Health and Social Care Bill

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Mr. Denham: The hon. Member for New Forest, West (Mr. Swayne) has raised some useful points and I hope that I can deal clearly with our policy intentions. We shall address these matters in regulations made under the clause, but what we intend to do on health authority accreditation goes some way towards meeting the hon. Gentleman's concerns, although not entirely.

If a GP co-op provides out-of-hours services covering two or three health authority areas, it is obviously sensible for the health authorities to agree that one health authority should take responsibility for accrediting the service for all of the others, to avoid repetition of a bureaucratic process, and regulations will provide for that. However, we do not think it appropriate that an out-of-hours provider who is on the list of one health authority should automatically have that accreditation accepted by all other health authorities. The reason is that some out-of-hours providers are very large--some are large commercial organisations. Although legally they are single bodies, they have a fairly loose federal structure, and the quality of service can vary from one part of the country to another, even though the umbrella organisation is the same.

Thus we feel it necessary to allow a health authority, if it wishes, to choose to accredit the organisation that offers the service to patients in its area. We believe that to be the right compromise. Under these arrangements, part of a large organisation—I do not want to single out the commercial deputising organisations—would not receive an automatic right to accreditation everywhere simply because it offered a perfectly satisfactory service in one place, as quality of service varies.

Mr. Hammond: I understand what the Minister says, but as the clause is phrased, it is the person providing the service—that is, the company—that is being accredited. The health authority would therefore be unable to determine who was providing the services. It could be a national company based in London that provided services all over the country.

Mr. Denham: The health authority would be able to look at the arrangements being implemented in that particular area—for example, to satisfy itself that the information technology requirements or the arrangements for clinical audit were in place for patients in its area.

Dr. Brand: Has the Minister considered an alternative way of tackling this problem? If approval in one health authority qualified a large company to practise in any other, it could lose that approval in all health authorities if its performance was unsatisfactory in any one of them. In some franchising operations, those who trade on well-known national images may not be diligent in ensuring that that national package is being delivered locally. That would make the larger organisations more accountable.

Mr. Denham: The hon. Gentleman is right about accountability. Our solution allows the individual health authority to carry out the accreditation process itself. That will provide a stronger safeguard than the health authority having to accept the accreditation of other authorities and being able to object only once problems came to light. I think that we are at one on the level of accountability required.

We entirely accept the principle behind amendment No. 169, but it should be dealt with in regulations. It is important that a patient's GP or a person providing personal medical services has full and up-to-date information when one of his patients has been seen out-of-hours—information on who saw the patient, the diagnosis, what was prescribed and so on. The out-of-hours review recognised that. The Government intend to specify that out-of-hours service providers must supply full clinical details of consultations to practices by the start of the next working day. We will make regulations to ensure that GMS principals and other providers of primary care receive the necessary information.

Mr. Hammond: If the Minister is committed to ensuring continuity of care and that information is passed back to the principal practitioner, what arrangements will he put in place to ensure that the details of a patient's walk-in consultation is reported back to his GP?

Mr. Denham: It is a consistent part of the walk-in centre programme to develop and improve those links. That relates to the electronic patient record, which the hon. Member for New Forest, West mentioned. Paragraph 4.21 of the NHS plan states that there should be

    access to electronic personal medical records for patients by 2004.

By that time, we expect that

    75 per cent. of hospitals and 50 per cent. of primary and community trusts will have implemented electronic patient record systems.

That is the extent of the progress that the Government hope to have made by 2004.

In the interim, it is not sufficient for walk-in centres to wait for electronic patient records to come along at some time in the future. Depending on the local infrastructure, local protocols are being developed with primary care groups to use electronic communications, fax or telephone, as appropriate.

Mr. Hammond: What would happen if a patient walked into a walk-in centre and refused to disclose his identity? My understanding is that the patient would receive a consultation like any other patient, although it would not be possible to report back, whether or not there is an electronic data system. That would be a serious disruption to continuity of care. If the Minister is concerned about the issue in relation to out-of-hours treatment, is he not also concerned about the proliferation of walk-in centres leading to patients being able to opt part of their medical history out of their records? That is happening in some walk-in centres.

10.45 am

Mr. Denham: Every effort is made not only to encourage patients to identify themselves at walk-in centres, but proactively to encourage patients who are not registered with a GP to do so. I am not entirely sure whether the hon. Gentleman was suggesting that those who, for whatever reason, do not want to disclose their medical histories should be turned away from NHS treatment. However, we are working hard to ensure that continuity of care is maintained. That is a key objective in our development of this new and convenient method of access to the NHS.

Dr. Brand: I am sure that we have a long way to go on information exchange, as a recent Which report pointed out. Would the Minister answer the question asked by the hon. Member for Runnymede and Weybridge slightly differently? If a patient registers normally at a walk-in centre but specifies that certain aspects of the consultation should not be shared, does that patient have the right to have those details withheld? The answer to that question will clearly be relevant to later debates.

Mr. Denham: I should like to take advice on that, as that is slightly outside the scope of the amendments, which are about out-of-hours services provided by GPs or walk-in centres if they are part of an accredited system of out-of-hours services. I am not entirely sure of the precise legal rights that patients may have, in any part of the NHS, not to disclose their full medical history if they prefer not to do so. I would like to be sure before saying how that would apply to walk-in centres or out-of-hours services.

Dr. Brand: It would help if that advice was made available in time for our later debates. It is not uncommon for a patient to share all sorts of information, and a core of information certainly needs to be shared, but a patient may not want to share certain aspects of a consultation. For instance, a pregnant under-age girl may not want a family friend who happens to be the GP to have that information shared. It is important, when we reach the information-sharing provisions, that we recognise that there are real ethical problems as well as administrative problems.

Mr. Denham: I am grateful to the hon. Gentleman for that early indication. I hope that the Committee accepts that it is better for me not to risk misleading the Committee on those legal issues, but I shall ensure that we can return to them in due course.

Mr. Hammond: I am grateful to the Minister for his indulgence in allowing me to make one final point in this rally.

He asked a few moments ago whether I thought that patients should not be seen at walk-in centres if they did not want to disclose their identities. I was not suggesting that; I was asking the Minister to acknowledge an inconsistency. We all believe that, in principle, continuity of care is a positive thing, and the amendment seeks to achieve that for out-of-hours services. Does the Minister accept that, by creating walk-in centres, with all their convenience, the Government have for the first time allowed patients access to the NHS free at the point of use without that consultation having to be entered in their medical records?

For the first time in the family practitioner service, we will allow patients selectively to edit their on-going definitive medical history. As in the example given by the hon. Member for Isle of Wight (Dr. Brand), patients already do that to ensure that information that may be embarrassing or inconvenient or that may affect their insurance ratings is excluded from their medical history.

Mr. Denham: I am not sure that that is the case. For example, those who go to accident and emergency departments and do not reveal their real identity are not turned away. There are many ways in which patients can do that. It is generally undesirable, although the hon. Gentleman mentioned circumstances in which it might be necessary. For example, in the tradition of genito-urinary medicine clinics, confidentiality is respected. It has always been possible to gain access to the NHS without identifying oneself. Perhaps we can return to that matter later.

Mr. Swayne: My hon. Friend the Member for Runnymede and Weybridge has drawn our attention to a key point that goes to the heart of our concern about the fragmentation of access to the NHS.

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