I am totally FOR an NHS database. The reason is the obvious benefits a computerised system can bring which commentator Axylotl explains in his post. The problem is with how it is implemented, how it is maintained and training of users. The root cause of this is that project estimates are over ambitious with what is being delivered and when, to satisfy targets in political manifestos. The problem is very precisely that its progress is too dependent on our political system. The time required to properly implement an NHS database would require many many years, spanning several government terms, over several general elections. This cannot guarantee continuity over an NHS database project. Goals will be changed by each government in the interests of their own political party disrupting the progress of the project. Public sector can suffer from inertia having no competition to drive them. But outsourcing to private sector means profit driven and telling the client things they want to hear. All of the discussion points you mention Tom could apply to a paper database. Specifically, regarding ID, why not use biometrics i.e. one or a combination of finger print, voice, retina scan? Seriously! No ID to forget or forge then is there? As for 'having access to the entirety of the UK population's medical notes', the database does not necessary have to provide this to all users. For example, in the case of a local GP surgery, records of registered patients at that surgery only need to be provided. To implement a database properly would 1) require a phased approach where functions are implemented in stages 2) immune from change due to political gain and 3) totally realistic in timescales for implementation, maintenance and training. Think of all the mash-up possibilities that a database could bring. When I say mash-up, I mean think how it could be linked to other data, like location, time of day, so that sensible NHS targets can be formulated, including those for LAS.