cards marked

The government's latest review of the identity card scheme promises to set out 'the next steps' for the project.But is its likely effect on healthcare any clearer, asks Lyn Whitfield

Say what you like about home secretary David Blunkett, but he is not a man to duck a fight. And with the Home Office already under fire left, right and centre, he is about to rejoin the identity card battle.

A draft ID card bill is due once the Office of Government Commerce has completed a 'gateway 0' review, and a good idea of its contents can be gained from Home Office document Identity Cards: the next steps.

Newspapers presented this as a setback for Mr Blunkett when it came out last November, because it says 'a full debate and vote in both houses of Parliament' will be needed before cards can be made 'compulsory'.

It is hard to see why. The scheme set out in Next Steps is very similar to the proposals set out in an earlier consultation paper, Entitlement Cards and Identity Fraud (the name has changed because the Home Office believes the public prefers 'identity card' to 'entitlement card').

A national identity register will be set up to store basic details about individuals against a unique biometric identifier, such as a fingerprint or iris scan.More secure passports and driving licences - that is, ones storing the same biometric identifiers - will be linked to the register.

As pressure group Privacy International points out, this will effectively make ID cards compulsory for the 80 per cent of the population that holds one or both of these documents. A plain ID card will be available from around 2007 for the 20 per cent that does not, and it is this card that Next Steps says will not be compulsory until Parliament votes on the issue.

However, it also says the Home Office will be working with the public and private sectors to encourage use of the cards - and since Next Steps came out, officials have admitted to the Commons home affairs select committee that 'life will become very difficult' for people without them.

It could certainly be difficult for people who need the NHS. The consultation document was silent about whether cards would be needed to access healthcare.

Next Steps says the NHS is one of the organisations the Home Office will work with to 'maximise the benefits of a card'.

But it will not be necessary to produce an ID card to access free public services unless - or until - Parliament votes to make them compulsory. Even then, it says, 'emergency treatment' will be open to people without cards. 'Emergency' has yet to be defined, but restricting access to such treatment seems almost certain to exclude illegal immigrants, groups with chaotic lifestyles and even the elderly.

British Medical Association spokeswoman Christine Munden says cards will put staff in a difficult position. 'Doctors are not agents of the state, to decide who is eligible and who is not, ' she says.

Human rights group Liberty says ID cards would 'alter fundamentally the relationship between the individual and [the] state', and doubts whether a scheme could be made affordable and secure.

Along with the Law Society and many others, Liberty says cards will not solve the problems for which they are touted as a solution. They are unlikely to stop illegal working, for example, because unscrupulous employers are unlikely to demand it.

All these arguments have been heard many times, but Mr Blunkett is pushing on anyway, and this may bring concerns about the impact of ID cards on public services to the fore.

In England, there are organisations, led by Migration Watch UK, that want to see ID cards keep 'health tourists' out of the NHS. And the home affairs select committee heard that people may not be able to register with a GP unless they have a card. But across the border, the idea of an ID card to use free public services is so sensitive the Scottish Executive has already said it will not happen, at least in the services it runs under devolved arrangements.

Mr Blunkett has an interesting battle on his hands.

Public inconvenience

Recent stories about airlines being delayed by inaccurate security information show that it is difficult to build systems to detect the guilty without inconveniencing the innocent.

An ID card scheme is not likely to be any different. Liberty says there must be 'thorough investigation' of biometric security - and in particular iris scans - before an ID card scheme is pinned on them.

If iris scanning was used at every airport on every passenger, it says, an impressive 99 per cent accuracy rate would still generate 1.5 million 'false positives' a year.Around 150 million people fly each year; rather more use the NHS.And being turned away from the health service could be rather more serious than being turned away from a flight.