The consultation launched last week by the Department of Health, seeking views on radical changes in the way patients can interface with their local doctors and exercise greater choice, comes at a time when the key enabler of change, the ‘Summary Care Record’, seems to have barely survived being strangled at birth.

But that observation, of course, does not tell the whole story.  At the same time as launching the consultation on ‘Greater choice and control’ the Department of Health also launched another consultation; ‘An Information Revolution’.  These two papers need to be read together although it already seems clear that the media (and hence public awareness) has been attracted more to the former.

There’s nothing new in our collective disinterest in the complexities and challenges of data management.  We vigorously uphold our rights to remain entirely ignorant of technical and ethical issues until, of course, such time as costs run over budget, systems are judged inadequate, confidentialities are inadvertently breached, data is found to be wrong, access is too slow or too difficult to use, government IT system delivery is yet again three years behind schedule, or.... you fall under a bus!

Even in these two concurrent attempts to engage citizens and stakeholders in healthy debate the overtones of ideological positions are on full display.  On one hand cautious political expression of market-making offset by heaps of reassurance of the NHS as ‘a great institution’ espousing ‘equity and excellence’, and the other hand waving acknowledgement to members of the sector’s dominant and deeply conservative Trade Union – the British Medical Association.

Technologists, those who really appreciate the practical and truly revolutionary opportunities afforded by new combinations of science, networking and data management, are kept in the back room where, with luck, they’ll not cause any trouble to those whose superior education has endowed them with (in the words of the late Archbishop Runcie) ‘minds as sharp as razors – and about as broad’.

As in many other parts of our economy, the current government is gradually realising that there is a mighty difference between infrastructure investment and how that infrastructure can subsequently be exploited.  The current confusion of banking (Clearing or Casino) or broadband (Access or Services) is in essence little different to health – access via the utility of General Practice and more-selective risk taking at higher levels of professional competence.

The BMA would, of course, be horrified at any dismissal of doctoring as a local utility.  There is no doubt that many GP’s aspire to and achieve a higher calling than this implies.  But that is entirely the point where technologists can see that a teasing apart of what they do into its utility and value-add risk-balancing components can open up tremendous opportunities for a real health and social care revolution.

Long before we can consider the scope for easier choices and greater patient engagement, or enjoy the luxury of ideological debates around healthcare policy, it would be helpful to attend to the provision of infrastructure – and it probably doesn’t help that, with every advance in technology, yesterday’s sophistication is today reduced to basics.  Email becomes normal, computers become usable for real people, cloud computing becomes undetectable, SatNav becomes endemic and Nintendo Wii games kit becomes a health and fitness aid available on short term loan from the surgery.

But for health and social care development the infrastructure bottom line is the way we manage the data about our personal health histories.  We might want to extol the virtues of having more information to ‘inform our choices’ but without accurate data about the capacities and conditions our individual bodies – and, moreover, professional access to that data with all the safeguards and privacy controls that individuals demand – it is a waste of time urging citizens to up-sticks and move their healthcare custom to a competing GP in the next village.

Moving house – something fewer of us are doing at the moment – illustrates the current infrastructure weakness.  GP’s not only use a variety of different computer systems but seem not yet to be fully equipped with any system (or service) to translate records from one to another.  Currently only around 5000 of nearly 10,000 practices are enabled to use the ‘GP2GP’ system for records transfer.  This may sound like slow progress but in the wider world of healthcare practice this system’s interface standards, agreed not only by the professionals but also by competing private sector manufacturers is, apparently, a world first! 

It's pity then that many GP's choose not to use GP2GP because of inconsistencies between Practices in the way that various medical conditions are coded and the consequent danger that automatic data transfer might inadvertently corrupt their own local classifications.  

So meanwhile the paper printouts keep highly-trained administrative people in surgeries across the land busy re-keying medically complex and nuanced details (or at least ‘the things we think might be important’) – with all the attendant risks of errors and lost data.   And that, surely, was (and still is despite BMA objections) the point of the Summary Care Record – a great enabler of data migration and a trustworthy up-to-date common source for critical care.

No-one disputes that the ethical issues are difficult, that the liability-risks in an increasingly litigious society need to be better explained to citizens, to their carers and to health professionals.  But those challenges and the current shortfalls in responses are no good reason to not place personal data into the hands of citizens along with a common access platform.

Without that basic data platform and networked access we will fail to grasp the opportunities for ‘Connected Health’, for remote monitoring, for technical triage services, for greater citizen engagement in their own personal health and well-being and for saving a shed-load of tax-payers’ contributions.

By not teasing apart the utilitarian from the expert services, by maintaining ignorance of the critical significance of establishing a platform for utility care and by not using this to engage citizens as co-producers of their own well-being, we forgo the opportunity of achieving higher orders of personalized care and disease prevention at an affordable price.

The target audience for these two consultations is the current healthcare establishment but (as with broadband where the voices that need to be heard are not in the telecoms sector) the inputs that are needed here are from those of us who are on the receiving end.

The consultation documents feature selected illustrations of health and social care scenarios to illustrate the policy persuasions and ‘direction of travel’.  Given the increased on-line capacity of citizens it will be interesting to see how many us of take the opportunity to throw in some reality checks of our own.

The consultations are open for comments until 14^th January.

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The editorial was written for the UK's 'Connected Health' community of clinicians and technologists,  The author is currently supporting the development of new models for disease prevention and has previously contributed to studies of the European market for Connected Health products and services.

Readers of this editorial also read 'Drastic Surgery for Health Services?' and 'Muddling through will not do'.