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The Parliamentary Under-Secretary of State for Health (Caroline Flint): I congratulate the hon. Member for Wycombe (Mr. Goodman) on securing the Adjournment debate today. His purpose has been to do what he can, quite properly as a constituency Member, to voice the legitimate concerns of his constituent. I fully understand those concerns. In many areas of life—whether in relation to banking, criminal or health records, for example—there is a requirement on the Government and the agencies with which they work to ensure that they maintain public confidence in the development of new technologies.
I am sure that the hon. Gentleman would accept that the best intentions lie behind these new developments. We want to ensure that people can get the best possible health care, and it is important to recognise that health care can be offered in a number of different environments, which involve different sorts of health professionals in both primary and secondary care. I hope that he agrees that our intentions are right, but that there is an important task for us all in ensuring that we have the public's confidence in what we are trying to develop.
I want to put on record my sympathy, which I am sure is shared by everyone who has heard about the distress experienced by Ms Wilkinson, for her distress at finding an embarrassing error in the record of her NHS treatment. I am very pleased to be able to confirm that that error has now been expunged and that we have respected Ms Wilkinson's further request that all her patient data be removed from the existing national database, although we have certain reservations about the consequences of doing so.
We recognise that there will be some people—Ms Wilkinson is, I think, the first, but no doubt there will be others—who feel so strongly about what they see as threats to the confidentiality of their personal health information that they will seek to remove any possibility of this information being shared within the NHS. Let me make it clear, however, that we do not envisage any circumstances in which patients who choose to have some or all of their records deleted will be "deregistered" from the NHS or otherwise denied NHS care against their wishes. That is an important point in the light of what the hon. Member for Wycombe said in his speech this evening.
What we cannot do, of course, is provide people who do not wish to be part of the new joined-up care records system with the benefits that an electronic record will provide. I would now like to focus on the new system of electronic records that we are in the process of introducing through the national programme for information technology, and the benefits that it will bring. In doing so, I hope to touch on some of the concerns that the hon. Gentleman has raised. If I cannot respond in full now, I shall certainly write to him in due course.
Some health records are already held on computers, but much—I would suggest too much—is still kept on paper. Records on paper can present challenges in respect of security of information. The shortcomings of
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the NHS, as it continues to depend in the 21st century on record-keeping and communication systems invented in the 19th century, are all too transparent. Records are not always available to staff providing care; handwritten entries in the record may be difficult to read; and important information may be missing. Patients themselves are often inconvenienced or put in a difficult position by having to tell staff the same information over and over again. Ms Wilkinson's distressing experience and the embarrassment that it caused her highlight the need for improvement.
We have committed quite unprecedented sums of taxpayers' money—£6.2 billion over last year and the next nine years—to revolutionise the way health information is accessed and shared. The key reasons are that electronic records and clinical communications will improve the safety and quality of care, underpin choice for patients, and increase the productive capacity of NHS clinicians and staff, potentially saving huge sums in unnecessary treatment and wasteful litigation costs. I think it will also help us to build a patient-led NHS, give us opportunities to consider how we can better safeguard information and give patients rights relating to it, and—this is important—create mechanisms to prevent some of the scenarios described by the hon. Gentleman. It will deal with questions of who will and will not have access to the information, and give patients some choice about who those people should be. It should also allow for electronic identification of people who may gain access to the system when they have no right to do so. That is important in any system involving information, whether it is held on paper or electronically.
The new system will give health care professionals secure access to patient information, and the means to update a patient's care record where and when that is needed. Errors will thus be more easily identified and corrected. From the outset, the system will hold records on an individual's care in a national computer system so that wherever care is sought, health care professionals can have access to the most up-to-date information.
The hon. Gentleman opened his speech with an example of what might happen. A receptionist might meet someone at a party, then go back to the practice and try to gain access to the person's records. I am informed, and I believe, that access rights will not enable those who are not involved in the provision of care to see records. Unauthorised access will be marked on the system, and therefore subject to audit. That is one of the opportunities granted to us by an electronic system.
We have provided the most stringent safeguards for security and confidentiality. We hope that anyone who is concerned about information will be reassured by them. The new system will allow patients to determine whether information recorded in one organisation can be seen elsewhere in the NHS: it will be their choice. Even when patients permit such access, only those involved in their care will have access to their records or to information that identifies them, and they will see only the parts of the record that are needed to inform care. That answers some of the hon. Gentleman's points about the whole health record, and about the possibility that some people might have access to information that
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was not appropriate. The system is designed to tackle that. Everyone who may have access will be authorised appropriately, and will need a smart card as well as a password. Crucially, the system will register the identity of everyone who looks at the records. That is important as a safeguard and as an audit trail to check that unauthorised access is not being allowed.
The way in which the new system protects patients' interests is explained in the care record guarantee published by my noble Friend Lord Warner on 25 May. Before the NHS care records service becomes operational, it will be made available to every household in the country. The guarantee makes 12 commitments to patients on their records, relating to matters such as access to records for NHS staff and how it will be limited. Patients will be able to block access to parts of their records to prevent them from being shared by anyone in the NHS except in an emergency. They will also be able to prevent their records from being seen by anyone other than the NHS organisations that recorded the information, although they will have to accept that that may sometimes affect the quality of care—which, again, is part of engaging patients in their care in the first place. Identifiable patient information will not be shared with any organisation outside the NHS unless patients give consent, the law requires disclosure, or there is evidence that failure to disclose the information might put others at risk. Child protection cases are an example of that.
Mr. Goodman: The Minister spoke of an audit trail, and the possibility of tracing the details of anyone who has looked at a patient's records. Will patients have an automatic right to know who has been looking at their records?
Caroline Flint:
I understand that they will. The hon. Gentleman referred to a sealed envelope. I understand that the sealed envelope will be opened only when health professionals are convinced that not doing so would put the patient's health at risk. The Caldicott guardian, who is a senior clinician in a trust responsible for
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confidentiality, will decide in those circumstances if the patient needs to be informed, but patients can ask at any time to know who has looked at their record.
The right to have inaccurate data rectified or erased, or to have any concerns about the processing of data seriously considered, is enshrined in statute. We are currently considering how such concerns can be practically addressed. We recognise that a transparent process needs to be established for people with concerns, and clear and applicable criteria for dealing with requests. It is not a simple matter, as there are significant medico-legal implications in deleting health information, even where it is incorrect, if someone has relied on it to make a decision. Part of the reason for that, as I am sure the hon. Gentleman will understand, is to protect the patient from people who might want to change records that could have implications in the future if the patient wanted to complain about their treatment or about how they were treated in the health service.
I also need to make the important point that, should people choose not to be part of the joined-up care records system, that will not only constrain how the NHS can help them but prevent the NHS from learning and improving on how it manages the care of others with similar conditions. That is not in order for people to know who the individual is, but to look at the case management of people with serious illnesses and diseases. We are determined to engage the public in understanding the benefits, both personal and system-wide, of the electronic care record and the way in which it will lead to a more efficient NHS, improve the quality of care and increase choice. That is why we published the care record guarantee.
I hope that my remarks will be of some assistance to the hon. Gentleman, to whom I will reply on any matters that I have been unable to deal with. I also hope that what I have said tonight has been a real opportunity to outline, in a public forum, some of the reasons why we are moving in this direction and how seriously we take the issues of confidentiality in the new system.
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