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Mr. Bercow: Does my hon. Friend agree that although the Government might not have devoted a great deal of thought to their proposals, they have thus far certainly devoted a great number of words to them? I am pleased to see new clause 1, which pithily sets out the basis of what Her Majesty's Opposition would like to insert into the Bill in only 151 words, in contrast to the two and a half pages of unreconstructed and inexplicable verbiage on pages 58 to 60 of the Bill.
Dr. Fox: It is becoming habitual for me to agree with every word that my hon. Friend says. He has encapsulated the simple idea that if the Government mean something by the legislation, they ought to say it in the Bill. This part of the Bill has been drawn far too widely. If the Government's intention is as the Minister explained in Committee, that should be in the Bill.
The Minister's comments in Committee demonstrated the lack of thought that had gone into the subsections of clause 62, formerly clause 59. Other hon. Members and I highlighted in Committee instances in which the law could either be unworkable or render existing practices unworkable. The Minister spoke frequently of the need to ensure that regulations were adequate and correct. The degree of thought that he now recommends should have occurred before the framing of the Bill rather than during the final days of Committee.
Adequate thought has still not been given to the matter, and no satisfactory response has been given to the concern of GPs that the powers in the clause could make it mandatory for them to pass on identifiable patient information against their will, or against what they believe to be their patients' best interests. Will the Minister explain how that provision is sustainable in the face of principle 10 of the NHS plan, which states that the confidentiality of individual patients must be protected? The two concepts do not sit side by side.
The definition of patient information provides the Secretary of State with the power to ban the use of important and beneficial non-personal data, yet it also allows him to share identifiable health data at his own discretion. The clause states that the Secretary of State will use his powers "in the public interest", but that could easily become an excuse for the suppression of politically inconvenient data.
Last year, the Government abolished the patients charter in favour of a glossy brochure called "Your Guide to the NHS". A Government who are willing to use public money to publicise their party's health policies are a Government who would be willing to use possible restrictions on data to suit their party political policies.
I can make no better summary of the problems that we are trying to address in new clause 1 than to quote a letter to The Guardian signed by the president of the Royal College of Physicians, Sir George Alberti, as well as by the chairman of the Royal College of General Practitioners, the director of the World Health Organisation Uppsala monitoring centre, the chairman of the Patients Association and the chairman of the Depression Alliance. I quoted the letter in Committee, but it certainly bears being put on record again. It was written by people who are well respected in their field, and who cover the whole spectrum of the practice of medicine, of patient groups and of those who have devoted their lives to patient care. They state:
As it stands, the Bill provides the Secretary of State with such sweeping powers as to allow him to curtail or prohibit the collection of anonymised patient information, however derived, and conversely require or regulate the release of confidential information, without the patient's consent, for reasons that he judges appropriate. Remarkable as it may sound, these measures have been barely raised either in or out of parliament and were not included in the Government's National Plan.
It is our view that independent collection of information on the NHS enables analysis of information that the NHS does not collect or cannot provide easily to patient organisations, academics, public health bodies and the pharmaceutical industry. We have witnessed the value of such data in scrutinising the performance of the NHS and improving healthcare.
We urge the Government, in the spirit of open government, to withdraw this clause until adequate consultation has taken place. Only then can we reach an informed consensus about what controls are required both to protect patients but nonetheless allow access to anonymised information so necessary in monitoring and improving patient care."
New clause 1 tries to tie down this part of the Bill to the purpose for which most of us believed it was to be used, involving one of the most important aspects of maintaining disease registries. If the Government do not accept the new clause, we can only believe that they want wider powers for reasons that go beyond those they gave in Committee as the justification for this part of the Bill. I commend new clause 1 to the House.
Dr. Brand: I declare an interest as a clinical practitioner, in that I work as an independent contractor to the health service as a general practitioner. It is relevant to make that declaration, as I would not like to be in conflict with the Secretary of State.
Renumbered clause 62 gives the Secretary of State powers to override the wishes of patients on the control of clinical data. I can tell the Secretary of State that most of my colleagues would join me in saying that the wishes and desires of their patients far outweigh any powers that any Secretary of State may care to take to himself or herself. Even the theoretical powers that the Secretary of State may be adopting could be profoundly unsettling for a profession that cares for patients above all, and could make the work of clinical practice a great deal more difficult.
Dr. Fox: To make the point even more explicitly, does the hon. Gentleman accept that, under the Bill, he and other practising doctors could find themselves in conflict with the Secretary of State for not providing data about a patient, or with the General Medical Council for providing it? Does he agree that that would be an unacceptable position for any practitioner?
Dr. Brand: That illustrates the position fairly clearly--and it would be a brave Secretary of State who took on a doctor acting in the interests of his patient. I hope that such circumstances never arise, but the Bill contains the potential for them.
We accept that there is a problem with the maintenance of existing disease registers, especially cancer registers. In the past, consent was assumed far too frequently. In my view, it would be impractical to refer to people on existing registers in order to obtain formal consent to enable us to continue the excellent work that has been going on for decades, and has done so much to help us to understand the epidemiology and treatment of cancers and other diseases. However, I do not think there is any justification now for not asking for patients' consent at the time of the onset of their illness, or when they may be entering a register. Even after the probing in Committee, I still cannot understand why the Minister must take potentially wide-ranging powers if the aim is to maintain an important register and to deal with the anxieties of the Data Protection Registrar.
A problem has been created by, I think, parliamentary draftsmen rather than Ministers. There was an opportunity to introduce a bit of legislation, and the Government clearly needed an NHS Bill before the election. They looked at what they should put in the legislation that they envisaged, and this is part of that. There is a real problem with, for example, the existing cancer registries, but rather than concentrating on that the Government said, "Here is an opportunity to create a few more sweeping powers". There was then a great outcry.