The proposal
On February 4th 2024, after one year of research, the Times Health Commission presented a ‘report into the state of health and social care of Britain today’, (Times 2024) including a 10-point proposal for the NHS.
The first point of focus in the report addressed health data fragmentation and highlighted how technology can transform healthcare by improving efficiency and reducing costs. The solution found and proposed by the Commission is the creation of a ‘Patient Passport’, according to which every patient treated by the NHS should have all their health information stored digitally in a single place, and every doctor who is treating a patient should be able to access that patient’s record. As with a real travel passport, the Patient Passport should work seamlessly and be accessible and considered valid across any healthcare institution: GPs, NHS hospitals, pharmacies, and social care.
The Commission found that - as highlighted also in this research - there are similar systems already in place in other countries, such as Denmark and Estonia, while in the UK, within the NHS, there currently are around 40 to 60 types of electronic patient records, and 10% of hospitals do not have any and are still relying solely on paper.
Key points emphasized by the Commission include the importance of prioritizing prevention and allocating more resources towards it, placing patients at the forefront of their care, empowering them to actively manage it.
In terms of the implementation methodology, the proposal is that the passport could be built upon and accessed through the NHS app - which would have to be improved accordingly to, among other things, include data from more healthcare providers.
Survey results
The Times also published data from YouGov polling for the commission :
81% of respondents support the patient passport proposal, with 10% against it.
89% of respondents believe that patients should have automatic access to their medical records.
56% of respondents think the benefits of being able to book appointments and access care online outweigh any potential privacy risk. 22% of respondents disagree with this.
68% of respondents would be happy for the NHS to allow other medical professionals to access their health records.
64% of respondents would be happy for their data to be used for research, anonymously.
How this maps to a Personal Health Record and other similar concepts?
The report does not specify who should control access - the patient or the NHS providers. It does state that the patient should see everything. It also has an NHS-centric view to the data sharing. So while it has many of the properties we of a PHR - a complete, accurate, real-time, persistent record that the patient can see for their own self-assessment and self-management, but also the provider access for safety and productivity - it leaves open the question of control and thus ownership.
NHS control means the NHS will miss out on non-NHS parties that can contribute to a citizen’s care, including the patient themselves. As soon as the NHS “owns” such a passport it also owns the risks: the clinical risk of seeing and acting on everything in the record to avoid liability; the technical risk of building such a platform; the security risk of managing access to so much data from so many sources.
The NHS does not want to take on such risks, according to our private interviews with NHS senior leaders. Government bureaucracies are also not able to take on such risks, as seen in other governments' IT projects. Thus NHS ownership would not deliver the goals of the patient passport, and we recommend an explicit commitment to patient ownership so that the patient passport is a PHR.
As it was found in this research, many countries have attempted to leverage technology to digitise patients' records, for the benefit of patients, professionals and the whole healthcare system.
What is the Times Health Commission?
The Times Health Commission was formed in January 2023 to look into the future of health and social care in England. This came about due to various factors like the pandemic's effects, budget pressures, issues in A&E services, long waiting lists, health disparities, obesity rates, and the aging population. The commission consisted of experts from different areas in health and social care.
To gather insights, the members visited medical facilities and care homes in the UK and abroad, including countries like Japan, Ireland, Israel, Denmark, and Spain. They wanted to learn from the best practices they observed before creating their 10-point plan.
Over 600 witnesses provided expert opinions, and the commission also conducted economic analyses, business surveys, opinion polls, and focus groups. These efforts aimed to get a comprehensive view of what's working well and what needs improvement (Sylvester, 2023).
Bibliography
Digital Health.,n.d.Times Health Commission presents 10-point plan with digital at the top. Accessed at:https://www.digitalhealth.net/2024/02/times-health-commission-presents-10-point-plan-with-digital-at-the-top/#:~:text=The%20Times%20Health%20Commission%20was,issuing%20its%2010%2Dpoint%20plan. (accessed 1 May 2024).
Sylvester, R., Hayward, E., & Lambert, G., 4 February 2024. Public back ‘patient passports’ to share medical records with any doctor. The Times. Accessed at: https://thetimes.co.uk/article/nhs-data-shared-freely-times-health-commission-bqhrfwh83 (accessed 4 February 2024).
Sylvester, R., 15 January 2023. What is the Times Health Commission? Its aims explained. The Times. Accessed at: https://www.thetimes.co.uk/article/times-health-commission-explained-objective-commissioners-bvl2937gf?gad_source=1&gclid=CjwKCAjwkuqvBhAQEiwA65XxQERSJk2nQgS-DWDRylo45QO9vi_67vC8mweo4kW2Cia4H-w-vX9R0xoC_JQQAvD_BwE (accessed 4 February 2024).
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