This article was published in Digital Health on 4 August 2025.

Do not miss the foundational idea in the 10-year plan. Amongst all the details of Wes Streeting’s 10-year plan for the NHS – scale up robotic surgery; shut down Qangos; tie doctors’ pay to patients’ opinions – the Single Patient Record may sound too dull to discuss. It is too important to ignore.

Surely this exists already?

Every person believes a single patient record exists. Until the person becomes a patient. Then they see the madness of health care: every specialist maintains a separate set of records. Your general practitioner is but one specialist of many. All of them chose their records system to support their billing, not your care. None of them knows what the other specialist is doing to you. This happens in every country.

The problem gets bigger as every advance in medicine heralds a new speciality, recording separately about its patients. Meanwhile health care rarely provides a record system to the biggest providers of care – the patients. For most of health care – diabetes, heart disease, asthma, every long-term condition – what you do at home matters more than what your doctor does in the hospital. But specialists lock out patients from records and ignore the records the patients maintain.

In reality, the patient’s memory becomes the real record. The only person who was there at every appointment is the patient. That’s why clinicians end up asking the patient what happened. That’s how the patient becomes the integrator across the health care system. 

A problem as old as health care

I welcome the UK government’s ambitious 10-year plan for England, particularly its commitment to a Single Patient Record and the expansion of the NHS App. This is a bold and necessary vision for the future of our health service.

I have dedicated my life to working on this problem. It is a wicked problem. But it can be solved and it is important to solve.

I first understood the problem as a patient with a rare disease, seeing the fragmentation of care from all the specialists who saved my life. They taught me to pay attention and take action to help them as they helped me. At medical school, I saw the problems they faced as I joined their ranks. As I learned to write software I also saw the solutions that could help everyone.

So I spent the last 17 years dedicated to the concept of patient-controlled health records: a single patient record, owned and controlled by the patient. We already know that this workable model exists, proven through successful regional implementations that demonstrate its efficacy.

This time is different?

The government’s idea only has a chance of working if the patient owns the Single Patient Record.

There have been many failures. The UK, with the world’s largest National Health Service, made the largest attempts at a national record system. Its National Program for IT became the largest failed IT program in history.

A Single Patient Record was part of the vision of the National Program for IT. Phase 1, the Personal Spine Information Service, failed early on with repeated reductions in scope. But speaking to founders of health records companies who worked during that period, the government made a concerted effort before quietly changing tactics.

Its next approach was for large top-down procurements in each of five regions of England. Originally budgeted at £2.3 billion in 2002, the programme ended 10 years and £12 billion later.

Care.data was the next decade’s attempt. The idea was to combine the data sets across government records systems to build up UK PLC. But Joe Public objected to pharmaceutical companies and the insurance industry having access to health information. Especially when the patient themselves could not access that information about their health.

This time the government has a chance if it sticks to one fundamental principle from its 2025 trial balloon: that the citizen owns the record.

The patient is the answer

In researching 16 countries’ national personal health records systems, only two countries had a health records system combining more than 5 million people’s data: the Kingdom of Saudi Arabia and Turkey. Western nations – Denmark, Sweden, Spain, Italy – all divided data regionally, and England has done taken the same path in its 42 regions.

But if the patient owns the record, the democratic deficit disappears.

Owning the record does not have to mean owning the responsibility. You own the money in your bank account but the bank is responsible for security and service. Society benefits when you don’t store cash under your mattress and society benefits when you don’t store your records at home. Everything is more efficient and pooled savings grow economies.

Correct consent gives the patient the power of control without the burden of control. Of course an adult patient can make their data available to anyone they want. There are nuances for children, and for adults who lose mental capacity, but the principle stands for most patients in most situations.

A patient can also indicate their wishes through passive actions to support active care. For example, consulting a clinician indicates the patient wants care and therefore consents for the clinician to see the data. This is how care can be safe. The patient can explicitly change their mind in the future, but they do not need to log into a web site while in pain on a stretcher. These workflows are already in place for millions of people in England every day.

The patient is the future

Healthcare has profoundly changed since the NHS was founded in 1948. Back then, it was often a “cure or die” scenario; today, long-term conditions dominate. In a long-term condition, what the patient does matters more than what the physician does.

Furthermore, a huge amount of data critical to their ongoing care – from blood sugar readings to exercise logs, mental health insights, and medication adherence – is generated outside the traditional clinical records. It resides with the citizen. The modern citizen is increasingly empowered by countless health apps, wearable devices, and personal health tools, generating a vast and diverse pool of valuable personal data.

A centralized, government-owned system, by its very nature, struggles to adequately govern, integrate, and effectively utilize this fragmented yet vital patient-generated data. The trajectory of healthcare evolution unequivocally demonstrates the necessity of integrating non-governmental entities – from innovative tech companies to community care providers. Yet each of the national government-owned systems we studied struggled therefore ignored these data sets. As devices advance, government systems fall further behind, unable to truly reflect the holistic health picture of an individual.

Without a fundamental shift to patient ownership, the system remains closed to the full potential of transformative technologies like artificial intelligence (AI) and predictive analytics, both of which rely on comprehensive, accessible data. This structural limitation stifles the very innovation the government rightly seeks to foster.

Furthermore, citizen ownership is crucial for accelerating clinical research. True progress requires citizens to trust that they have control over access to their data. Empowering individuals to share their de-identified data safely and securely fosters a broad, democratic research community, essential for breakthroughs in diagnosis, treatment, and prevention.

Seizing the Opportunity with Citizen at the Core

My 17 years in this field have only strengthened my conviction: the patient-owned model is the only robust, future-proof, and truly universal way forward for health data, regardless of who builds the underlying infrastructure.

The government’s 10-year plan presents an unprecedented opportunity. For the Single Patient Record and the NHS App to truly succeed and transform healthcare in England, they must be built on the bedrock of genuine citizen ownership. This isn’t just about technical implementation; it’s about a philosophical shift that empowers individuals and unlocks the full potential of our collective health data for the benefit of all.

Let us not just build a system, but empower a nation, by putting the citizens firmly in control of their most personal asset: their health.