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- Smart Healthcare, Wednesday 19 August 2009 09.00 BST
Conservative thinking on NHS IT: a little less clouded? Photo: jiunlimited.com
"It sounds apocalyptic, but I believe it is true, to say that some of the underlying freedoms which underpin parliamentary democracy are being seriously eroded," said Damian Green, the Conservative party's shadow immigration minister, recently. In a speech that could have been delivered by a civil liberties campaigner, Green said government IT projects were responsible for much of the erosion.
With less than a year to the general election and a real possibility of gaining power, the main opposition party is thinking out loud about how the state should use IT and data, particularly in the fields of health and social care. It does not sound like business as usual.
The cancellation of some projects, such as the identity card and the ContactPoint directory of children, has been party policy for some time. In July, shadow home secretary Chris Grayling said that a Conservative government would also cancel the National Identity Register, the core database in the government's identity scheme, and reduce the size of the National DNA Database, by forcing English and Welsh police forces to follow Scotland in removing the records of innocent people.
But Green went much further, listing 28 databases or types of systems he saw as supporting "streams of state control which flow together to form a river which is toxic to our basic freedoms". His list included four central NHS systems.
Green argued that control over data should be moved from the centre to individuals, quoting party leader David Cameron's views on power in general. But was he offering his own thoughts, or flying a kite for official party thinking? As far as the health service is concerned, the answer seems to be the latter, based on the 10 August publication of the review of NHS and social care IT commissioned by shadow health minister Stephen O'Brien's, and the Conservative party's response.
O'Brien promised a dismantling of central NHS IT infrastructure and more choice for local trusts in what systems they use, as long as these meet open interoperability standards. He also confirmed the party's interest in allowing patients to use personal health records, such as those supplied by Google, Microsoft and Dossia, and in promoting open source software.
The announcement reflects a maturing of the Tories' approach towards the NHS's National Programme for IT. In April 2008, David Cameron spoke about a "hubristic NHS supercomputer" and blogged about "no more NHS computers". However, the party also commissioned a review of NHS and social care IT led by Dr Glyn Hayes, and is now proposing to renegotiate Connecting for Health's local service provider contracts rather than cancelling them.
But some themes are consistent: the Conservatives are keen on decentralisation, citizens having control of their own records, more competitive procurement, open standards and use of open source software. The last three were promoted in a recently released report written by Liam Maxwell.
The Conservative Party now has some clear policies on NHS and social care computing. But they are not without their problems. Former shadow home secretary David Davis has raised one, in his attack on Google's record on privacy.
If a future Conservative government offered citizens a choice, presumably Davis would not be forced to use Google. But David Cameron has said that part of its attraction is that its electronic health records service is free, paid for by targeted advertising. So would the government fund a range of storage providers free at the point of delivery, or would the highest levels of privacy only be available to those going private?
* A longer version of this article will appear in the September issue of GC magazine. Click here for subscription details.
