It’s 2 years to the day since Care.Data was suspended amongst public outrage. The failed programme is showing no signs of restarting, as NHS England and the Department of Health continue to sift through old pampers, and keep finding yet more problems.

The Caldicott Review of Consent, which began after NHS England lied to the Care.Data Advisory Group, should report soon, if those who want to water it down to avoid having to make uncomfortable decisions. Why might they do that? Well…

Another Jeremy Hunt promise is broken – Your Hospital Data is still being sold

Before their January deadline, HSCIC finished the testing needed to implement the hospital data consent promise that Jeremy Hunt made to every patient – which 1 million patients who opted out took him up on. The final step was for Jeremy Hunt to give the go ahead to keep his promise. He didn’t.

Let us be clear: Jeremy Hunt made the patient promise 2 years ago, and it appears in the 2015 conservative manifesto (pg 38) “We will give you full access to your own electronic health records, while retaining your right to opt-out of your records being shared electronically.” Only he can break his promise, and he has chosen to do so.

So when will the opt outs be implemented? We look forward to hearing any answer the ICO receive shortly on exactly that question, as they respond to our complaint. The Department of Health are refusing to answer questions – which is understandable as they don’t have any answers.

Your GP will honour your request for data not to leave your GP practice, both because of medical ethics and because of their direct connection to you. Who is Jeremy Hunt connected to?

The interim-type-2 opt out can be implemented tomorrow if Jeremy Hunt tells HSCIC to do it. Why hasn’t he?

You may wish to write to your MP, and ask the question, “when will the Secretary of State for Health implement patients’ choices to prevent data about them leaving the HSCIC for purposes beyond direct care?” – please also say why this matters to you. (and sorry the question is a bit of a mouthful)

This can be fixed. The Health Secretary just has to take the single action necessary to fix it, permanently.

A perfect overarching consent flag is something we support; but at best, it is a year away from being something a patient can ask their GP to do. No scenario, other than immediate implementation of the interim-type-2s, addresses the gap between now and then. A long-term maybe-mythical “perfect” solution is currently the weapon of choice of those who want to prevent any patient choice over data usage at all: that change being the consent choice (aka “interim-type-2”) which 1 million patients have requested be actioned, and that they are all waiting patiently for. When the first step down the path to consent has been taken for national datasets, there can be confidence that subsequent steps will be taken. If not, and the Department of Health breaks Jeremy Hunt’s promise this time, why should anyone believe them next time?

What’s next: Care.Data Everywhere?

On Friday, we’re expecting that Cabinet Office to launch their data copying consultation, which probably won’t have the subheading “care.data everywhere”, but unless they’ve fixed their compulsion to copy, it probably should have. It’s not all terrible news; the worst projects (probably) didn’t get this far – what the consultation will show is the stuff that they don’t think is terrible (that’s probably not reassuring).

Every project involved has had to explain how “it’s not like care.data because…”, but the Cabinet Office has seemingly learnt only the lessons convenient for them to learn. It’s hard to all learn the right lesson when institutional incentives encourage people to learn easier ones.

The lack of critical thought across the programme appears in Parliament’s report on the “Big Data Dilemma”, which says the NHS could save £66bn from more data copying. Saving about two thirds of the NHS budget (equivalent to getting rid of all staff from the NHS) seems… unlikely.

We’ll see what the Cabinet Office consultation says over the weekend, and any health implications will appear in the next newsletter. The Caldicott Review is also due to be consulted on, if it ever gets published.

What’s Next: Saatchi Bill returns to the Lords

With the most problematic bits of the bill removed by MPs, the Saatchi Bill on “medical innovation” is now a mechanism to create new databases, and do so only with the approval of Parliament.  How is this different to care.data, which Tim Kelsey repeatedly said was “the will of Parliament”?

That’s a very good question. The main difference is whether Parliament says yes, or whether it chooses not to say anything. Currently, silence means support, which was the approach that failed catastrophically with care.data.

We’ll be looking to have conversations with their Lordships about an amendment to require Parliament to approve any plans, rather than simply not objecting. Especially as this Government is looking to remove the ability for the Lords to object to anything…

More soon, and we especially thank all those who have made donations.