The new Gift Relationship between the public and the NHS. Not blood but data.

Some of the time I enjoy being old and retrieving the value of important experiences from long ago. In 1966 I went to the LSE to study social policy. One of my teachers, Richard Titmuss, had played a major intellectual and practical role in creating the post-war welfare state. He and his colleagues had a great combination of intellectual drive and moral strength. Whilst I was being taught by him he was working on a major book about the welfare state that was published after I left in 1970 as The Gift Relationship.

It has a simple but powerful message about the way in which blood was distributed in UK and other societies. In the UK we gave blood to each other. We did not know who would get the blood we donated we just did it. I remember discussing this with my Mum and Dad as a youngster* and of course it was described as a completely normal way of giving and receiving blood.

This relationship of a gift to strangers was used by Titmuss as an analogy for different sets of social relationships. His social policy point is that if your health service depends on buying blood, the people who were most likely to sell it were those that needed money who were likely to be amongst the poorest, and the poorest were more likely to have diseases. And if you really needed money, you were not likely to tell a buyer the truth about any infections you had had.

Paying for blood made it more unreliable. Giving blood made it more reliable and cemented relationships between strangers across society. This was a strong point about who were are in this country and his book hammers this home with power and relish.

If this hadn’t already happened, and in 2018 people still jealously guarded their blood and I suggested that, as a society, we could start giving blood to each other – I would be dismissed as horribly naïve. It would never work because – well why should people do it?

But given that it’s been happening for so long we know why people do it – they know that when they need blood someone else will give it to them – a reciprocity if human relationships between strangers makes the system work. And its normal.

So now, in 2018, I want to suggest something that many will dismiss as naïve.

We should have a clear and consistent campaign for people to donate all of their health and healthcare data to the NHS to be used beyond their own health needs for the good of others.  Like blood we should trust the NHS to use our donation for the best outcomes.

If we collect most patient data in a single database it would be immensely useful both in saving lives and diminishing pain and distress. But to do it we would have to trust the NHS with our data in the same way as we do with our blood.

Actually, given that at various times of our lives we trust the NHS with our very lives, it’s not so odd to trust it with anything less and however important we think our healthcare data is, it isn’t as important as life itself.

But as I suggested yesterday, this goes beyond the use of data to help others get well. Yesterday I suggested that it is the new driver for wealth in the same way as energy or cars had previously been drivers for wealth.

Facebook Instagram and Google are all worth hundreds of billions of pounds because they capture our data. The NHS, if we donate our data, would have a database that would be worth billions. Anonymise that data and the English NHS would, for the first time, have a significant resource stream that would remove it from 100% reliance on taxation.

The English public would give its money as taxation and its data as a source of wealth.

We don’t need partnerships with big private data companies to do this, we need to have the skill and determination – as we have had with the NHS as a whole – to find public ways of turning this resource to the advantage of the NHS.

Naïve? Maybe, but then so was the notion of giving blood.


*I must have known about this by the age of 13 because Tony Hancock’s famous blood donor episode was screened in 1961 and by then I knew that blood donation was a normal part of life.

One Reply to “The new Gift Relationship between the public and the NHS. Not blood but data.”

  1. Profoundly right. There’s a great body of evidence (see Alfie Kohn for example) which shows that extrinsic rewards destroy intrinsic motivation, which I think is the point here. “Reward” for giving blood is not the tea and biscuit, but the sense of contribution.
    Data is even easier and can do so much good. We need to be absolutely bombproof on the information governance though. Look at the destruction wrought by, and even today I question what EMIS have done with their survey to Patient Access users. Every abuse of trust puts back the cause of freely given data for the common good.

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