UK looks at 'integrating' ID card with health care

To 'maximise benefits for patients', of course...

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The question of whether or not the UK national ID card will be required for access to health care is a fascinating one because, although the answer is almost certainly yes, nobody in government is prepared to say so at this juncture and risk general outcry. Instead we have a drip, drip of hints, suggestions and signals that will (they hope) lead us to a point where the ID card somehow, sort of, becomes the obvious and inevitable answer to everybody's healthcare problems.

The process, whereby the Home Office's cunning plan for a universal ID system efficacious in every way slowly subverts every other form of ID, could be thought of as a sort of Invasion of the ID Snatchers.

Health Minister John Hutton MP dripped some more in Parliament earlier this week, in answer to a query about any assessment the Department of Health had done of how the EU health access card might be integrated with "other proposed UK entitlement and identity cards." He answered that the Department was working in three areas, EU card, NHS card and national ID card, and was "considering how in the medium term this work programme can best be integrated, so as to maximise the benefits for patients and frontline services."

The timescales are important here, most so for the EU card which needs to be in place by the end of next year. In the longer term this card is seen by Europe as having smart card possibilities, but initially it need be no more than a piece of plastic with stuff written on it. As a matter of fact, it needs to have all of the stuff written on it, because it's intended to give EU citizens access to health services in any EU country, and there's no guarantee that anything machine read is going to be universally readable at this juncture. Brussels even suggests that roll out of the new cards could be eased simply by issuing a sticker that people could stick onto an existing card, where one exists. But an EU card of some sort is definitely something the NHS needs to have issued by 31st December 2005, because otherwise UK citizens won't be able to get access to treatment in other countries. The NHS will also have to be geared up to recognise other countries' cards by then.

The NHS card is on the contrary a considerably fuzzier matter. The NHS has been considering smart card access to services for quite some time now, but seems reluctant to share any conclusions of such consideration it might have come to. The NHS plan, which was put before Parliament in June of this year, said the Department was "considering the development of an NHS Card, which could support smart access to personal data and speed confirmation of access to appropriate care", but that's all it said. More recently it indicated that the EU card and the NHS card "could" be the same thing, while this week Hutton simply parroted the reference from the Plan.

The Department of Health is however very keen to eliminate the 'problem' (it thinks there is one, it has no credible data on the subject) of health tourism, and according to the Home Office (in its response to the Home Affairs Committee) is "developing a culture of checking identity and entitlement as a matter of routine practice." The Home Office has also said that national ID card reading capabilities are being built into NHS systems as part of the NHS IT programme, and has floated the notion of the ID card as NHS gatekeeper on numerous occasions.

So, you've got an EU card that has to go out next year to replace the old E111 form, but this won't provide any kind of smartcard validation. You've got an NHS Card under consideration, but possibly not being considered very hard, and you've got card readers going into the NHS which will read a national ID Card, but nothing else that the Department of Health has so far publicly committed to.

The national ID card however cannot be used directly to make access to health care conditional until such time as the Government is prepared to say so, and if it did that before the end of the 'voluntary' phase of the ID scheme, the voluntary nature would look even more threadbare than it does now. In addition, Europe complicates matters because, although the national ID card could be used for access to multiple services in the UK, it couldn't be used for access in the EU. The situation with driving licences is similar, and conforming to EU harmonised standards essentially compels the UK to have its 'universal' ID system and individual cards for practically all services as well.

So the case for evolving the EU card into an NHS Card, and syncing the validation and technology in with the UK ID card, begins to look attractive. An NHS Card could also, possibly, provide the Home Office with a useful for getting ID cards out. At the moment it has the theoretical notion of a standalone ID card which you could buy if you didn't want a passport but did want an ID card, but it's difficult to see many people figuring out why on earth they'd do this before the law forces them to. So to get ID cards seeded in areas other than passport renewal, the Home Office has to ID snatch other services. Driving is the option most often talked of, but what about making the NHS the third option, sign up for your new combination NHS/Euro Card, get an ID card thrown in? ®

It's probably just about possible for you to sign No2ID's online petition against the ID card. The deadline is today, sign here.

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