• United Kingdom (English)
Mike Cross

Cross talk - Green shoots for the Summary Care Record

Officials are now looking to the private and voluntary sectors to provide front-end products for online health records.

Originally published on the Microsoft NHS Resource Centre on 13 April 2011

Richmond House, the Department of Health’s headquarters in Whitehall, has a dedicated room for media briefings. It’s just inside the right hand security gate, presumably so that journalists can be escorted there without passing any ministerial private offices.

I’ve been there often in the past 15 years, and the room brings back many memories, especially of the last days of the John Major government and the early, testosterone-rich years of the Blair-era National Programme for IT.

But when I was invited there the other day for what they call an “off camera briefing”, I noticed something new.  The briefing room itself is dominated by a stage, topped with an imposing wooden desk, rather like those found in magistrates’ courts.

It’s there for the same purpose - to make it absolutely clear who’s in charge. This time, however, the stage was empty. The dozen or so assembled journalists addressed their questions to four people sitting in a row of chairs at the same level. The meeting’s whole style was collegiate and low-key, with, unusually, much more time for questions than for speeches.

I don’t think the change of style was accidental. The meeting’s purpose was to announce the resumption of mail-outs to patients about the Summary Care Record in England and (we hope) a resolution of the long drawn-out battle over consent. The notification letters still require patients wanting to opt out to take active steps to do so; but, in an important concession, this now involves filling in a postage paid form, rather than a patient having to make a personal appointment at Room 101 of the local primary care trust (open 8am to 9am every other Tuesday).

I exaggerate, but to judge by some complaints, not by much.

The response of the British Medical Association was likewise eminently sensible. It welcomed the new procedure, with the caveat that practices should upload patients’ records only when “they are satisfied that public awareness is high enough to allow genuinely informed consent”. While this may look like a licence for obstruction, the  Department of Health really cannot grumble: “genuinely informed consent” is the bedrock of a clinician’s relationship with the patient. It is by necessity a fuzzy concept, and one that is open to interpretation. If some doctors feel that even the new letter does not do the job, their wishes will have to be taken in to consideration.

Of course the pity is that all this was not resolved years ago.

However, seven years after the government first announced the Summary Care Record as an early win for the National Programme, and one with self-evident benefits, it is clear the debate is moving on.

At the press briefing, many of the questions concerned the next stage in the process, including the voluntary addition of further details to the summary and patient access via the HealthSpace portal. This is where it starts to get really interesting.

There is anecdotal evidence that a substantial minority of patients are passionate about enriching their summary records with data such as their wishes for end-of-life care.

Another intriguing snippet from the press briefing was the revelation that officials are now looking to the private and voluntary sectors to provide front-end products for online health records. No one would be drawn on details, but this is a welcome change of tack from the “not invented here” syndrome that has plagued NHS developments.

No doubt the new information strategy for the NHS in England will reveal more. Don’t hold your breath for a definitive line, though - the Department of Health has already missed its own target for responding to its Information Revolution consultation, and with the current furore over the funding reforms there will be plenty more excuses for delay. My guess - and this is just a guess - is that we will be lucky to see a strategy appear before the autumn.

This need not matter too much - we know the direction of travel, if not quite where we’re going. We’ve also learned a lot of lessons from the past. Let’s hope the strategy continues to make more use of collegiate chair arrangements, and less declaiming from the bench.