The government is to push ahead with the creation of an NHS summary care record after making partial concessions to doctors and privacy campaigners on confidentiality and consent.

Outgoing health minister Lord Warner announced that patients will be able to refuse to have their summary uploaded to the NHS 'data spine' and not just to block their summary being shared.

However, he also announced that patients will have to 'opt out' of the new system after local publicity campaigns, instead of 'opting in' as some campaigners wanted.

National director for patients and the public Harry Cayton, who led a task force to defuse rows about the scheme, said this was the most ethical position because the elderly and vulnerable people most likely to benefit were least likely to opt in.

However, Ian Herbert, vice chair of the British Computer Society's health informatics forum, said the government had still not clarified what the summary is for and how it will be used: 'It is rebadging it as something akin to the Scottish emergency care summary, and there are clear benefits to that. But patients must give consent each time it is used and it has not been said that will happen in England.

'Nor has it been said it will only be used for emergency care. If it is going to have other uses, patients should be told.'

Big Opt Out campaign leader Helen Wilkinson-Makey said the new commitments were 'meaningless' because patients could not get out of other parts of the NHS care records service.

Despite continued scepticism, about 50 primary care trusts have expressed an interest in piloting the summary care record and the way is now open for around five to pilot a version with information about medications this spring.

A number of these 'early adopters' will be able to let patients see their summary through the 'health space' feature of NHS Direct.

The decision to press ahead with the summary element of the NHS CRS was made amid signs that other aspects of the national IT programme are being changed.

The NHS operating framework 2007-08 confirms that a local ownership programme will make the IT programme 'part of mainstream NHS business' and that there will be devolution of responsibility to NHS organisations.

Strategic health authorities will become responsible for realising the programme's benefits, while primary care trusts and providers will be expected to draw up plans to deliver national systems and local priorities.

The BCS has urged the government to go further. A report from the health informatics forum says the national programme should be recast as a business change programme, with local organisations given advice and funding to invest in IT within national standards.

It also says the CRS should be redefined and the development of the summary record put on hold, in favour of a system of messaging that would allow clinicians to access information in diverse systems.

'There are some areas where we need more information about where things are going, but where we do have information, things look good,' said Mr Herbert. 'We do not want the IT programme to be abolished. We do want it to change.'