Following
the implementation of the Occupational Health Smart Card Scheme for
GMC-registered doctors working in the NHS in England, we look at the follow-up,
the ‘cardholder internal placement scheme’. By Linda Goldman & Joan Lewis
In
the vast medical world that exists outside the NHS, it may not be widely known
that occupational health records for NHS doctors are kept on a type of credit
card. This, to all intents and purposes, puts the details of their lives on to
something that is so like Visa, you have to hope that they do not use up all
their credit in one go.
The
NHS Personal Data Card has the prime purpose of holding a doctor’s OH records
so that they can show that their health is up to scratch as they move from one
NHS appointment to another. Being something more than a highly-specialised
identity card, it holds other information, including essential personal and
contractual details such as the doctor’s grade and specialty.
Hierarchy
The
card is similar in shape and structure to that of a credit card. Consultants were
initially displeased with the universal dark-blue format but have been placated
by the new-style cards to be issued from the beginning of April, indicating
professional status in the sort of obvious way that has long been favoured by
credit card companies. Thus, consultants with sufficient seniority will not
only have a platinum card but will also be able to offset merit awards against
having their cards constructed in a plasticised version of platinum. The
additional weight of the precious metal is seen to be a minor factor when
assessed against its obvious value. Doctors can also apply to have their
specialty reflected more visually in their cards. For example, radiologists
will be able to choose cards that glow in the dark. The health risks will be outweighed
by the practical uses.
The
extension of the use of these cards to OH practitioners has not been widely
publicised, mainly because the OH card is beige – a colour from which no overt
inference can be made as to status unless you read the PIN (Personal Income
Number) on the reverse. All PINs begin with 0104 and are followed by two
numbers showing, first, the hundreds then, second, the tens of thousands of
pounds in annual wage/fees. Status is only achievable by leaving the PIN number
on display (see box below).
For
example, a nurse practitioner in a lucrative private consultancy in Mayfair
holds a card of the same outward appearance as one who is under threat of
redundancy in a moribund industrial plant in a slum clearance area – the only
difference being the PIN. At present, there are serious discrimination issues
looming under the Diversity Act (Financial Trappings) 2000 as there is no route
(hence no appeal from any refusal process) to gold or platinum status. Even
silver has not been contemplated.
The
only concession that is being planned is in the form of acquisition of OH Miles
for each transaction performed. The system is not generous. For example,
scanning a pre-employment health questionnaire will attract 10 OH Miles. Even
difficult exercises involving, if you will excuse the Department of
Occupational Health jargon, anti-personnel-rage-intervention limitation for
Outside Organisational Licences, will only credit the practitioner with 25
miles. The problem is that, at present, no matter how many miles are collected,
OH practitioners will be familiar with the concept that there is nowhere to go
with them.
Fraud
Further
extension of the use of smart cards is currently at a standstill because of
serious and unforeseen concerns. As scientists struggle to find a secure method
to prevent fraud in the use of credit cards, it is apparent that a veil of
secrecy has been thrown over well-founded rumours that the cloning of smart
cards has already happened. It has also been said, though still unconfirmed, that
this has resulted in the appearance of cloned doctors, complete with
registration numbers.
The
real fear is that the OH card, by reason of its beigeness, will be even more
vulnerable to the cloning process. It is not reassuring for members of the public
to know. It is a profoundly ethical trans-professional duty that they should
not be allowed to know that cloning so far has resulted only in a duplication
of an individual frozen in time in terms of practice and training. Genuine
(original or ‘born-as’) OH practitioners should be readily identifiable by
checking their answers to a few short but relevant questions about up-to-date
knowledge, recent courses, articles they have read (particularly this one) and
so forth. ‘Original’ practitioners should be able to identify clones by their
failure to keep up to date. So far, there is no sign of the ‘second-generation
clone’, which, although not actually up to date, can pretend to be.
Security
take-up: personal identification data
Although
the idea of status identification with a card is interesting, and the
temptation of miles may act as a lure to draw OH practitioners into these
portable data schemes, the risk is that some sort of data carrying will be
compulsory. It is currently proposed by the Department of Occupational Health
that the OH profession should be the flagship for the use of the new cardholder
internal placement scheme, although some would argue that the label
‘guinea-pig’ might be more apt.
This
scheme involves placing all the data held on the smart card onto chip, which is
then inserted into a suitably accessible part of the body. A system of scanning
the chip, akin to passing through security controls at the airport, would be
used to make sure that the practitioner had the credentials required and was
fit to practice in terms of character, health and training. References could be
included on the chip as well.Â
The
scheme is proving problematic, as those who are part of the experimental group
have been all stopped for suspected shoplifting (those who have been in stores
with tagged security systems). Unfortunately, this information is then
permanently recorded on the chip, thereby damaging their characters, unless the
chip is removed. Hence, siting the chip has been critical. Placement under
acrylic fingernails with 6mm overhangs has been useful for females but has not
been used with much enthusiasm by male participators. Some chips got lost in
layers of fat, which were otherwise deemed to be safe sites, necessitating
stringent dieting to enable recovery. It was foreseeable that the traditional
hiding place in dental fillings would give rise to teething troubles, but an
ingenious device for increasing the acidity of saliva by use of vinegar has reduced
some of these problems. The place that has been most satisfactory and is most
likely to be the preferred site, having stood the test of time, is the
shoulder.
Human
rights issues
There
is a legal difficulty with the use of chips. This is not to do with the
placement of the chip but in the knowledge that, should the scheme become
compulsory once an ideal insertion site had been determined, there will be a
claim that the system infringes Article 1404 of the European Convention on
Occupational Health Rights as incorporated into the Occupational Health Rights
Act 2004.
The
chip, by transmitting data about the carrier, is saying more than any truth
drug could ever say. Those who have nothing to fear can wear their chip with
pride, but there is more to fear than release of personal data. What if OH
records about clients or patients ever made their way, even inadvertently, on
to the chip? As the ethical issues are limitless, it is right that full
consultation should take place within the profession about the best way to
store data and to make it readily accessible. The Occupational Health Data
Commissioner – www.ohinapril@gain – will be interested in your views on whether
there is a useful life for the chip in the future or should it go in the bin.
Linda
Goldman is a barrister at 7 New Square, Lincoln’s Inn. She is head of training
and education for Advisory, Consulting & Training Associates and Virtual
Personnel (ACT Associates & Virtual Personnel). Joan Lewis is the senior
consultant and director ACT Associates & Virtual Personnel, employment law
and advisory service consultancies, and licensed by the General Council of the
Bar under BarDirect. Tel: 020 8943 0393
Pin
numbers showing wages
010447
– 47 are the relevant numbers: annual fees/wages £470,000
010409
-09 are the relevant numbers: annual fees/wages £90,000
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010402
– 02 are the relevant numbers: the rarely seen fees/wages £20,000*
*This
card could be a collector’s item if found
