHS has become essential. The service has become increasingly devolved and diverse with patients accessing care from different providers so the principle needs to be that there are national standards so that information can be easily and safely exchanged but with local decision making about how that is delivered.'

'Any radical change in direction will have to satisfy concerns over the security of data, the cost of a new approach and the skills mix of people working in the NHS. It needs to be shown to deliver practical, day to day, improvements for patients.'

'Currently some parts of the NHS national programme for IT are working well and it is important the progress already made is built upon rather than discarded. Major structural changes to the project should only be considered if it can be shown they will save money rather than generate extra costs.'

Liberal Democrat health spokesman Norman Lamb MP

'Giving patients greater access and control over their medical records is an important step forward but the Tories' proposals do little to alleviate fear over the security of our medical records.'

'The Government's NHS IT programme has been a complete disaster from the very beginning but we can't simply look to quick-fix solutions without considering the consequences.'

'Today's announcement does nothing to answer the very serious concerns raised by David Davis. This could amount to a Tory government playing fast and loose with our most personal data by placing it in the hands of private companies without sufficient guarantees on confidentiality.'

'We can't ignore the fact that this type of personal information is very valuable and commercial companies would love to get their hands on it. It seems that David Cameron has yet to convince his own party that these proposals are at all viable, let alone the wider British public.'


Conservative Shadow Health Minister Stephen O'Brien MP, who launched the review

'We now have the evidence we need to exploit the power of technology to improve patient care.'

'Labour's handling of NHS IT has been shambolic. Their top-down, bureaucratic plans have been hugely disruptive to the NHS and have been plagued with delays and cost overruns.'

'Conservatives will not let patients pay the price for the Government's inaction. The proposals we are setting out today will secure a better deal for taxpayers and will make sure the NHS has the technology it needs to deliver world-class healthcare for patients.'

Dr Glyn Hayes, a GP and former chairman of the British Computer Society, who chaired the independent review

'I welcome the Conservatives' proposals for a localised vision of NHS IT. The Review makes clear that NHS IT will only succeed in improving patient care if information is held locally and centred on the patient.'

'The Conservatives are moving in the right direction by accepting the Review and I hope this report helps redeem the National Programme for IT from its current difficulties and transform it for the benefit of patients and doctors alike.'

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