The government wants NHS staff to help in the fight against crime.But there are misgivings that such collaboration will undermine patient confidentiality. Lynn Eaton reports

You could be forgiven for thinking that the NHS is about treating patients who are ill and improving the health of the nation. Think again. In the government's latest plan, it will help tackle society's ills as well.

Crime and violence figures in the UK are far higher than in other European countries. Something, prime minister Tony Blair has decided, must be done.

And who better to help than the NHS?

As government ministers are more than keen to point out, ill- health, poverty and crime are closely linked.

NHS staff have a huge amount of information about patterns of crime in their area. Professionals in accident and emergency departments know if a new group of people are presenting with drug-related problems or if the same woman is attending repeatedly with injuries caused by domestic violence.

And hospitals themselves - particularly car parks - are crime hotspots.

Health service staff are also often the victims of violence.

The government argues that, in return for better information, the number of patients who need treatment as victims of crime can be reduced. Crime and violence within hospitals might also be tackled.

That, at least, is the theory. In practice, it is still too early for evidence to prove the point. But ministers are so convinced it can work that they are holding a series of 'road shows' around the country to put forward their views.

The first of these was organised in London last week. Two ministers - the Department of Health's John Denham and Charles Clarke from the Home Office - turned up to promote the idea.

Mr Denham was very concerned at the failure of the health service to pick up its new responsibilities under the 1998 Crime and Disorder Act (see panel), which introduced the concept of local partnerships working together to tackle crime.

'NHS organisations have not, in general, maintained a full contribution to these partnerships, ' he said. 'I know there is a big agenda for the NHS, but it is essential that NHS organisations play a full role in these partnerships.'

Both ministers were keen to push a two-prong approach: first, that by having good relationships with their local police, the NHS might help tackle crime in its own hospitals and GP surgeries; second, it might, through anonymous data, provide information to the police about patterns of crime in their area, from violence on a housing estate to an emerging drugs problem.

They also touched on a highly contentious issue in their suggestion that where a patient gives a member of staff information which could help in the investigation of a crime, that information can be passed on to the police.

Mr Clarke addressed this from a Home Office perspective when he spoke later in the morning (joined-up working may mean two ministers appear at the same conference, but don't expect them both there at the same time).

'The idea, ' he reassured delegates, 'of putting a policeman in every conversation a doctor has with their patient is not what we are talking about.'

Nonetheless, this issue goes to the heart of patient confidentiality. While most patients might feel information told to a doctor would never be passed on, the NHS was given the power under the 1998 Crime and Disorder Act to do just that if it feels the information is in the public interest.

The act does not, however, force disclosure.Where a patient does not consent to disclosure, staff must decide whether public interest outweighs the duty of confidentiality.

Mr Denham had hoped to have new guidelines on improving safety for community staff to present to the conference, but these have been delayed until June.

He also wanted to create a culture in which the NHS took responsibility for tackling crimes such as domestic violence rather than assuming it was someone else's responsibility.

Mr Clarke argued for improved healthcare to help tackle crime, particularly treatment for offenders wanting to give up their drug habit.

'The biggest hole in our position is the question of proper rehabilitation facilities for people to come off hard drugs, ' he said.He hoped more money might be forthcoming for this in the next spending round. He also singled out mental health trusts as being particularly poor at communicating with their local community.

Admitting that one of the biggest problems was getting two completely different cultures to find ways of working together, he promptly started to use language that would leave many NHS staff feeling distinctly uncomfortable: 'We believe your intelligence is a really important asset potentially.'

Pity those delegates, like the security or fire safety officer, who had to go back and persuade their chief executive that, yes, this really must be yet another top priority. And yes, big brother is watching your progress.

Acting up: where the NHS stands Under the 1998 Crime and Disorder Act:

The NHS has a statutory duty to participate in local crime partnerships, run by police and local authorities.

The NHS has the power to disclose information to help tackle crime.

The person holding confidential information must decide whether the duty of confidentiality or harm to the relationship with the patient outweighs the public interest.

The DoH advises all NHS organisations to have protocols for handling information in such situations and is working on national guidelines.

Anonymous statistical information can be disclosed without fear of breaking confidentiality.

Crime and Disorder Act. www.homeoffice.gov.uk/cdact/cdaguid.htm