Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO)

In 2014, a leaflet describing the care.data programme landed on doorsteps across England. Many households later said they had never noticed it, and others took it for junk mail. The programme was paused within months and closed in 2016. Seven years later, plans to extract GP records for research drew such opposition that the rollout was delayed, with well over a million people registering opt-outs before the pause. Both episodes involved sound analytical ambitions. Both stumbled over the same obstacle, which was whether the public believed the system had earned access to its records.

That history gives a document published this week by the World Health Organization and the University of Zurich unusual relevance in Britain. The Trust-building self-assessment tool for health data policies in the digital age is aimed at officials who write and revise data policy. It asks them to consider when trust matters, who should be involved, which conditions must be in place and what the evidence says. It produces no score and no certification. It is meant to be used in a participatory way, with policy staff and ministry colleagues working through the questions together.

The British debate has largely treated trust as a communications problem to be solved after the policy is settled. The WHO tool moves it upstream, into the review process itself. That is a more useful place for it. Trust, as the authors observe, is often regarded as vague and abstract, yet it is shaped by concrete choices about governance, transparency, consent and oversight. Naming those choices makes them discussable, and discussable choices can be changed before they harden into programmes.

The timing suits the NHS. The government's reform agenda rests on a shift from analogue to digital, with a single patient record, wider use of the NHS App and a growing role for artificial intelligence in diagnosis and administration. Each of these depends on data that patients must be willing to share and clinicians willing to record accurately. Waiting lists and workforce shortages give ministers little room for another stalled flagship. A programme that loses public confidence loses months, and months are the one thing the system cannot spare.

Procurement adds a further dimension. Contracts with large technology suppliers have attracted sustained scrutiny, much of it focused on who holds the data and under what terms. Whatever the merits of individual contracts, scrutiny of this kind shows how readily public doubt attaches to any arrangement that is poorly explained. A structured review of trust conditions at the procurement stage would give NHS leaders a record of the questions asked and the answers given, which is more than most programmes can currently produce.

Life sciences have a direct interest as well. The government's ambition to make Britain a destination for clinical research and health-tech investment depends on linked, high-quality data from a population that continues to consent to its use. Companies cannot manufacture that consent. They can only operate within the social licence the public extends, and that licence is renewed or withdrawn according to how institutions behave. Industry therefore has good reason to welcome any process that tests public confidence before capital is committed.

The tool has limits, and its authors do not claim otherwise. It was designed for the WHO European Region, which includes the United Kingdom, and it must be adapted to local governance. Britain's four health systems hold different data arrangements, so no single review would fit all of them. A self-assessment also relies on honesty from those conducting it, and an exercise completed to satisfy a checklist would add little. The absence of a score is a considered feature in a system used to league tables, since it discourages box-ticking and invites argument among the people best placed to resolve it.

Still, the contribution deserves credit. WHO Europe has taken a concept that every policy professional endorses and few know how to operationalise, and given it a structure that can be used on an ordinary Tuesday in a government department. Its guidance draws on research with policy professionals who said they valued trust but lacked concrete direction. That is a direct answer to a stated need, and few international publications can claim as much.

The practical step for NHS England, the Department of Health and Social Care and the devolved administrations is modest. Run the questions against the next major data programme before its design is fixed, include patients and frontline staff in the room, and record what is found. Public confidence is the scarce input in a data-driven health service. WHO has handed officials a way to measure the risk to it before the money is spent.

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