NHS to hunt out patients who are costing too much

Bosses will trawl records to find frequent visitors to GPs and A&E

NHS bosses are to trawl medical records of tens of thousands of patients to find out who is costing them the most money.

They will identify which individuals frequently see their GP, go to A&E or are on lots of prescription drugs with a view to ‘reviewing’ their care, and trimming their budget.

Patients are not being asked for permission and can opt out only by making a specific request at their surgery. The controversial scheme will begin next month in Southend, Essex, and involve 175,000 patients, although it could be rolled out across other areas.

But concerns have been raised that the information will be used to drive down costs by rationing certain treatments or urging GPs not to refer patients to hospital. There are also worries that bosses will urge expensive patients such as the elderly to buy-in extra homehelp or even move into a care home.

It has striking similarities to a national data harvesting project which has been put on hold after concerns were raised that sensitive details would fall into the wrong hands.

The NHS’s Care.data scheme was meant to begin last spring with information from millions of patients’ due to be uploaded so it could be analysed by experts to look at trends.

It was later postponed following opposition from doctors and campaigners who warned that not enough had been done to prevent patients’ sensitive details falling into the wrong hands or being made public.

But experts say the latest scheme – uncovered by Pulse magazine – is even more worrying as patients have been kept so much in the dark and the information could be used to ration care. From July 27 certain details from the medical files of all patients living within Southend Clinical Commissioning Group will be automatically uploaded on to a database.

This will include their age, postcode, a list of all prescribed medications and how often they see their GP or go to A&E, as well as their NHS number. Officials will then sort through the data to identify ‘high-cost’ patients so their care can be ‘reviewed’ with the aim of looking after them at better ‘value’. The patients will not be told they have been identified, but could see changes to their care plans.

The CCG is seen as a ‘pioneer’ within the NHS for the way in which it uses data and if this scheme is deemed to be successful, other areas may follow suit.

But senior doctors from the Essex Local Medical Committee – a regional body of GPs – are so opposed they have written to managers demanding to know who will see the information, and how it will be used to drive down costs.

Roger Goss, co-director of Patient Concern, said: ‘This is mind-blowing disrespect for patient privacy and confidentiality. It is hard to think of a better way to sabotage patient trust in the NHS.’

Professor Sir Brian Jarman, from Imperial College London, raised concerns that patients were not being properly informed that their information would be trawled.

He also pointed out that there was a high risk that this sensitive information would be lost, or leaked onto the internet.

‘Every year there are hundreds if not thousands of breaches of confidential NHS data, some of which could go into the public domain – against the patients’ wishes.’

Although patients’ names will not be put on the database, if it was to be leaked onto the internet it would be easy to identify individuals by their postcodes and ages alone.

A spokesman for the CCG said: ‘Our main aim, through data sharing, is to improve services and the quality of care to patients with multiple care needs.

‘By reviewing data across the system we will be better placed to see opportunities to join up health and social care services and provide patients with a single package of care.’

The Care.data scheme is still under review and pilot projects are still due to get under way in Leeds, Blackburn, Somerset and Hampshire.

And last week officials admitted that 700,000 patients who had tried to opt out, and not have their details uploaded, had been ignored due to a technical glitch.

‘Mind-blowing disrespect’