Liberal Democrat health spokesperson Norman Lamb laid out his party’s vision for the future of the NHS at a high profile policy speech earlier this month and had some interesting things to say about patient records systems.  Lamb’s vision is of an NHS that empowers individuals, with easy access to one’s health records and a simplified Choose and Book system.  Lamb claims that a decentralized system would hand power and budgets to hospitals and GPs, encouraging collaboration and cutting costs.

Lamb proposes radical changes to two of Labour’s key NHS IT projects: Choose and Book, and the National Care Records System (NCRS).  Choose and Book, he argues, should be a streamlined service which allows patients to book appointments online.  The NCRS, on the other hand on the chopping block, as he viewsa centralized database is unnecessary, and that connectivity between primary, secondary, and social care is more important.

His plans reflect the frustration felt by many with the NHS National Programme for IT, which is hugely expensive, behind schedule, and still rife with controversy over the implications for personal privacy and technical security.  In fact, many of Lamb’s proposals bear similarities to the Tories’ proposals to scrap the central database.  However, there are issues with this approach. While localized databases might eliminate some concerns about personal privacy, they wouldn’t necessarily reduce costs: the NHS has long-standing contracts with IT companies who would expect compensation for their work thus far if smaller, local IT companies stepped in to finish the job.

Nor do localized databases address the concerns for communication between primary, secondary, and social care.  It is still unclear how much access other medical personnel such as care workers and pharmacists would have, and whether they would be able to put that information into a database for a doctor to see later.  Furthermore, some would argue that abandoing the national Summary Care Records service – which contain basic patient information such as allergies, blood type, and operational history- means giving up a significant benefit to patients receiving out-of-hours or emergency care.

Lamb also suggests that patients should be able to consult with physicians via email or telephone, which is currently not permitted.  This proposal opens up an interesting discussion on modern communication.  Given some of the firewalls and high-security passwords that keep our email hidden from unwanted eyes, it could be argued that email is even more secure than the post.  To date, however, it is not illegal to open another person’s email from an account left open on a desktop, whereas it is illegal to tear into someone’s letter.  How can we ensure security for minors, who may be forced to give their internet passwords to their parents?  Would those without the internet effectively be marginalized, demoted as GPs address their bulging inboxes first?  Perhaps email consultation could happen on an “opt in” basis, where patients sign a form consenting to email communication and the potential conflicts involved.  Such a system could very well improve patient-physician communication and lower NHS costs, but it does open up a new set of risks to security.