But while Cameron’s announcement that patients will “be able to check your health records online in the same way you do your bank account” is very appealing, there was less detail about how this would be implemented. At present, no one GPs’ surgery or hospital has all the information about every patient so an online access system will need to be able pull together data from multiple places into a single coherent display for the patient – no easy task. And much historical data is still locked away in paper files so, if complete records are to be made available, the huge NHS programme of transferring records to computer will need to carry on in earnest.

In fact, despite their reported hostility to the big NHS databases which have been a feature of Labour health IT policy, any online access system is going to rely heavily on the infrastructure that’s already been put in place, from the N3 national broadband network, to the Spine database which links different patient records systems. Even Cameron’s other announcement – that patients have access to detailed performance statistics for different GPs and hospitals, will rely heavily on patient data collected via the Secondary Uses Service database which has attracted a lot of criticism from privacy campaigners.

If the Tories do win the next election, it’ll be interesting to see how likely Health Secretary Andrew Lansley tackles these apparent contradictions – especially in an environment where money for new projects is extremely difficult to find.

Here’s to an interesting 2010, eh?

At the moment, nothing concrete has been decided, but on Wednesday the Chancellor is expected to publish more details in his Pre-Budget Report.

The NHS IT project is certainly an easy target. The project is estimated to cost £12.7 billion pounds – a number that is so large, it’s basically impossible to comprehend. But as we mentioned earlier this year when the Tories suggested cutting the scheme, it’s not clear that this is the money-saving trick it appears to be. An estimated £400m of public money has already been spent on the project, and one of the contractors, Fujitsu, is apparently owed a further £800m in payments. Cancelling the project at this point might not create immediate savings.

And Darling’s proposals might be a false economy in a more general sense. In November, NESTA (the National Endowment for Science Technology and the Arts) came out with an interesting report on the future of healthcare in the UK. They recognised that the NHS needs to save 15-20 billion over the next few years, and that they need to do this in the context of an ageing population in which two fifths of adults say they live with a long-term health problem. Cuts won’t do it, they argue. Something big needs to change.

The NHS was originally designed to deal with short-term, infectious illness. The biggest challenges facing the NHS today, however are long-term, preventative diseases such as cancer, cardio-vascular disease and diabetes. In order to tackle these conditions, the NHS needs to adapt to focusing on behaviour change, prevention and self-management. And this, NESTA argues, can only be done by giving patients control and responsibility over their own health.

HealthSpace seemed an important first step in the right direction. By giving patients access to their records online, patients could monitor their own health conditions and be less reliant on constant visits to health professionals. HealthSpace is also an important step in the development of telehealth, which can decrease the amount of time spent in hospital beds – a significant cost to the NHS.

HealthSpace was one of the first casualties of the NHS IT project, and was shelved back in June. Yesterday’s announcement, however, suggests there’s even less hope of getting it back on track. It seems that Darling’s plans may be a case of short-term cuts at the expense of a more long-term sustainable decrease in NHS spending.

One of the reasons HealthSpace was shelved back in June was the low take-up of patients who chose to access their record in the pilot areas. But Dr Braunold, directional head of HealthSpace, argues:

“Very few patients keep going back if all you can do is just look at your record. It’s like having an online bank account and not being able to do anything with it.”

She is determined to make patient access a central plank of the NHS IT project and hopes patients will be able to order a prescription, make an appointment and view additional information about an illness.

And her faith in the value of a centralised NHS system seems to be mirrored by a survey by E-Health Insider which is being published at just the same time. It shows that 90% of their readers would rather their records were accessible through HealthSpace than through companies like Google or Microsoft, as the Tories have proposed.

The green light has not yet been given, however, and this latest instalment of the HealthSpace drama still leaves lots of questions begging. The future does at least look a little brighter for giving patients the access and information they need to take more control of their own healthcare.

Well, that research is now being carried out and you can fill out this 5-minute online survey on what services you would find most useful. The results may be crucial to whether the NHS IT project will do anything to increase patients’ control over their own care.

Although this is currently just a suggestion from the opposition, handing data over to a private web provider raises a whole new set of questions – ones which we will no doubt need to face as healthcare becomes increasingly electronic.

Taking the records system outside the NHS could be a way for patients to gain increased control over their own records. Unlike the NHS’s proposed HealthSpace, patients on Google and Microsoft can not only view and comment on their health records but also add to them, delete them or change them. While this will no doubt infuriate various healthcare professionals, it would give patients greater ownership over their healthcare – one of the aims of the IT programme.

But it would also re-cast previous debates about privacy and security. These companies make their money from advertising. John Caulthard of Microsoft argues that sharing patient data with companies could be ethical and beneficial, allowing the NHS to target those with potential health problems. But could we also see nightmare scenarios where those with a history of anorexia were targeted by beauty experts, or by dieting pills? And would Google staff be added to the list of hospital staff, clinicians and GPs secretaries who can get access to our records? Regardless of privacy policies, such a system would have greater security risks with data moving between the NHS and private providers. Privacy advocates have long been critical of the amount of data which Google accumulates on its users – search histories, emails, documents and much more – but the storage of health data would be far more significant.

Like so many questions at Who Sees What? this one comes down to who the public trusts more with their personal information. At present, the answer is far from clear.

Currently, HealthSpace allows patients to book appointments and record health information. Patients in pilot areas can also view the basic medical information held on their Summary Care Records (SCRs). But the Department of Health had much bigger plans for HealthSpace in the long-term. It was hoped that it would give patients more control and ownership over their medical care, allowing them to read through doctors’ notes after a consultation, order repeat prescriptions, add to their SCR, check for accuracy and upload tests and measurements to aid the management of long-term conditions.

However, the programme has been severely delayed and only a tiny number of patients have accessed the services offered by HealthSpace – just 812 from a possible 250,000. In an unexpected announcement the Department of Health has said it is reviewing the value of HealthSpace to patients, and has halted the work in its tracks.

If the service stops at only allowing patients to view their SCRs, its value certainly is questionable. The Summary Care Record contains only basic information so it’s unlikely to be of particular interest to patients. For patients with chronic conditions like diabetes who do need to keep track of their health, the SCR will be of little use. The meat of GPs’ and hospital records remains firmly locked up in local systems.

In fact it’s not yet clear how many patients want access to their health information online at all. While a few GPs who’ve experimented with giving patients full access report real interest there’s yet to be a systematic evaluation of this type of system. In this context, the suggestion from University College, London of focusing on providing an tailored system for a limited number of patients carrying out self-care for chronic conditions, seems a reasonable next step.

Dr Neil Bacon and others argue that there is strong patient demand for access to medical records, but that the solution must be innovative and entrepreneurial, and should come from ‘trusted brand names,’ not the government. But it seems (thankfully) unlikely that Google or Microsoft will be given access to the NHS records systems so any commercial system will struggle to join up with existing systems of patient care. In the absence of an NHS-wide system, however, it may be up to private companies to deliver what they can.