Tuesday, 1 January 2008

The Entitlement-to-Care Record

Is one of the real political motivations behind the development of the centralised medical records system beginning to reveal itself?

Gordon Brown has started 2008 with a somewhat disquieting statement: That he intends to "set out for the first time the rights and responsibilities linked to entitlement to NHS care" in a new 'NHS constitution' (BBC).

Articles in the Guardian and Telegraph speculate that this will translate into people being expected to lose weight, give up smoking and/or take more exercise in order to access healthcare. Unsurprisingly, this has brought an outraged response. Bloggers such as Tim Worstall point out that if this becomes the case, working people across the country will pay (through taxation) for the NHS, only to be denied care on lifestyle grounds:

"What is [Gordon Brown] on about now? Responsibilities? Establishing an entitlement to care?
Is being forced at gunpoint to pay for it every working day of ones’ life no longer enough?"
- Tim Worstall

Another libertarian blogger, the Longrider, also makes the point that the NHS is taxpayer-funded, not "free"* He also makes a more thought-provoking point in the form of the following anecdote:

"One thing I have noticed recently during visits to the GP have been a series of ever more personal questions – how much do I smoke, how much do I drink, how much exercise do I take? I think in future, the answer is going to be increasingly; that’s my concern and has nothing to do with why I’m here. If I have a problem with my hay-fever, then, yes, something that might have an effect on respiration may be appropriate. If I go in with a gammy knee, then none of those things is relevant." - Longrider

All of your answers to the sort of questions Longrider is referring to go onto your computerised medical record. It lists smoking status, average number of units of alcohol per week, BMI, exercise frequency, and probably a couple of other things I don't remember as well.

Surely I don't have to be the cynic of the year to conceive that the possibilities accorded adminstrators by the NHS Spine would be ideal for this kind of condition-setting. Just search for all smokers, or everyone above a certain BMI, or everyone with an alcohol intake of over a certain number of units, and send them a letter telling them if they don't change their lifestyle they will no longer be 'entitled' (what a hideous word to use in this context) to use the NHS that they have paid for through their taxes!

Now I'd be surprised if they were quite that bold about it. The point is, the centralised system makes that kind of thing practical for them.

The first 100,000 patient records were uploaded to the NHS database in the past few days (Daily Mail), from up to five pilot areas: Bolton, Bury, Dorset, South Birmingham, and Bradford & Airedale,. The trusts have timed the upload during the holiday season (I wonder why?), and former NHS manager and privacy campaigner Helen Wilkinson reports that many patients are not receiving promised leaflets setting out options regarding consent to upload of personal data.

In view of the potential implications of today's announcement by Gordon Brown, and taking into consideration the appalling record on data security across several Government departments, and nine NHS trusts (Link), why would any thinking person give their consent?

Especially if you live in the pilot areas, opt out now. Use the letter that you can download from the link below:
The Big Opt Out

* Incidentally, I propose this as another test that can be applied to distinguish between individualist and collectivist debaters in the UK (or 'C' & 'non-C', if you prefer). Collectivists have an irritating tendency to refer to the NHS as 'free'; individualists take pains to point out that it is 'taxpayer-funded' and at best 'free at the point of delivery'.

† See here if you don't know what I'm talking about.

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