An official agreement that lets NHS Digital share patients’ addresses with immigration officials has sparked concerns from doctors, public health officials and the national data guardian.
The concerns were aired during a Parliamentary health select committee into a memorandum of understanding between NHS Digital, the Home Office and the Department of Health which came to light last year.
Thousands of patients’ addresses have been passed to immigration officials. Only a tiny fraction of requests are declined.
GP and health adviser humanitarian charity Doctors of the World, Lucinda Hiam, told the committee that patient confidentiality was the ‘cornerstone of the doctor/patient relationship’.
‘Without that, with that broken, I don’t think that you can carry on to have such a good relationship,’ she added. ‘If you do have to break confidentiality, it is a fraught decision. At the moment, it’s happening to us, without us knowing, all the time, routinely.’
Dr Hiam knew pregnant women who were too frightened to access healthcare, due to their immigration status. ‘It’s something that really worries us.’
Public Health England director of health improvement John Newton told MPs: ‘Evidence suggest that fear about confidentiality compounds a number of other concerns and can be the thing that stops patients consulting.’
He added: ‘We know that migrants internationally are dissuaded from seeking care for a variety of reasons, which confidentiality is one.’
Question of trust
Concerns about the memorandum were also raised by Dame Fiona Caldicott, the Government’s national data guardian through Joanne Bailey, a member of her advisory panel.
‘[Dame Fiona] has concerns that the public interest criteria which are applied either by doctors using the GMC confidentiality code or by NHS staff, using the Department of Health NHS code, are not reflected in the MoU,’ Dr Bailey told the committee.
‘Her key concern is the implications of this policy behind the MoU for public trust are far reaching.’
Health minister Lord O’Shaughnessy, defending the memorandum, said that NHS Digital had established that sharing information with immigration officials was ‘a lawful thing to do’.
The NHS shared ‘administrative Information’ for a number of purposes, Lord O’Shaughnessy added, such as using address on NHS databases to track patients who owed the service for treatment.
But Dr Hiam said the distinction between ‘administrative’ and clinical data was ‘irrelevant’ to lots of her patients.
‘I saw a woman a few weeks ago from Eritrea who had been living in this country for seven years, been kept as a slave and subject to horrendous sexual violence. She didn’t feel able to go to a GP,’ she added. ‘That’s the atmosphere of fear we’re creating.’
BMA medical ethics committee chair John Chisholm said the memorandum could set a precedent for lowering the threshold at which health bodies can hand over identifiable patient data to authorities.
‘This would potentially leave all patients unsure about whether the information their doctor holds on them is truly confidential,’ he said.
‘These disclosures to the Home Office are well below the threshold for disclosing confidential information in the public interest, set for doctors by the General Medical Council.’
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