Dr Raj Persaud argues that electronic identity cards could be just the ticket for the nation's health
The debate about id cards often centres on civil liberty issues, but many in the medical field believe a national computerised ID card system could have some unexpected benefits for your health. It might for example make immediate access to health records possible from a swipe of such a card, no matter which casualty department you end up in, and even facilitates this if you are unconscious and therefore cannot provide your personal details.
Another potential use could be in helping people create artificial boundaries that assisted in behaviour change - particularly addictions or impulsive behaviour.
Dr Gavin Watt and Dr Mireshini Naidu writing in the British Journal of Psychiatry recently pointed out that one unforeseen benefit of the introduction of ID cards is they could be used to control access to alcohol. They point out that alcohol misuse is estimated to contribute to 40 per cent of violent crime, 78 per cent of assaults and 88 per cent of criminal damage, and alcohol is a contributing factor in approximately 50 per cent of homicides.
ID cards would identify individuals who would be eligible to purchase alcohol and would allow people, who have committed crimes while intoxicated, to be effectively prohibited from doing so. A powerful message of deterrence would be sent to those who might offend.
Besides criminals, the second group to be prohibited compulsorily from purchasing alcohol could be children. Evidence from the recent European School Survey Project on alcohol and other drugs is that British children have almost the highest rate of misuse of alcohol in Europe. To protect children, there is a temptation to make identity cards compulsory just for young people.
In addition to compulsory prohibition for the above groups, there would also be a voluntary scheme. People who are alcohol-dependent and who cannot cope with the unfettered access to alcohol in our society could elect to have their identity cards revoked or altered so that swiping them prevented an alcohol purchase. Impulsive purchase of alcohol and then fear of severe withdrawal are potent factors in their relapse into uncontrolled drinking.
A low technology equivalent to this scheme occurred in Sweden from the early 1920s to 1955. Ivan Bratt, a Swedish physician, devised a form of individual control for alcohol. It was based on a ration system where individuals were given an allowance of four litres of alcohol a month. Individuals had to buy their alcohol from only one outlet.
If they offended while intoxicated they could have their ration reduced or stopped. It was very successful in reducing overall consumption, admissions with medical problems related to alcohol, violent crime (by 60 per cent), public drunkenness (by 70 per cent) and the overall prison population. It was abandoned in favour of a system of higher taxation, which has not been so protective.The possibilities for ID cards are indeed endless - but in a positive way - not the negative connotation usually involved by the civil liberty lobby.
Case study three:
Central Southern Critical Care Network's Bed Management scheme
The need for critical care networks to have timely, accurate bed availability information can often be an urgent one. The Central Southern Critical Care Network's "Winbeds" application has been developed to help NHS Trusts struggling to cope with the increasing pressure on bed management.
Ward staff update the web-based Winbeds system with bed status and an expected discharge timescale. Critical care network staff can then easily search the system to find an available bed in any of the 10 hospitals across the network.
The system is easy to use, with wards viewed as a map, with colour-coded beds indicating status and availability.
Clinical Governance Co-ordinator, Lisa Dawson, says that the new system has helped in the actual decision making process: "If we go through the old Emergency Bed Bureau system we would have to have made the decision to transfer first before we approached them. Whereas now we can identify where the bed is. If it is five minutes down the road, you might think 'okay we'll wait', but if it is 30 miles down the road, you'll think 'let's do it now before anything else happens'."
By cutting time, cost and bureaucracy, Winbeds has meant that patients are reaching critical care beds sooner. "It certainly enhances patient care," says Lisa, "because you are able to base your decision making all around the risk benefit equation."
Prior to using Winbeds, staff had to phone around trying to find an available bed, potentially involving staff at all 10 hospitals - not only the person calling to find a bed, but staff at each ward answering the query.
