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Work has begun on a social care equivalent of the care records guarantee for medical records, paving the way for merging health and social care records. The plans were disclosed as part of a debate at the annual Care Records Development Board meeting in London, yesterday.

The work is still at a very eary stage, and no final decision has been taken as to whether or not a single record will be created. But the possibility of two services sharing data in this way illustrates exactly those concerns about patient privacy and confidentiality that have been raised by opponents of a centralised medical records database.

The workshop - a group of forty or so patients, health professionals and other interested parties - was asked to debate the proposition that there should be a "single holistic record" of patient care, encompassing not just health records, but social care information. The idea, the session chair explained, is that information should meet the needs of the individual, rather than the other way around.

It was during the ensuing debate that the news of the planned social care records guarantee emerged.

The care records guarantee (pdf) sets out the rules that will govern the management of information in medical records when the NHS Care Records Service goes live next year.

It describes who may access medical records, what security will be in place to protect patient confidentiality, for example. It also promises that patients will have access to their own medical records, and that they will be able to see who else has had access.

Part of the guarantee is that only those with a "legitimate" relationship with a patient may have access to the record.

The ninth point states: "We will make sure, through contract terms and staff training, that everyone who works in or on behalf of the NHS understands their duty of confidentiality, what it means in practice and how it applies to all parts of their work. Organisations under contract to the NHS must follow the same policies and controls as the NHS does."

Putting together a similar guarantee for social care records, and enforcing similar standards of social care workers, is the first step in making sure the two organisations can have shared access to patient data.

Many of those attending the workshop were concerned that sharing records would dilute the quality of care, and could compromise the quality of a patient's relationships with his or her carers. Some people might be reluctant to share information with their GPs if they thought social services would also have access to that information, one delegate suggested.

Another said that she was fully supportive of a multi-disciplinary approach to care. Health and social workers should work together and share information, but the records must be kept separate, she argued, to protect patient privacy.

"Having a single record could also be a breach of the third prong of the Data Protection Act - excessive information," she said. "And of the seventh: unlawful disclosure."

The advocates of the single record argued that with adequate controls, this need not be a problem, and that sharing information would improve patient care, not erode it.

A vote at the end of the debate was narrowly in favour of a single record (18 to 15, with seven abstentions). The session chair said that plenty of valid concerns had been raised, particularly over the questionable value of a single record being held by two separate services. ®

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