Great comment from Cameron and typical of him. Having a central database has many advantages and disadvantages - those related to security pretty much cancel out, a huge number of records in one place could lead to security issues if not properly managed, but having a large number of disparate databases each requiring a separate manager to patch etc. is equally risky. I've been involved in building large systems for banks - they tend to go for the centralised approach as it is easier (and therefore safer) to manage.

When is somebody going to challenge the Tory party's complete lack of IT understanding?

Google has 3 million medical articles online....and how many of them are actually accurate? Do I really want to be treated on the basis of articles most popular in Google?

"No problem" says the doc "you seem to have leprosy and terminal cirhosis - ahah - this article suggest that you take a dose of viagra, and even suggests some cheap suppliers. Isn't that handy?"

The existing NHS may not be brilliant, but I think I'll take my chances (just keep me off the database!)

What's Cameron doing here? Comparing anecdotal medical stories passed around between patients with intra- and interhospital/GP moving/sharing of patient data? I'm sure the former is cheaper, but it's nothing to do with the latter.

"It is this evolution, Cameron claimed, which undermines the need for a huge, central database of medical records."

Is he saying that the NHS should store it's patient records on Google?

Is he saying that patient records should be retrieved by patients and then passed from patient to patient (or client to client as they are now called)?

Maybe his idea is that patients waiting in the surgery could do useful work by retrieving records from Google and then passing them to the doctor?

What is he actually saying?

I'm just an engineer with a long term working knowledge of english. Can anyone tell me what it actually means when a politician says things like this?

"When is somebody going to challenge the Tory party's complete lack of IT understanding?"

Probably if/when they get into power and can be blamed for IT screw-ups on the same level as the ones circulating various government departments at the moment.

"distributed horizontally from patient to patient".

Much like, say, Chlamydia or Gonorrhea.

I'll get my own coat thanks, you don't want to be touching that...

.. something happens when I'm 100 miles away and they can't get hold of my GP - given they can work out who they are.

I guess he also thinks it's better to keep this all on bit's of paper as well.

Lets' get him to try to use the banking system with his records only kept by his local bank, he'll soon see the benefits.

Dan

Even if Cameron doesn't have a clue - as neither do the vast majority of voters - this sounds good, end of the day that's all politicians seem to care about.

Wake me up when someone starts talking sense and not pandering to current concerns or slating the opposition for carrying out policies the same as their own - then I might take my fat arse to a voting booth.

I really don't see why a doctor in Aberdeen needs access to my medical data if I'm knocked down by a bus in London. If I have a medical condition which might affect my treatment I could always wear a bracelet or carry a card like diabetics sometimes do - which could include the address of my GP who currently keeps my records.

Why not scrap this pointless IT scheme and employ some doctors in casualty and someone who can keep hospitals clean?

But surely having so much critical information stored in one place would be protected by some security procedures policy like they have for the benefits data.

Oh! wait a minute...

,,,right. So the GP now has to understand security procedures, backup procedures, hardware requirements etc, not to mention that for electronic records to be of any use they need to be accessible by others, such as if Im admitted to A&E, so you need some kind of permissions system.

Cameron is clueless.

Cameron has rightly complained about the NHS mega IT project, but he is wrong on Google. Google is well known for it privacy, i.e. none, such as keeping records of your searches for in the UK, for 2 <b>years</b>. I don’t trust it to keep safe that one has a mental disability, privately.

Plus, should it be a concern about the links between Google and the Tories. Why Google, why not the hundreds of other companies? Plus, any thought on the NHS using the American VistA system, it is free (public domain) and it keeps the records of every US veteran.

The man clearly has has no idea.

It's actually a lack of proper management / change consultancy* that has resulted in the big IT vendors shoeing in systems without thinking through the requisite changes in culture and system adoption, training etc. This has resulted in the Clinician's perceptions that the systems don't meet their needs.

CFH seem to have jumped from "we have a problem, let's get some new systems" without resourcing the bit in the middle properly. To be fair they had little choice but to do so given the politicians had made so many bullish promises about transforming govt / healthcare without building an understanding of the problem / what needed to change before starting the procurements.

* declaration of interest - I'm a management consultant.

What a typical response from a clueless idiot. I'd rather know my data is in one central database rather than getting posted around the coutry on cd's and emails. The main security risk in any system is the human factor, increase the number of humans looking after all the hundreds of database and your bound to get more mistakes. I'd rather trust a secure system with my personal details than Doris who works on reception any day.

It was the Tories that started the whole pocket-lining farce running.

Huge amounts of dosh spent and none of it doing anything than either lining the pockets of IT consultants or diverting NHS funds from actually treating people.

We also had the start of 'competitive tendering' which meant cleaning and other work went to contracting agencies who also demand their slice of NHS money and then reduce the number of cleaners and support staff.

The Shiny Headed One ought to look back at the failed central records projects before instead blaming it on those who followed. It may well not help that NuLabor(tm)* also use the corporate model to ru(i)n what was public services but it does help to remember when the ball started rolling.

NuLabor(tm) a Bush/Haliburton company

whether you use a local or large company, except for the cost factor. large companies will just drill out more money because they know they can.

At the end of the day, the government (any, not just labour) are spending other people's money (ours). It's amazing how different corporations run their businesses when it's their money they are losing.

The problem is, they don't actually care how much money it costs, and they don't know what they want. Whatever company you choose to build your system, if you keep changing your requirements as you go, you'll never have the system you want. If you keep doing it, you simply delay the first draft, which will be so far from the required result that it will be publicly outed. Large org's are used to the shit they have to deal with, so charge accordingly. I'm not saying they're right, they're still money grabbing ba****ds but they know what they expect, and always lower their bid amount below actual expected cost. The lowest bid is never the cheapest, everyone knows that.

Did any once else think "Dr Nick" when they read Cameron's Google comment?

"Hello Everybody. Now just wait a minute while I Google 'vasectomy'. Ah there we go, Wikipedia has an article! Now sit very still!"

Madness!

Could this be the same Conservative party that employed the same consulting companies to build NIRS2? I worked for the DSS IT Services Agency throughout the 90s and I well remember the projects where these companies put in inexperienced graduates who worked alongside you for 5 weeks, disappeared to the states for their "training"; usually a Cobol course, and when they came back they were suddenly your boss. I saw some real heaps of crap put in place over those years and those systems still hold our data.

It makes my head hurt too when i try and think about it too hard, but really and as we've come to expect from politicians of all parties, he is making alot of noise but sadly saying nothing.

He might need it if you were knocked down by a bus in Aberdeen!

You seem to have a lot of faith in your GP who presumably works 24/7 and can track down and read the information in your Lloyd George envelope stored oh so securely behind reception where noone could get past the 93 year old receptionist.

Wake up and join the 20th century then maybe try to join the rest of us in the 21st!

Have to agree wholeheartedly with you. A central database is a lovely idea for banks where a large volume of clients will be wanting to use different branches of different banks to access their money but how many people just 'pop-in' to a different GP since they were in the area.

If patient data was held at PCT level then as long as there was a standard format for the data, and lets face it these are all medical records and I'm sure there is a fairly standard set of fields per patient and you could always add a couple of spare free-text ones for luck, if you were out of area then it would be possible to make an audited request to access your data from whichever PCT area you happened to be in. This isn't a complex solution and reduces the volume of data to much more manageable chunks better suited to fit a CD.

*Flame on*

..because I feel sick; I agreed with Dave "The Toff" Cameron about something and now my body is going into shock. I knew that I had an allergy to Tories.

"I really don't see why a doctor in Aberdeen needs access to my medical data if I'm knocked down by a bus in London. If I have a medical condition which might affect my treatment I could always wear a bracelet or carry a card like diabetics sometimes do - which could include the address of my GP who currently keeps my records."

Sooo... you go to Aberdeen for a good old Highland ceilidh. And get knocked down by a late bus at 3.30 in the morning.

You could wear a bracelet, but let's say it came off in the accident and is now lying in the gutter at the accident scene.

You're wheeled into A&E unconscious. Doctor takes a look at you. Maybe he finds your GP's address in your wallet. Tries to ring, but surprise, surprise - the surgery's closed. All he's got to go on is your unconscious self.

Because you've been dragged along the ground, you've got lots of nasty lacerations full of tyre rubber, oil, petrol, microscopic bits of fag ends, vomit and dog shit - the normal mix of road dirt. So the doc decides to put you on ass-kicking penicillin-based antibiotics to try to stave off infection and gangrene.

Except you're allergic to penicillin and your records weren't on the national database.

So the question remaining is - would you like roses or lilies on your coffin?

Cameron should shut his stupid mouth until he knows what he's talking about. It would be nice never to hear from him again.

We know they know nothing about IT*, so why wont they listen to people who know?

And rather than outsourcing it, which ends up overpriced, delayed and wrong for the job, set up an IT department for the government. (In fact, put BOFH in charge, he'd sort those fat, lazy, self obsessed arseholes... I mean politicians... out). They could then plan things and do them right.

A centrtal NHS database is a good idea. You get taken to hospital, and the doctors there instantly know your medical history and can deal accordingly. Details are then added to your record of your treatment there and your doc knows next time you see him.

The problem is security, but this CAN be done. Banks dont loose peoples data, and they use centralised databases, so why can't a govt IT dept do the same?

Cameron is talking out of his arse and trying to win votes by telling the people what they want to hear (OK, that didnt need to be said, I know, "he's a politician" would've done).

And Google? Next thing he'll be telling GPs to stop getting medical books and journals, just look it up on wikipedia. IDIOT!

*Actualy about anything, but I was trying to be nice.

Surely all the medical knowledge you will ever need is available on Wikipedia?

And why mess with some expensive database thingy when you can store your medical records Facebook securly and for free.

(Actually this would work really well in attracting a "Silver Surfer" wrinkly crowd to facebook -- they can discuss thier operations and compare hip x-rays to thier pace makers content).

I'll just get my coat and Zimmer frame.

'Cameron said much knowledge was being added by patients themselves - and "distributed horizontally from patient to patient".'

mediwikipedia.com is only just around the corner...

"When is somebody going to challenge the Tory party's complete lack of IT understanding?"

They seem to have understood it fairly well, you're simply judging them from the wrong perspective - that of someone who'd get fired if they didn't know what they were doing. He's working on the assumption that it will be run by ministers who haven't got a clue what they are doing and won't be accountable.

Accept that the system will be run by incompetents and design it to limit the potential damage of the inevitable cock-up.

I would prefer to have my medical data stored and accessed locally - how often does one need to receive treatment elsewhere that would rely on that data? If I change my GP, or need to receive treatment elsewhere that does require this data, that can be securely transferred - and preferably only the information required, not my whole history.

With a distributed system, it wouldn't be difficult to have pre-specified security procedures, with a centralised support service. Having worked in the public sector for the last 6 years I've seen too many times a poorly specified solution that doesn't match the problem. Cameron may not be an IT guru, but I much prefer his decentralised stance than Mr Bean's centralised command and control approach.

Just my 2p.

Yes you are missing something. The NPfIT has been very badly sold and there's a lot more to it than is reported. It's not just a bunch of patient records stored on the Spine but a whole suite (eventually, anyway) of clinical applications that will replace some frankly hideously outdated systems that no longer match the needs of the modern hospital. The problems, IMO, arose because they decided to allow multiple companies/conglomorates, to pitch their solutions on a regional basis rather than having one master plan, one national solution, one standard. Well, that and the government couldn't organise a piss-up in a brewery if they had to use a computer to do it.

To go back to your example of being knocked down by a bus in London, which has many hospitals covering various areas for A&E treatment. In order to provide the best, safest care for you upon your splattered admission, no matter which hospital ends up treating you they need to know if you are currently taking any prescribed medication (on a short term basis) that you may have left at home, for instance, or are you allergic to ibuprofen or have you recently recieved a certain type of general anaesthetic?

How good would it be if you were taken to have an MRI scan and they didn't know you had a pacemaker?

There are many clinical benefits to the NPfIT and, of course, many challenges (i.e. complications if they're going to get around the potential security/privacy SNAFUs) to overcome to get it right. Selected regional vendors not going titsup would help tremendously.

If anyone of you wants to search for publicised government information or a form do you use (a) Google or (b) direct.gov.uk

To those of you that answered (b) you should try (a) it will surprise you (see directionlessgov.com)

Do you realise that direct.gov.uk costs shed loads of money that doesn't need to spent in that way because of (a) and all the alternatives?

My understanding of the Cameron point is that there are many institutions (hospitals, universities etc.) that publish valuable information information so governments don't need to. Further, if one has a rare (e.g., sarcoidosis) or unfashionable condition (e.g., eczema) the aggregated experience of other sufferers can prove more valuable than the limited experience (sarcoidosis) or lack of interest, or time of one's GP. See also: sites such as mumsnet for the value of aggregated experience on other health matters.

Of course, if one happens to be a self-interested purveyor of all things IT, then one might prefer government to spend money on failing to duplicate all of this.

What is never explained is why the information that would be provided in such circumstances will be of any better or worse quality.

Finally, whereas it might be true that a centralised database containiing information regarding one's penicillin allergy could provide help in the manner suggested by Mike Smith it is also necessary to consider whetther the cost of such provision versus the rareity of the occasion might cause one to think this is unnecessary diversion of shedloads of money from more worthy initiatives such as better healthcare.

I would imagine more people die on the road each from mad motorist than from penciillin allergy.

with NPfIT there isn't one big centralised database, there isn't just one place where all the data is held (Disaster Recovery).

a GP/Doctor in a different trust or PCT does not have access to your records and access is controlled locally by the trust/PCT.

Oh and why is everyone asking or assuming a centralised secure system is worse then current security.. oh wait there isn't currently ANY security and any technitian can copy and past an entire LOCAL database into excel and email it anywhere. A centralised database means the NHS bods don't have access to the data in the database, they can only view and edit it through an application that only lets them view one record at a time not take a dump over the entire system!

Everyone should contact CfH and ask for an overview of the architecture and then walk into their local hospital and see if they can just walk out with a PC with that hospital's records on it. If you don't understand Tech Architecture then stop talking like you do.

"Finally, whereas it might be true that a centralised database containiing information regarding one's penicillin allergy could provide help in the manner suggested by Mike Smith it is also necessary to consider whetther the cost of such provision versus the rareity of the occasion might cause one to think this is unnecessary diversion of shedloads of money from more worthy initiatives such as better healthcare."

Good point, but that was an extreme example. Instead, think about referrals, where patients get passed from A to B to C and back. This happens very frequently indeed.

Patient goes to see GP, who refers them to the local hospital. Before the NHS database, the GP would write a letter to the hospital, who eventually gives the patient an appointment. Now they can use Choose and Book. Patient toddles off to hospital A where the staff take their details and enter them onto their own computer system. This raises the risk of the patient forgetting to tell the hospital A staff something important or not knowing details they need - "I take the little blue pills, doctor" isn't terribly helpful to a clinician. If the NHS database is available, the doctor can see the patient's GP record, thus removing the single point of failure.

Hospital A does some investigation. Before the NHS database, they eventually write to the patient's GP and hope the letter doesn't go the way of child benefit CDs. With the NHS database, they add the results to it and the patient's GP can see them immediately.

Hospital A refers the patient to a specialist centre at hospital A. Before the NHS database, hospital B has to take the same details from the patient that hospital A did. They do their investigations and decide to schedule an operation. Before the NHS database, a letter goes to the patient and to hospital A (NOT the patient's GP - the GP didn't refer to hospital B). With the database, hospital B can see both hospital A's test results and the patient's GP record.

In the meantime, the patient goes to see their GP on an unrelated matter. The GP only has half the story without the NHS database. With it, they can see both hospital A's and hospital B's test results without having to wait for a letter which isn't guaranteed to arrive or even be written - people do make mistakes and forget things.

Having a clear and complete set of information DOES make for better healthcare. And the new NHS database will go a long way towards providing it.

Well, as a doc I have mixed feelings about this. It WOULD be very nice to have access to the medical records of a patient who turns up in A&E in Doncaster when he usually lives in Dover. I don't think this can be argued against. IT security is a matter of design and making rules which are not possible for the user to break.

On the other hand, does anyone really have any faith in NewLab to actually implement this properly? I won't be able to access all the records as a standard user, but will a central admin agency have access to everything or nothing (note there would be NO clinical or ethical reason for a central clerk to have ANY access to ANY patient details). How long before CDs get sent to a drug company showing them what other medications patients recieving their drugs are getting? This information would be woth Millions to a drug company - could a cash strapped government IT department resist?

Nothing this government has done has given me any faith that they could handle this data with both competence and probity. Until the NHS is independant and completely away from the control of politicians (any, but especially new lab at the moment), I would not have confidence in a centralised system.

Anon 15:01 is right. Has anyone actually assessed the benefits against the costs? I suspect that there are countless ways that 15 billion quid could be spent to better effect in terms of improving public health overall.

This project is entirely about the tail wagging the dog. If I remember rightly it was at a meeting between Bill Gates and Tony Blair at Number 10 that the whole hair brained scheme was devised. That's a bit like the government launching a pro-smoking campaign because the chief exec of British American Tobacco told them it was a good idea.

In the meantime, the paper based systems combined with bracelets and the likes, which have served us perfectly well in the vast majority of cases, are in disarray. Old systems, including local patient administration systems, have been run down in the expectation that a new system will arrive - which it hasn't and probably won't.

I'm no Luddite. IT has a valuable role to play in the delivery of health care. The NPfIT however is an object lesson in the art of getting things arse about tit.

Arguing that a central database is needed for regular referrals is bogus, because all the patient treatment centres will be in the same local area, anyway. Most hospitals allow access to their PASs (Patient Administration Systems) to local PCTs and have done for some time.

The only time that you will be treated outside of your area is if either you go to a specialist treatment centre (covered by the referrals process) or A&E while out of your usual area.

In that case, how is the doctor supposed to know which of the 3000 "Mike Smith's" on the database is you if you're unconscious? She/he will treat as appropriate and monitor for adverse reaction, as currently.

Unless, of course, everyone has their ID card on them so the Triage nurse can pop it into his/her handheld scanner and get all your details in one fell swoop. Assuming your card hasn't been cloned to hell and back, that is: "Ah, Mr Smith, we think that your stiff neck is caused by all the Viagra you appear to be buying..."

Apart from the Blue Meanies instigating the whole mess of NHS IT, isn't dreamy Dave also carping on about 'decentralisation' again?

This seems to go against the idea of a centralised database but do we end up then with loads of local databases coupled to a central one?

We'd most likely get problems transferring data from one site to another, the best option then would be to post it on CD's.

Many people seem to be missing the point about the current state of IT in the NHS Dave "freaky fatboy" included. in many cases it's still seen as evil. everything is kept on paper in envelopes, anyone who has ever spent any time in a hospital will have seen people wandering round with shopping trolleys (I kid you not) full of patient records! It will be difficult and it will take a long time but thanks to years of underinvestment and neglect (hmm I wonder who was in power for most of that time - not that labour are completely blameless) we have a system which is frankly shocking and I for one welcome any atempt to improve it.

Dave "I might come up with an actual policy someday" should stick to what he knows about rather than playing political tennis by spreading misinformation and lies!

We have been keeping them, quite safely and usefully, for some decades.

Some of us even start talking about things like medical informatics, and some of the reasons why a pile of records from several databases made by several orgs for several purposes turns out to be just a pile when you amalgamate them.

In Exeter in the '80s the experiment of building a record for use by specialties and GPs was tried. It didn't work. The current effort does not include any solutions to the problems that killed that.

Medical records are not the only thing that we should be looking at, they are relatively easy, accept that there are several sorts of Practice software, note that the laboratory is a good place to hang on to lab results, that the PACS of the local imaging department can usefully hold the pictures and reports, do some caching and devise a framework perhaps with a PKI to allow my machine to ask the machine of a GP in Aberdeen (it won't work BTW since that is another country, come back South to Carlisle for examples) questions such as "IsADiabetic(ID)" or "ListAllergiesAndAvoids(ID)" at need, and send a list of those to the patient as well in a quarterly statement.

No, how about a bit of informatics, of computing, of weak AI, or at least Hinting Engines and Opinionated Systems (one of those would model many of my colleagues quite adequately, and they are easier to build than the Eschaton I think)

Or if you want a working system, take copies of the GPL'd US VA system - called VistA for the last couple of decades, install that and then work on from there...

Because of all the long-term infrastructure systems that should be built of Open Source, healthcare IT is hard to find a better example.

What is being done at the moment is driven by money and power, not by cleverness in IT or medicine. Which is a pity.

"I would prefer to have my medical data stored and accessed locally - how often does one need to receive treatment elsewhere that would rely on that data?"

Once would be enough.

Despite my severe misgivings about the competence of the NHS management and their ability to organise a drinks party in a bonded warehouse I _would_ want the doctor treating me in Belfast to know about my allergy to antibiotics or whatever.

The real problem, however, is the complexity of medical records as discussed here: http://www.bcs.org/server.php?show=ConWebDoc.2972

"The issue here is that patient records are a mixture of data, facts, opinion and observations from and for a wide range of clinical professionals and purposes.

"The temporal and contextual properties of this varied information make health records unlike any other. Information that is hugely important in one context - such as automated blood pressure readings taken in hospital after heart surgery - may be of little significance to a GP during an appointment some weeks later, whereas a single routine reading can be highly significant years later in the event of unexplained heart failure.

"In addition, although basic data such as blood pressure or haemoglobin readings are precise and easily categorized they might be linked to observations and non-unique interpretations or opinions such as 'it is low' or 'possibly due to inflammatory bowel disease'. Indeed, patient records can contain seemingly contradictory statements, but there might be no contradiction if the statements are by different observers at different times.

"Such observations, interpretations and opinions are difficult to record in a structured form. Possible relationships between pieces of information make patient records very complex - but these records must meet the needs of different specialists: some might be interested in a patient’s psychiatric history, others in the progress of diabetes. Different specialists will want specialist information and will interpret it in their own specialist ways."

NHS IT WORKER

"How long before CDs get sent to a drug company showing them what other medications patients recieving their drugs are getting? This information would be woth Millions to a drug company - could a cash strapped government IT department resist?"

This type of comment (from a Doctor) is part of the problem.

Doctors in the NHS are sounding the siren over systems and technologies they don't understand.

What the Doctor here seems blissfully unaware of is that prescription level data is freely available to the Pharma companies already - and not just care of the NHS where in Kent last week a load of prescription papers "fell off the back of a lorry" and had the local plods chasing all over the place picking them up before anyone noticed.

I think i would prefer that such a huge sum of money be spent on Doctors, Nurses, Cleaners, in hospital catering etc.

I have plenty of faith in the skills of the hospital staff to correctly diagnose and treat me regardless of where I present. If the sum of money was spent on improving numbers of staff available so that they were not over worked and under appreciated; that hospitals were cleaned by staff directly employed by the hospital and felt they had some appreciation and ownership of there job; if food was cooked and prepared on site rather than delivered and microwaved then people may actually get better instead of dying from MRSA and other post op complications. If we were seen by the same doctors for repeat appointments so that they actually knew who we were and what our problems were rather than an endless procession of locums, trainees, fill ins, and people whose qualifications may be fine but are barely intelligible because they have such a poor grasp of spoken or colloquial or regional (scouse, geordie, etc) English because it is not their first language.

No amount of money thrown at IT systems can help any of these problems and to have spent 15 Billion and still no end in sight is not just incompetent, its obscene.

I really couldn't give a stuff whether my information is held on a central database, in a brown manila envelope or on sticky notes as long as it works. Most of the money spent so far is on a system that doesn't.

Having worked in an orthopedic department that covers the lake district I can tell you that people being admitted to hospital far from home is not that uncommon (tourists seem to love to fall off mountains). If someone is admitted from another PCT we will have to rely on photocopied/faxed notes from the patient's PCT (as no PCT will send their notes to another for fear of them being lost in the post which would compromise patient care in the future) which can take a long time to get at 3.30am. Even getting notes from another hospital in the same PCT can be a nightmare due to chronically understaffed and underfunded Medical Records departments having to hunt through massive libraries full of disintegrating paper records, often in several volumes and then sending them by taxi if they are required urgently (how secure eh?). I'm not saying that computerized records will solve these problems but to say that 'its all working fine why change it' shows frankly massive ignorance.

One last thing, for all you people not wanting to be on 'The Database', too late, the chances are you already are on the admin database which covers inpatient history (what you were in for and when), appointments, address, marital status, next of kin, clinical and non-clinical correspondence to name just a few. This I do actually support, having seen it most likely save several lives due to being able to quickly get into contact with unconscious patient's relatives who advised about drug allergies

OK, I've seen a number of crackers here, I'll limit myself to two.

"When is somebody going to challenge the Tory party's complete lack of IT understanding?"

Strangely enough, the Tories are actually responsible for the single largest innovation in government IT. The Government Secure intranet (aka GSi) was requested, designed and built during Tory reign. They had the smarts to leave the project alone until it was ready, instead of blathering about it ad infinitum in the press. They were also smart enough to go to vendors instead of spending the money on costly management consultants. Sure, they may not know about IT per se, but with roots in business they have at least a clue.

New Labour introduced their buddies at Microsoft to the platform. The best known instance of that is the Government gateway which has technically no need at all to be dependent on IE.

"It's actually a lack of proper management / change consultancy* that has resulted in the big IT vendors shoeing in systems"

BS. It is a lack of knowledge of the *civil servants* which causes this - created by the same Management Consultants you're so keen to give work because there's never been any knowledge transfer. The arguments for using consultants is the same as for outsourcing and privatisation: if it goes wrong it gives politicians someone to blame instead of taking the hit themselves like responsible adults, and so enormous amounts of tax money have been paid to consultants for sometimes utterly bizarre work.

Remember the "speed camera" study which proved that adding cameras "saved lives"? If you get a document with a fairly simple premise and you find that 50% of it is spent explaining how they got to those (wrong) figures you know precisely that it wasn't a study - it was a conclusion needing a defense.

Remember the ID cards? Check out who did the feasibility study, and who got the work afterwards.

Government procurement? Why did that study not pick up all those fun things which later required expensive change control? Surprise..

Use of Open Source in government? eGIF has been around for a long time, but show me ANY consultancy that is going to suggest something that isn't going to keep them in business with patching and fixing for a long time. It's the ideal dependency generator. Besides, they need a return on investment on all the costs sunk in buying Microsoft tools so there's no way they'll advise using something that is more stable and cheaper to the tax payer.

Please don't sing praises of management consultancies. I haven't come across an honest one yet when it comes to government work. For them, 'ethics' is a sales term, not an operational parameter. It was a good move to put an ex Management Consultant as head of NAO because it means a lot gets 'missed'.

But hey, it's a living. Politicians have to retire somewhere too..

Despite what many people on this thread seem to think, Cameron has it right on the nail.

Where Labour takes every opportunity to remove responsibility from the people that should have it and hold it all centrally, Tory Cameron's policy is completely the opposite and these comments are just an extension of his policy.

I trust my local GP, who knows nothing about IT security far more than I trust any central control-freakish government project because my GP is accountable to ME directly. I trust him to take on the appropriate advice and secure my records appropriately.

As for the Labour model of centralising everything, we all know we can't trust them to take proper advice and the result is catastrophic - as seen with the recent Child Benefit fiasco.

He sure nailed that on the head.

If someone would actually use their brain they'd see the solution isn't that complicated.

It is possible to set up an x500 directory tree structure which can PULL data when required. The problem is defining a standard of control (a hospital should be able to draw your record but an insurance -for instance- shouldn't), but it would allow for local storage, control and monitoring, distributed presence (resilience) and in general would solve all those pesky problems of one set of idiots holding all the data and then losing copies of it.

The basis is that you do NOT have to trust some centrally managed club who got their code from the lowest bidding outfit.

If government was REALLY serious about IT they'd do what happened in the Extremadura region of Spain for schools and business. There the Government paid a couple of people to code up a complete Open Source software package (admin et al), then distributed it for free. Instant standard, single point of support and fixes, no incompatibility problems and easy to control integration..

However, doing that would deprive a Godawful amount of people from having their snout in the trough - can't see any consultancy going for that..

They would if an Open Source solution was stated in the specification.

Seems to me that the Government's "UK Data Warehouse Program" has not been run for the benefit of people of the UK from the start, and is as disasterous as foreign policy has been.

For those who think central is more secure, try it out for yourself.

Set up a few databases on some machines, and place a secret on one of them.

Then split that secret up on many machines.

Now step back and consider where you are going to go to get that secret from.

There is very little value in having your records at the NHS, and there is a lot of value to the governments, this is why you are hearing such ludicrous scare stories; I thought Lord Lucan riding Shergar was going to make an appearance in the 'Londoner goes to Aberdeen one'. :)

And banking has a lot of compromises, credit card fraud is probably happening every minute of the day. I hardly think bank systems are a good example, it is the surrounding security systems in shops and ISPs that are the main defense, not the banking system, which has probably made itself a lot less secure thru centralization. I do hope most realize that is the merchant who gets offloaded with the theft, not the banks.