Chris Smith is a nice chap but, like most politicians, he has enemies. During the 1990s, powerful interests would have loved to expose the shadow health secretary and later culture secretary as HIV-positive. The fact that Smith was able to keep his secret for 17 years is testimony to the resilience of the medical profession's Hippocratic oath. "Whatever I see or hear ... which ought not to divulged, I will keep secret and tell no one."
Can the 2,300-year-old oath survive the age of the joined-up electronic medical record? Yes, says the government: the care records service now under construction will flag up unauthorised attempts to look up anyone's medication record. No, say sceptics: a system with a million users can never be secure. Even if the snooper is caught and disciplined, the damage will have been done.
The debate is important. Most of us are not HIV-positive or public figures, but we can all imagine confiding in a doctor things we would want to keep secret from a parent, an insurance company or an employer. As a result, the NHS IT programme has stressed from the beginning that patients will be able to "opt out" of their records going on to the system.
What this will mean in practice is still unclear.
Last week, the care records development board, set up to advise the IT programme on ethical issues, agreed a form of words for the opt out, together with a guarantee of how the NHS will safeguard personal data. The exact wording hasn't yet been released, but according to Harry Cayton, the board's chair, it amounts to: "You cannot refuse to have a record kept by your clinician, because they have a duty to keep records. But you can control who sees that record."
That sounds fair enough: health professionals have rights, too, and we all have an interest in the NHS maintaining a robust evidence base of data. The problem is, the guidance seems to contradict the impression given at a press briefing earlier this month. (I cannot report what was said because journalists who write regularly on NHS IT were not invited.) Those who were there, however, quoted an assurance by health minister John Hutton that patients would be able to opt out of electronic records entirely. It now seems that this will apply only in the most exceptional cases - HIV-positive politicians, perhaps.
This needs to be sorted urgently, if the electronic health record - the famous "spine" designed to enable services such as electronic booking and prescribing - is to become reality.
Perhaps, though, we're still asking the wrong question. Instead of working out a form of words for opting out, shouldn't we be asking patients whether they want to opt in? The onus would then be on the NHS to educate the public on the benefits of maintaining and sharing electronic health records, so patients can make informed choices.
And isn't choice what this whole multibillion-pound IT revolution is supposed to be about?
