Is he listening? Jeremy Hunt on his way to the Conservative Black and White Ball, February 2014. (Photo: Getty)
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Care.data is really about making Britain the go-to country for pharmaceutical development

Dr Phil Whitaker’s Health Matters column.

I wonder whether Jeremy Hunt, the Secretary of State for Health, is secretly pleased about the recent furore over care.data. The plan to merge GP, hospital and social care records into one database has provoked enormous public concern over potential breaches of confidentiality – and fears that the National Health Service would subsequently sell data to commercial insurance companies have flushed out embarrassing admissions that it has done this sort of thing in the past.

So Hunt is getting to play Mr Fixit, announcing draconian penalties for anyone attempting to identify individuals from anonymised data and promising legislation to prevent the sale of NHS information for “commercial insurance or other purely commercial purposes”.

The row over confidentiality and commercialism has distracted attention from what the government hopes this database will do. The standard rubric passes without comment: it will be a unique research resource, giving us an unprecedented opportunity to investigate links between lifestyle and disease and to detect unsuspected side effects of drugs or other medical interventions.

On the face of it, this argument seems to be uncontroversial. Yet the work that care.data will supposedly enable has been going on for years. The General Practice Research Database (GPRD) has been around since the early 1990s; it is a huge repository of primary-care patient information that has spawned hundreds of studies into lifestyle, diseases and treatments. Participating practices supply anonymised data voluntarily, with 20 million patients represented.

Groups such as the Haematological Malignancy Research Network (HMRN) have long linked to hospital and GP records in their studies of leukaemia and lymphoma. Patients’ NHS numbers enable researchers to track the lifelong health of each cancer sufferer in their study. Analysis of past GP records is uncovering important health antecedents that may help to explain the development of these diseases.

If this kind of research is happening already, why the sudden need for care.data? On coming to power, the coalition government commissioned a wide-ranging review of how to rebalance the UK economy and make it more internationally competitive. The results were published in March 2011 in The Plan for Growth, described as an “urgent” strategy to turn our economic fortunes around. In the report, health-care research was identified as a strong candidate for growth and inward investment and there was a new appreciation within government of the unique opportunities offered by the NHS.

Nowhere else in the world are the details of an entire nation’s health recorded so comprehensively by a single service – and one that is at the forefront of computerising its information. The existing NHS data is attractive to all researchers but it could be most lucrative for those in the pharmaceutical industry. The NHS’s already well-developed data infrastructure makes it an enticing arena in which companies can conduct clinical trials of new drugs. Forget selling information to commercial insurance companies – care.data is about making England the go-to country for pharmaceutical research and development.

So, in order to maximise the attractiveness, the entire population needs to be on offer. In March 2012, the voluntary GPRD was subsumed into the Clinical Practice Research Datalink (CPRD), a new body tasked with exploiting the NHS’s potential to the full, but voluntary enrolment was never going to deliver the whole-country data set required. Cue the automatic uploading of GP records to care.data.

The haste with which all of this is happening has major downsides. The HMRN is successful because the researchers, pathologists and clinicians in the network are all speaking the same data language. But throughout the wider NHS, information is still being recorded with varying degrees of rigour. The Health Informatics Unit at the Royal College of Physicians has been driving forward the adoption of a universal data language across the NHS but this is still years away. There is concern that the advent of care.data will overburden NHS providers, preoccupying them with trying to extract data for which they don’t have the systems or the right language at present.

Another rationale for care.data is its ability to audit care and pick up poor performance. Again, this kind of work has been going on for years and the data is still criticised as being of poor quality. My practice repeatedly flags up as an outlier: while we appear brilliant at preventing heart attacks, we seem to be appalling at treating children. In reality, our population is heavily skewed to young families, as a result of which we have many paediatric admissions but fewer older patients to develop heart disease. The algorithms that are supposed to adjust our data to match our demographics simply don’t work. More development will be needed before meaningful audits and performance checks can be conducted.

The publicly trumpeted goals of care.data are laudable and all should be achievable, given time. Hunt should be frank about the economic imperative behind the urgency to establish the database and should engage in a sensible discussion about what might be compromised by undue haste. 

 

This article first appeared in the 12 March 2014 issue of the New Statesman, 4 years of austerity

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Let's turn RBS into a bank for the public interest

A tarnished symbol of global finance could be remade as a network of local banks. 

The Royal Bank of Scotland has now been losing money for nine consecutive years. Today’s announcement of a further £7bn yearly loss at the publicly-owned bank is just the latest evidence that RBS is essentially unsellable. The difference this time is that the Government seems finally to have accepted that fact.

Up until now, the government had been reluctant to intervene in the running of the business, instead insisting that it will be sold back to the private sector when the time is right. But these losses come just a week after the government announced that it is abandoning plans to sell Williams & Glynn – an RBS subsidiary which has over 300 branches and £22bn of customer deposits.

After a series of expensive delays and a lack of buyer interest, the government now plans to retain Williams & Glynn within the RBS group and instead attempt to boost competition in the business lending market by granting smaller "challenger banks" access to RBS’s branch infrastructure. It also plans to provide funding to encourage small businesses to switch their accounts away from RBS.

As a major public asset, RBS should be used to help achieve wider objectives. Improving how the banking sector serves small businesses should be the top priority, and it is good to see the government start to move in this direction. But to make the most of RBS, they should be going much further.

The public stake in RBS gives us a unique opportunity to create new banking institutions that will genuinely put the interests of the UK’s small businesses first. The New Economics Foundation has proposed turning RBS into a network of local banks with a public interest mandate to serve their local area, lend to small businesses and provide universal access to banking services. If the government is serious about rebalancing the economy and meeting the needs of those who feel left behind, this is the path they should take with RBS.

Small and medium sized enterprises are the lifeblood of the UK economy, and they depend on banking services to fund investment and provide a safe place to store money. For centuries a healthy relationship between businesses and banks has been a cornerstone of UK prosperity.

However, in recent decades this relationship has broken down. Small businesses have repeatedly fallen victim to exploitative practice by the big banks, including the the mis-selling of loans and instances of deliberate asset stripping. Affected business owners have not only lost their livelihoods due to the stress of their treatment at the hands of these banks, but have also experienced family break-ups and deteriorating physical and mental health. Others have been made homeless or bankrupt.

Meanwhile, many businesses struggle to get access to the finance they need to grow and expand. Small firms have always had trouble accessing finance, but in recent decades this problem has intensified as the UK banking sector has come to be dominated by a handful of large, universal, shareholder-owned banks.

Without a focus on specific geographical areas or social objectives, these banks choose to lend to the most profitable activities, and lending to local businesses tends to be less profitable than other activities such as mortgage lending and lending to other financial institutions.

The result is that since the mid-1980s the share of lending going to non-financial businesses has been falling rapidly. Today, lending to small and medium sized businesses accounts for just 4 per cent of bank lending.

Of the relatively small amount of business lending that does occur in the UK, most is heavily concentrated in London and surrounding areas. The UK’s homogenous and highly concentrated banking sector is therefore hampering economic development, starving communities of investment and making regional imbalances worse.

The government’s plans to encourage business customers to switch away from RBS to another bank will not do much to solve this problem. With the market dominated by a small number of large shareholder-owned banks who all behave in similar ways (and who have been hit by repeated scandals), businesses do not have any real choice.

If the government were to go further and turn RBS into a network of local banks, it would be a vital first step in regenerating disenfranchised communities, rebalancing the UK’s economy and staving off any economic downturn that may be on the horizon. Evidence shows that geographically limited stakeholder banks direct a much greater proportion of their capital towards lending in the real economy. By only investing in their local area, these banks help create and retain wealth regionally rather than making existing geographic imbalances worce.

Big, deep challenges require big, deep solutions. It’s time for the government to make banking work for small businesses once again.

Laurie Macfarlane is an economist at the New Economics Foundation