NHS: Healthcare Data

Lord Macpherson of Earl's Court Excerpts

Thursday 6th September 2018 Lords Chamber

[Lord Macpherson of Earl’s Court (CB)]

My Lords, I congratulate my noble friend Lord Freyberg on securing this timely debate and on his thought leadership and his excellent contribution. I also congratulate the noble Lord, Lord Bethell, on his eloquent maiden speech. I know that we are not supposed to believe in the hereditary principle any more, but I am quite sure that he will bring the same credit to this House as his four predecessors did.

As a former Treasury official, my interest in this debate is in the prosaic issue of finance. Pressures on NHS expenditure are set to increase hugely in the years ahead; that is partly due to the long-predicted demographic pressures finally arriving, but it is also about raising expectations about the standard and quality of care. According to the independent Office for Budget Responsibility, spending on health and adult social care is set to rise by 3.2% of national income in the next 20 years. That is £64 billion at current GDP levels. Taxes will clearly have to rise, but so will the efficiency and effectiveness of the National Health Service, and that is where the use of data comes in. Take Tesco or Amazon. Using their customers’ data to provide a better service is fundamental to their business model. The NHS has a dominant market position in its field; it needs to find a way to do the same. I welcome the new Secretary of State’s commitment to technology-driven health and care and the £475 million he has put on the table; like other noble Lords, I hope that that is new money. But we are still not making sufficient progress: the whole approach is too fragmented and balkanised.

Britain starts with an advantage. The clue is in the name: we have a National Health Service. It should not be beyond the wit of government to join up hospital data with general practitioner and other data sources through greater interoperability. But, to use one example a GP mentioned to me the night before last, in many parts of the country paramedics in the ambulance service still cannot access a patient’s wider medical records. This cannot be good for the service patients receive.

I know and recognise that the mishandling of large-scale data initiatives, in particular the care.data programme, has not been conducive to public trust. Many noble Lords have spoken eloquently on this subject today. Obviously we need a coherent, comprehensive and ethical system for protecting people’s privacy, and we need to make restoring trust in sharing health data a national priority.

The message should be simple. If we are to nurture the right to a publicly funded health system, we have a duty to share our data. Other countries have grasped this nettle and their citizens have responded. We must do so too. That will require strong leadership from the centre as well as at a local level. I would strongly recommend a campaign which health practitioners and patient advocates own and lead.

Healthcare data is undoubtedly an asset. But I am agnostic at this stage on whether we should seek to monetise it. I recall a debate some years ago in the Treasury about the Ordnance Survey: should it be privatised or not? Were its services effectively a public good for which no charge should be paid? In the end, the Government, correctly in my view, went for a more open-source approach. Healthcare data may be different. The fact is that trusts are already exploiting its value potential commercially although, as my noble friend Lord Freyberg suggested, some of the current deals look too one-sided. If the NHS could harness its negotiating power at a national level, underpinned by a strong national framework on confidentiality, I am confident we could unlock much greater value. As my noble friend Lord Mitchell said, our aim should be to maximise that value. If it were clear that value would be recycled in higher spending on health and research, I believe we could yet secure the necessary public support.

The Treasury’s balance sheet review is due to report in the Budget and is set to cover intangible assets. I hope the Treasury will work with the National Audit Office to develop an appropriate accounting framework. Above all, the review provides a golden opportunity to examine the value of NHS information the better to inform public debate. Knowing the Treasury as I do, I am sure that, even now, officials are considering the best way of unlocking that value. I look forward to the Government bringing forward a vigorous response to the review in due course.