Shame

In the flood of positive PR for Freedom of Information’s 10th anniversary, a piece appeared in the Manchester Evening News that shows a possible downside of the legislation. The MEN is my local paper and the main hospital in the story is the closest to my house, but I didn’t notice it – it was highlighted on Twitter by Dr Ben Goldacre and then to me by Sarah White.

The story concerns individuals who make multiple visits to A&E departments, and in particular, the revelation that one person went to A&E at Wythenshawe Hospital more than 100 times in an 11 month period in 2014. Several individuals – including a child – are mentioned, including the number of times they attended and the hospital in question, although the reasons for attendance are not revealed. The information was obtained using FOI.

An (unnamed) spokesperson says: ““Due to patient confidentiality, we would not comment on individual cases” but the problem is, they already have commented on individual cases by releasing data at an individual level. Goldacre’s concern – encapsulated in a comment he put on the story – is that by releasing the information and facilitating comments, these individuals are being exposed to unkind comments from strangers. As one of the other (unnamed) spokespersons observed, one of the likely reasons for multiple A&E attendances is mental health issues. Imagine being the person who went to Wythenshawe 116 times last year, and reading your story, reading comments about what you have done being ‘disgraceful’. Admittedly, the MEN’s handling of the story isn’t as hysterical as it would be in the Dailys Mail or Express, but how long will it take for them to pursue a similar story?

What happens if the parents of the kid mentioned in the story realise that it’s their family who are the “A&E frequent fliers“, draining the resources of “embattled” local hospitals? What happens if, as a result of the shame (which I suspect is the intended effect of this story), they don’t take their kid to A&E next time? What happens if the alcoholic, the self-harmer, the domestic violence victim, the anorexia sufferer – what happens if one of them knows or suspects that they are one of the frequent fliers, and then they don’t attend when they need to?

I live in the same postcode as Wythenshawe Hospital, I frequently drive and cycle past it, and several people that I know and love have been treated there. The ‘frequent flier’ could be one of my neighbours, someone who shops at the local supermarket; if I wasn’t so resolutely anti-social, I might even know them. It’s not likely that I would be able to identify them, but University Hospital of South Manchester NHS Trust (UHSM), the public authority that runs Wythenshawe and answered the FOI request, have consciously set those hares running to make a point about the over-reliance on A&E. That woman who always has an ambulance outside her house, that woman who is always down at A&E, I bet it’s her.

I am about to fall into the worst FOI trap, one I mention every time I run an FOI training course. It’s almost impossible to say that any request is an abuse of what FOI is intended for, because FOI is not intended for anything. It has no purpose clause, nothing to say what you’re supposed to use it for. If the Manchester Evening News want to try to use it to get a quick headline at the expense of vulnerable people, they’re absolutely entitled to do so but they shouldn’t get the information. And here I jump into the trap: FOI is not for this. FOI is not there to expose citizens, it is to expose the organisations that serve them. We need to know that A&E departments are run properly, that the managers responsible for them ensure that services are available so that people are not reliant on them when they should be elsewhere in the NHS system. However, exposing civilians to the glare of publicity is wrong and moreover, unnecessary.

I believe that the likelihood that the individuals cited in this story may be identifiable to their friends and neighbours, and as such, the release of their personal data is unfair – UHSM should have used Section 40 of the FOI Act to refuse to disclose this information on the basis that to do so would breach the Data Protection Act. I also believe – as Ben Goldacre said – that disclosure is likely to lead to adverse comment, and so Section 38 of FOI (which prevents disclosures that would endanger physical or mental health or safety) should also have been used to refuse. No matter how difficult and expensive some of these people might be, exposing them to shame and possible identification is a disgrace. It should not have happened.

Comments

  1. You are right – you have fallen into the trap! The problem is not the request, which throws light on to the impact of official decision and policy making, but the response which failed to apply the safeguards built into the Act. Anyway, Happy New Year and keep up the good work.

  2. Bilal Ghafoor says:

    A good article, Tim. Your point about FOI being there for us to understand organisations and no members of the public is a good one. But this (moral position that I totally agree with – nothing is more important in info rights than personal data) can often be got around by restating a question.

    So, ‘Can I have the pass/fail rate for course X at university Y’ can also be stated as ‘I am looking into how well university Y runs course X and, as part of that, can I please have the pass/fail rate?’

    Or, ‘can I have stats for the ages of young females who have had abortions, broken down by age and numbers of abortions’ can be restated as ‘I am interested in knowing how well schools in your area have done on sex ed and how well public health services are running – as part of this, can I please have stats on abortion for young females, etc’.

    No doubt, s.40 applies and so the information might not get released (although DH lost its case on abortion stats quite badly a few yrs ago), but while I agree with the principle of not exposing citizens, sometimes the only way of understanding the work of an organisation is to look at the impact on and outcomes for citizens.

    So, I totally agree with you, and work hard on personal data issues, I wish that your moral axiom could be restated to make it work (I can’t figure out how to do it).

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