Getting people taped
A couple of years ago doctors in Sussex received a pamphlet from the Health Department of the county council which might well have come from a medical department of the Third Reich. It extolled the virtues of the new computerised school health service and had this conclusion: "In 1907 the then Board of Education issued to local education authorities Circular 576 explaining the purpose of the newly created school medical service. The circular contains the following passage . . . the Board desire at the outset to emphasise that this new legislation aims not merely at a physical or anthropometric survey or at record of defects disclosed by medical inspections, but at the physical improvement, and, as a natural corollary, the mental and moral improvement, of coming generations . . .
Although the passage of time has brought many changes in emphasis, this purpose is still valid today and the new system will continue to improve the prospect that children are medically fit to benefit from the various types of education available to them".
Of course the worthy doctors of Sussex are interested in enuresis and earache, and not at all in eugenics. Indeed the principal medical officer, Dr Wilde, is both aware and concerned about the nature of computerised medical files. But, for all that, it is only occasionally that the full horror of what has been done in the field of medical records breaks the surface and then it disappears again below the bureacratic sea. The memo quoted above is a typical example;, There have, however, been others. In 1970 Enoch Powell raised the question of a morbidity survey carried out on behalf of the Royal College of General Practitioners. No fewer than fifty-five GPs had merrily sent off personal details of their patients to the computers of the DHSS without consulting, let alone obtaining the permission of, the patients concerned. Naturally the prospect of being pursued by the redoubtable Mr Powell concentrated the mind of officialdom, and the then minister responsible, Sir Keith Joseph ordered that a code number should be substituted for the names. However he made it plain that he had the powers to carry out the survey under Section 16 (1) of the National Health Act.
Sir Keith is not specially culpable, for a succession of ministers including Barbara Castle and Richard Crossman himself, have been outlasted by the civil service who have had their own purpose to create a fully computerised medical records system since the mid 'sixties. It is, of course, useful for medical research and is of great administrative convenience. Unfortunately it also erects the perfect apparatus of the police state and it is this aspect of the, now almost completed, system which is a threat to our liberty. In addition, even in the most benign hands, the identikit picture of human beings is both misleading and damaging. The children of Sussex may rest assured that if they were bed-wetters, or took fits, this will come whirring out of the computer for the rest of their lives.
In the case of computerised medical records the medium is well and truly the menace. Doctors have always possessed potentially damaging information about their patients but until now this has been kept under control of the doctor concerned. Now computerised files disappear into the maw of the bureaucracy and control is lost. Just how powerful the computer is, as a weapon of bureaucracy, may be gauged by the fact that enough information on each single individual in the UK to fill this issue of The Spectator could be stored on one tape which would fit into a brief case. It would have almost instant recall. Indeed the power of modern computers to survey information was shown last week when it came to light that the US National Security Agency was able to scan all telex and telegram communications going in and out of America by programming its computers with key worlds like 'agent' or 'heroin'. The computer reads the astronomic number of communications — including those between correspondents and their newspapers — with an ease which could not be matched if the entire US armed services were put on the same job.
Such a weapon has been the dream of every dictator from Genghis Khan to Hitler. Indeed had the Nazis possessed computerised medical records there would have been no difficulty in finding the Jews, the epileptics, the Jehovah's Witnesses, or the mentally retarded. For that matter had President Nixon possessed the kind of system which we are so swifly developing he would not have had to indulge in anything so vulgar as burgling a psychiatrist's office to find damaging information against Dr Ellsberg. It would have been a simple matter to have obtained his file, within minutes, just as the journalists who caused him so much trouble could have been checked out by simply feeding the computer with the words, 'Journalists — Washington — VD — alcoholism — mental illness — prison'. The list would have shot out of the computer in minutes.
Of course the standard reply by officialdom is that such police-state excesses could not happen here. Unfortunately this is not the case. While one may absolve the present civil service from any interest in eugenics there is no doubt that computerised information has been transferred around the departments and used. The 1971 national census was the seventeenth since 1801 and asked questions of the most intimate nature ranging from marital status, whether there was a toilet in the house, country of origin, and parents origin, address in 1966 and 1970, number of children, and so on. It was intimate, searching,detailed and computerised.
Not unnaturally quite a few people became distressed at the thought of this information being recorded. (What, for example, if your address in 1966 had been a mental hospital?).
Some on principle, refused to fill up the form and a 73-year-old man went to Pentonville rather than pay the fine and a 66-year-old lady went to a remand centre. Sir Claus Moser, the government's leading statistician, made reassuring noises about secrecy and confidentiallity. Yet within a short time officials were calling on 150 women, who had identified themselves as former nurses, to ask why they had left. Incredibly enough it was also planned to sell the information in blocks of fifty to commercial organisations. A spokesman blandly commented: "It is true that a salesman would be given a lead. He would still have to go around the houses but at least he would know where to start". So much for see wrc u
The trouble is that, even without a dictatorship being in control of the country, computerised information will be used. At the moment if a crime is committed which seems to be the work of mentally ill people — for example baby-snatching — the police will approach the local mental hospitals and ask if there were any inmates who might be involved, Often doctors, having satisfied themselves that their patients were not free at the time, will refuse to let the police harry the mentally sick. If the information is computerised there is no such barrier. Where does it stop?
Just how keen government departments are to exchange information came to light a few years ago when an official in the DEP was so shocked at the secret methods employed by their special investigators that he sent me an internal memo issued by the Regional Controller of the DEP in Bristol. Paragraph 9 read: "The Grade 5 investigation officer will maintain a close working relationship with the special investigation offices of the DHSS so that information of mutual interest can be passed on and views exchanged as to the technique, method and sources of information which from experience have been found to be best suited to different types of suspected fraud".
With computers there will now be no meetings in pubs clutching buff files. Just ten minutes access to the computer.
The nature of the damaging information lying around medical files may be judged by a small incident when Dr Wilde, the West Sussex Medical Officer (and someone who, on balance, favours computerising medical files) noticed that information he was sending to the social services contained reference to a homosexual offence committed by a man who had been a useful member of the community for years since the incident. He burned that sheet. But the computer does not forget and the very mass of information it contains limits the number of kindly doctors who can take out embarrassing references.
The start of the civil service campaign to put us all on the computer goes back to 1967 when hospitals were asked to fill up a computer sheet on each patient and send it to the regional authority who in turn passed it on to the Office of Censuses and Population Surveys. The information required included occupation, addresses, birthplace, husband's occupation, religion and so on. Of women it wanted to know if they had ever had an abortion and a special line asked for the 'disposal' of the patient. Some doctors objected but were blandly told that the name of the patient was unimportant since it was only a study of hospitals' activity. However it did take a special effort to remove the name of the patient since there was a carbon below that section and the top copy was retained at the local hospital. By last year 98 per cent of the nation, who had been patients, had been recorded and the whole of Scotland nestled on the computer in St Andrew's House. At the same time an even more searching form was issued to psychiatric hospitals which housed more than 150,000 patients in 1972. The most intimate details of these patients is coded on to the form including prison record if any, method of admission, intelligence level, diagnosis with underlying causes, addresses, and whether the patient has ever tried to abscond. One line, separated from the others, asks whether the inmate has ever suffered • from epilepsy, drug addiction, alcoholism or 'none'.
Then early in 1970, when the systems were fully established the Nuffield Foundation, with DHCC approval, set up a record linkage scheme in Oxfordshire aimed at a seven-year experiment in linking all medical records in the area on one regional computer. The departmental line is that there are no plans at present to make it a national system—which may be taken with a pinch of salt.
Fortunately some doctors have rebelled against the system which has caused much distress in the department. The Aylebury group in Oxfordshire itself are refusing to co-operate in the scheme and their large psychiatric hospital, St John's, refuses to put patients' names on the psychiatric computer forms. Others have joined in, including Friern Barnet in London. In these cases the ministry men lie doggo and wait for the personnel to change, for they have time and ministers come and go. So do awkward consultants.
Nicholas Ridley, after his experience in the Department of Trade and Industry, wrote the following about the civil service in an Aims of Industry pamphlet, which has been abundantly confirmed by what we have been allowed to see of the Crossman Diaries: "I suspect the Civil Service is a political party of monolithic view, which believes in a whole series of policies because it thinks they are in the "national interest". It has its own incubus, its own colossal research department. It thinks it has the solutions that are most perfect.
"It realises that it is necessary to make concessions both to the opinions of the governing party, and to the clamour of the people. But it views these concessions as diversions into politics and acknowledges that this is the proper domain of the politicians. It is important to get back to the 'right' road as soon as the political situation permits".
And how right he is. Never more so than in the decision of the grey men of Whitehall to remove our freedom with the aid of our medical records and the computer.