It's 3am in casualty and the latest customer is noisily unwell. Luckily, the police know part of his name, which the doctor taps into a terminal. Up comes a history of substance abuse, psychiatric care in the community and records of current prescriptions.
Normal practice in the modern NHS? Dream on. Even if the hospital has an electronic patient-records system, it will almost certainly not contain information from GPs, psychiatrists and community carers.
At best, this lack of shared information between health and community care is inconvenient. At worst, it can allow tragedies like the Victoria Climbié case.
The gap is partly caused by IT: systems on different sides of the divide were never designed to communicate. Nowadays, however, IT is less of an excuse.
A bigger barrier is the professional chasm between local authority-run social services and NHS medical professionals. The two even speak different languages. "NHS organisations talk about treating patients while their colleagues in social care talk about support for clients," says Dr Gillian Rankin, director of service development at South & East Belfast trust, which runs both health and social care.
Under the latest NHS reforms, shared social service/NHS teams are to become the norm.
Everything depends on sharing information. South & East Belfast is piloting a system to be used by all professionals when assessing, referring and planning care. It is based on a community system born as part of a European-funded research programme, Ithaca, and commercialised by a specialist firm, In4tek.
However, a shared record can also be built from existing systems. In Doncaster, a local health community including hospitals, social services and GPs practices has been sharing medical records electronically since 2000.
Its solution, says Ian White, head of information at Doncaster and South Humber NHS Trust, is a "community data warehouse" based on browser technology. The software, from specialist firm CSW, uses XML mark-up language to assemble records from records such as discharge letters stored in existing systems.
Consultant psychiatrist Dr Keith Wildgoose says the system is a breakthrough for clinical practice. "One person had 22 sets of case notes within this organisation: you're expected to make rational, informed, safe decisions on that?"
Clients will benefit, too. "I did a domiciliary visit to an elderly lady the other week and it transpired that on the same day the social worker and community nurse had also called. She was well fed up at being asked the same questions for the third time."
But any hopes for the NHS to adopt shared records face a further barrier: patient confidentiality. This is one of the oldest principles in medicine: after decades of relatively cavalier treatment of people's records, the NHS has ruled that personal health information must not be shared without the patient's "informed consent".
It is now wrestling with what this means in practice. Earlier this year, a public consultation found, not surprisingly, that people are happy for information to be shared among their care team, but they are unhappy for it to go to managers (or IT contractors). Results of this consultation are due to go to ministers next month.
"There does need to be some very clear coherent policy on this," says Marlene Winfield, head of patient and citizen relations at the NHS information authority. "But we're not there yet."
Wildgoose says that the Doncaster warehouse works on pragmatism. "We explain the purposes to which the information we gather can be put. But we don't pro-actively seek individual consent from every individual for every use because that would paralyse the system."
Doncaster is already piloting one aspect of the national shared record, an online service called Health Records Infrastructure (HRI), which will pull together information from existing computer systems to create a virtual record. This will be made available to hospitals and GPs as part of the Integrated Care Records Service (ICRS), one of the major applications being procured this year under the NHS's £2.3bn National IT Programme.
Richard Granger, the NHS's IT director general, said last month that although the ICRS will eventually integrate all aspects of care, NHS records would have to come first. "We need to be very focused on the core NHS segments of ICRS. The other things are important, but they're going to be done in ICRS release two or three."
In Belfast, Rankin reports one breakthrough: an answer to the question of client or patient: "We now talk about users, or even better, people."
