The NHS could face a£400m bill if it seeks 'express consent' from patients for all uses of their medical data, experts have warned.

But in an analysis of how confidentiality issues affect the health service, a report commissioned by the NHS Executive says seeking express consent for all uses is 'not an option'.

Instead, it recommends a 'silver solution' to the issue that has threatened the work of the UK's cancer registries. It is a solution that is costed at£25m over five years.

Controversy between advocates of patients' rights to confidentiality and public health experts seeking population-wide data on diseases such as cancer, increased after new confidentiality guidelines from the General Medical Council prompted several trusts to stop supplying data to cancer registries. The row became the backdrop to debate on the Health and Social Care Bill which will result in establishment of a statutory patient information advisory group.

The report by Cambridge Health Informatics accepts that the NHS is 'at risk of legal challenge' due to breach of the 1998 Data Protection Act and that the concept of 'implied consent' the NHS has relied on is 'flawed and not valid'.

But its report argues that obtaining patients' express consent for all uses is 'not an option', and 'may not reduce the risk of legal challenge in proportion to the cost of obtaining it'.

The lesser 'silver' option proposed would provide a 'best return' by reducing the risk of legal challenge for reasonable cost. It would include a package of measures, including a communication campaign to 'bring about a major increase in transparency about how the NHS uses personal information'.

The campaign would include distribution of leaflets through the NHS and the provision of information through the media.

Training for staff on how to handle patient enquiries would also be involved.

Gaining Patient Consent to Disclosure.

www. doh. gov. uk/nhsexpiu/ whatnew