THE NHS AS "BIG BROTHER"

The Department of Health provoked uproar among doctors yesterday by asking GPs in England to send in correspondence from objectors who do not want their confidential medical records placed on the Spine, a national NHS database. Sir Liam Donaldson, the chief medical officer, said letters from patients who want to keep their private medical details out of the government's reach should be sent to Patricia Hewitt, the health secretary, for "full consideration". Campaigners who fear the national database will infringe patients' civil liberties said the exercise would give Ms Hewitt access to the names and addresses of patients most likely to be offended by government intrusion.

GPs wrote to the General Medical Council asking for a ruling on whether Sir Liam had broken the doctors' code of good practice by using his authority to encourage GPs to breach patient confidentiality without clinical justification. Sir Liam's letter complained about "misleading statements" in a Guardian article on November 1 that the police and other agencies might be able to access medical records once they had been loaded on to the national database. The article included a form of words patients could use to ask Ms Hewitt to refrain from uploading their records without their explicit consent. Sir Liam said patients were sending a similar request to GPs instead of the health secretary. He added: "If you do receive any such letters I would ask you to send them to the Department of Health so they may receive full consideration."

Hamish Meldrum, chairman of the BMA's GPs' committee, said: "The chief medical officer's intervention is not helpful and GPs should not forward these letters. It is possible that some patients might think this is a breach of confidentiality in that a letter sent to their GP is forwarded to somebody else without their consent." Paul Cundy, the BMA's spokesman on IT, said: "For a GP to forward such letters without the explicit consent of the patient would be a gross breach of privacy. In effect it is asking GPs to spy on his behalf. He should retract immediately. "Since these patients are objecting to the Big Brother society, this is an astonishingly incompetent gaffe."

Ross Anderson, professor of security engineering at Cambridge University, said: "It is not for the government to decide unilaterally to override the wishes of those patients who decide to write to their GP, but not to Ms Hewitt. For the chief medical officer to so recklessly put news management ahead of patient privacy is shocking." The government wants to start uploading a summary of patients' records in trial areas in the spring. Sir Liam reassured GPs: "There will be plenty of time to discuss patients' concerns with them before any data uploads ... in their areas."

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Unbelievable: Carelessness about meningococcal disease

What harm would precautionary antibiotics have done? A private doctor who failed to prescribe them in a risk situation would be sued for millions

The first rule to help doctors and nurses identify meningococcal disease is "listen closely to patients and friends", says an educational DVD that calls it the most rapidly lethal infectious disease known to man. But when George Khouzame raised concerns he might have passed on the illness to his girlfriend, Jehan Nassif, he was told he had probably only had the flu, the inquest into her death heard yesterday. Three days later Ms Nassif, 18, was dead.

Mr Khouzame and his cousin Elias had been overseas and both felt ill just before they returned to Australia. George's symptoms eased but Elias Khouzame became weak and had a headache, painful limbs and a fever. During a stopover he noticed red spots on his skin and suspected meningococcal disease. Back in Sydney, Elias went straight to hospital, while George attended a welcome-home party, where he kissed and cuddled Ms Nassif.

The next day a public health officer, Carla Ghezzi, spoke to George and his friends about their contact with Elias, who had been diagnosed with meningococcal disease, the inquest was told. George and his friends claim he told Ms Ghezzi he had had similar symptoms a day before his cousin and wondered whether he had passed the disease on to him. Ms Ghezzi allegedly told him: "If you had meningococcal you wouldn't be here now. You probably just had the flu." The inquest at Westmead Coroner's Court was told Ms Ghezzi also dismissed his concerns about Ms Nassif, though Ms Ghezzi had said she did not remember this part of the conversation.

Ms Nassif later briefly visited Elias in hospital, probably without wearing the prescribed face mask. National guidelines say anyone in close contact with a patient with meningococcal for at least four hours in the previous week should get antibiotics to prevent the spread of the disease, the court was told.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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