Wales rejects England’s merger proposal
April 2007
NHS Wales has rejected
pressure to join the NHS
care-record system being
developed for England
by Connecting for Health
(CfH), it emerged at last
month’s HC2007
Conference.
CfH and its prime
contractor BT approached
NHS Wales in January
proposing that Wales
should “take their
solution”, Martin Murphy,
Clinical Director of
Informing Healthcare
(Wales’s counterpart to
England’s CfH), told the
conference.
The merger suggestion
had been prompted by
the substantial flows of
clinical information
across the two countries’
120-mile border, which
passes close to busy
population centres like
Chester, Shrewsbury and
Hereford. Moreover
Wales, with only 3m
inhabitants, is short of
specialist treatment
centres; as a result it
has to refer 6% of its
population to England
each year.
Accepting CfH’s offer
would have meant a
common personal demographic
system (PDS)
and database between
the two countries. But
NHS Wales turned down
the offer in order to keep
control over its information
systems. It plans
instead to maintain a
separate system for
demographic services and
a Welsh administrative
register. This will keep
records on people in
Wales only, while freely
exchanging information
with England’s PDS.
Murphy stressed the
political motivation behind
Wales’ choice. He noted
that the NHS reforms in
England, with an emphasis
on competition between
providers, are in “quite
stark contrast with our
Welsh approach”.
“If you lose control
over your information
systems you lose control
over an important lever
for policy”, he said. “We
don’t want to mortgage
our future to the English
approach. The idea of
taking everything lock,
stock and barrel from
England is not an acceptable
position for us.”
In particular, said
Murphy, Informing Healthcare
wants to avoid the
security and provenance
issues surrounding the
English national database.
These centre on the role-based
access model
(RBAC) which is based on
the concept of a “legitimate
relationship”
between NHS staff and
patients.
“According to our
consultations, RBAC is
unwieldy, requires huge
long-term maintenance, and encourages people
to work around it”, he said.
“We don’t believe it can
be done”. So instead of
the legitimate relationship,
Wales is basing its access
controls on the idea of
“legitimate purpose”,
associated with only four
defined roles. “We
consider it’s all about
trust”, said Murphy.
Informing Healthcare is
developing a model very
similar to the Scottish
emergency care record,
with out-of-hours services
being granted
read-only access to
summaries of GP records,
provided patients give
consent. Since the end
of 2006, it has gone live
with 350,000 online
records in Gwent. “That
took six months to
implement and cost only
£200,000”, said Murphy.
He says the plan has
widespread support from
clinicians and GP system
suppliers. “We are very
proud of our achievement
and we don’t want to get
involved with other systems
that might spoil it.”
Individual GPs will
remain free to use standalone
systems of their
choice, Murphy told
bjhc&im. But he estimated
that 15% of practices
had already migrated to
commercial data-centrebased
solutions and said
that trend would
probably continue.
Scotland too is coming
under pressure to connect
directly to England’s
PDS, according to Dr
Kenneth Robertson,
IM&T Clinical Lead at the
Scottish Executive
Health Department.
But
Robertson told the HC2007
Conference that Scotland
is already ahead of
England, having completed
the national
rollout of its emergency-care
summary record
last year. About 100
people have opted out of
the scheme, “and most
of them are healthcare
professionals or IT
people”, he claimed.
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