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6.45 pm

My final point is on rural pharmacies. Pharmacists receive additional revenue from commercial companies in return for anonymised data. That revenue is greatly welcomed by rural pharmacies across the country, which provide pharmaceutical cover to many housebound and many elderly patients through, for example, prescription delivery and collection and extended opening hours. The remuneration that pharmacists receive from the NHS has been reduced significantly in recent years. That has led them to look for new revenue sources. Income derived from prescription data can help provide additional employment, extend opening hours and be of broader use to the NHS.

I therefore ask the Minister to think again about that very wide definition and to see whether, even at this late stage, he cannot help the House by being more explicit about why he needs such very wide-sweeping powers.

Mr. Fabricant: On clause 59, which has become clause 62, the Bill's explanatory notes state:


If the Bill's aim was to try to limit the complexity and uncertainties, it has patently failed to do so. As the hon. Member for Isle of Wight (Dr. Brand) said, there could well be conflict between the current terms of clause 62 and his responsibility to the General Medical Council. I would state the case even more strongly. As things have not changed so much in these days of new Labour that doctors no longer adhere to the Hippocratic oath--they still do--I wonder whether there would be a conflict between the Bill and the Hippocratic oath.

There is no question but that the Secretary of State could find himself in conflict with the General Medical Council or with the British Medical Association. The hon. Member for Isle of Wight said that a Secretary of State who willingly engaged in such conflict would have to be a brave Secretary of State. I say that he would have to be not so much brave as foolish. Nevertheless, although it is most unfortunate, foolish Secretaries of State are not unknown, particularly in this Government.

It is important to gather such information, particularly in disease registers, for epidemiological purposes. However, as both my hon. Friend the Member for Woodspring (Dr. Fox) and the hon. Member for Isle of Wight said, it is also important that we know where certain drugs are being used. I take the hon. Gentleman's point on generic drugs. Drug companies often push their own branded analgesics and other remedies that could be bought at one-tenth of the price as a generic product at Boots or another pharmacy. Paracetamol with codeine is available under the most marvellous names, pushed by drug companies at 10 times the price of a generic product. I can understand why the Government would be cautious in allowing that type of detailed information to fall into the hands of drug companies.

As my right hon. Friend the Member for North-West Hampshire (Sir G. Young) said, anonymised information does not fall into that category. During the past few weeks, I have become aware of how the National Institute for Clinical Excellence--which was established not so long ago by Health Ministers--has made recommendations on drugs that should be available for

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doctors to prescribe free to their patients. In some areas, however, those drugs are still not available because of postcode funding. In some parts of the country, drugs are not available because the money for them is just not available. That has happened in the South Staffordshire health authority area, for example.

New clause 1 is still not as tight I would like it to be. It still gives considerable powers to the Secretary of State.

Mr. Bercow: I feel sure that the House will want to hear my hon. Friend expatiate on the subject of new clause 1. Before he does, would he turn his mind to clause 62(4)(c), which is part of the genesis of our objection to the Government's proposals? The subsection provides for regulations


Does that not create a potentially hazardous and even sinister conflict of obligations? If not, would it not be better if the Government explained themselves more clearly?

Mr. Fabricant: My hon. Friend, as ever, has put his finger on the heart of the matter--if that is not mixing my metaphors. I think that doctors and the BMA have every reason to be alarmed by the far-reaching nature of clause 62. It is saying, in effect, that if the Secretary of State so decides, any question of confidentiality that might exist between a patient and his doctor can be swept aside and the information can be made public. Should we be surprised that so many august organisations acting on behalf of patients and people suffering from specific dysfunctions such as AIDS are concerned about the clause?

Dr. Stoate: The hon. Gentleman makes a fair point about the proposal, which does have potential problems. But surely he must accept that there have always been notifiable diseases that a doctor has a legal duty to notify, including patient-sensitive data. That even includes food poisoning. If a patient visits a GP with food poisoning, that doctor is under a legal obligation to notify the health authority, whether the patient likes it or not. We have always had the need for public health measures such as the notification of diseases and disease registers. Surely this is not a draconian and brand new measure; it is merely what has gone on for some time, but in a slightly different way.

Mr. Fabricant: The hon. Gentleman misses the point and does so because he is a doctor and not a lawyer. Of course he is right that this sort of data have always been collected for epidemiological purposes. That is tremendously important. When the Conservative Government introduced trusts--which the present Government are attempting to build on--we made sure that epidemiological research would continue nationally. Clause 62(4)(c) makes it clear that the information so provided may not now be anonymous. That is the difference. In the past, doctors would notify the NHS through its various agencies of a particular event

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or dysfunction. However, there was no obligation previously to provide the name of the person suffering from such a dysfunction.

Dr. Stoate: This is an important point. The notifiable disease register contains patients' details; it must. If a patient of mine were to get tetanus, polio, typhoid, cholera, hepatitis or even food poisoning, I would have to identify that person to the local health authority by name, age and address, as the patient would have to be contacted and followed up for public health reasons. Patient- sensitive data have always been held.

Mr. Fabricant: But that data were always confidential. The point is that now they may not be.

Dr. Brand: I wish to clarify something said by the hon. Member for Dartford (Dr. Stoate). Epidemiology can deal with anonymised data, and it is perfectly proper that it should do so. Notifiable diseases are notifiable because they may present a risk to the patient if not treated. More importantly, they present a direct risk to people coming into contact with the disease. That is not an argument that can be applied to most registers.

Mr. Fabricant: That is the point. [Laughter.] It is all very well people who have just walked into the Chamber laughing at this exchange--it demonstrates why time is needed for Members such as myself, who did not serve on the Committee, to explore the meaning of the clause. That is what this Parliament is all about, for God's sake. But the Government are saying that these important issues have to be terminated at 9 o'clock. It is all very well for Labour Members to laugh and say that the issues are not important, but the BMA and the other organisations to which my right hon. Friend the Member for North-West Hampshire referred are worried. As the hon. Member for Isle of Wight said, it is one thing to discuss notifiable diseases such as tuberculosis, or other diseases that can generate epidemics; it is another to talk about other forms of disease, details of which may now be placed in the public domain by virtue of the Bill.

Dr. Fox: Does my hon. Friend agree that it is not a question of what has happened in the past--even in specific cases, such as notifiable diseases--or even what is likely to happen with the use of data, but what could happen under the wide powers in the Bill?

Mr. Fabricant: My hon. Friend is right; that is why there is concern among organisations such as the BMA. We recognise that some form of register needs to be kept--that is why my hon. Friend has tabled new clause 1, which still gives considerable powers to the Secretary of State. Subsection (2) says that


The Secretary of State will be free to prescribe, but by regulation which requires the scrutiny of this House; that is right and proper. The definition of "prescribed patient information" is of great concern to some doctors inside this House and to the BMA. In the new clause, the definition is


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There is clearly concern among the medical profession about confidentiality. It is one thing to provide information to the NHS about those dysfunctions that may produce an epidemic in this country; it is another to give far-reaching powers to an unscrupulous Secretary of State to require personal information given by patients to doctors or learned by doctors from their patients to be given to him, and for that information then to appear in the public domain.

It is no surprise to me that the BMA should be concerned. What surprises me is that Labour Members do not share that concern.


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