Mr. Burstow: Will the Minister develop that point a stage further? If the Secretary of State has to decide how information is dealt with, will the Minister assure us that in all circumstances the consent of patients or relatives will be sought before the information is passed on to some new body?
Mr. Denham: We shall need to work through the exact arrangements in detail but, on first hearing, the hon. Gentleman's suggestion sounds eminently sensible. The Secretary of State will have to act properly with regard to the fact that the information is personal and confidential.
Question put and agreed to.
Clause 8 ordered to stand part of the Bill.
Exempt Information Relating to Health Services
Mr. Denham: I beg to move amendment No. 189, in page 58, line 37, leave out from `Authority' to end of line 38.
In the old days, before programme motions, one could happily dwell on one or two amendments for an entire afternoon. These days, the mind has to switch from topic to topic much more quickly.
This amendment amends paragraph 8 of schedule 1, which relates to GPs providing general medical services, or other practitioners providing services under part II of the National Health Service Act 1977, such as dentists. The amendment ensures that the description applies not only to those practitioners who provide services in the area of the scrutiny committee's local health authority, but to any part II practitioners.
Paragraphs 10 to 12 are intended to prevent the public disclosure of confidential or personal information about GPs and other primary care practitioners. The provisions also apply to their employees, such as practice nurses, placing them in the same position as employees of NHS bodies under paragraph 1 of the schedule. In practice, a scrutiny committee may deal with a wide range of different NHS bodies, and that may involve information going beyond that concerned solely with the committee's own area.
At present, paragraph 10 refers only to the part II practitioners on the list of the scrutiny committee's local health authority. However, there is no reason to protect only local GPs and not GPs in neighbouring health authority areas. Paragraph 11 already applies generally to providers of personal medical services or personal dental services, as does paragraph 1, which concerns the employees of NHS bodies. The amendment merely brings paragraph 10 in line with those provisions.
Amendment agreed to.
Schedule 1, as amended, agreed to.
Public Involvement and Consultation
Mr. Swayne: I beg to move amendment No. 246, in page 7, line 39, after `Authorities', insert `(including Special Health Authorities)'.
The Chairman: With this it will be convenient to take amendment No. 79, in page 7, line 39, at end insert
`( ) Special Health Authorities'.
Mr. Swayne: Clause 9 places a duty to consult and involve persons for whom services are provided on health authorities, primary care trusts and NHS trusts. Our amendment would include special health authorities.
We have to put the case for the inclusion of special health authorities, but I rather hoped that the Minister would persuade me why they should not be included. They provide services to consumers, as set out in the clause. I notice that line 31 of page 7 states that people may be involved ``directly or through representatives'', which strikes me as entirely appropriate to our amendment, given the nature of special health authorities and the people that they serve. It strikes me that the clause was almost designed to accommodate them through representatives.
I look to the Minister to either accept the amendment or tell us why special health authorities should be excluded from the provisions.
Mr. Denham: Essentially, the reason for not including special health authorities is that by 2002, when the scrutiny committee procedure is in place, there will not be special health authorities providing services directly to patients, certainly in the way that we have been discussing. At present there are 17 special health authorities, but only the three special hospitalsBroadmoor, Ashworth and Ramptonprovider health services directly to patients. The others provide a service to the NHS or carry out some other health service function on a national basis, for example the Prescription Pricing Authority, which administers prescriptions and payments to pharmacists.
Mr. Philip Hammond (Runnymede and Weybridge): Would the Minister rule out the possibility that a special health authority would be created in the future to provide other services directly to patients? It is a mechanism that the Government has already used a couple of times to implement provisions quickly.
Mr. Denham: We certainly have no intention to do so. We have moved away from the special health authority model. As the hon. Gentleman will know, the services provided by Broadmoor and Rampton will be provided by trusts and that is clearly the direction in which we wish to go in respect of Ashworth, too.
Our approach has been to build into the organisations that have been set up under the provisions of special health authorities their own arrangements for patient involvement. The National Institute for Clinical Excellence, for example, was established as a special health authority and NICE has its own arrangement. We ensured, for example, that the partners council of NICE would have representatives of the health professionals and patients and carer interests as well as other involvement. That is the approach that we prefer to take. The hon. Member for New Forest, West asked me why we had excluded special health authorities. It is because they are not direct providers of services to patients in the same way as the other bodies that we have mentioned.
Mr. Burstow: We, too, have sought to include in the Bill a requirement that special health authorities are part of the new empowering regime within the NHS. That is not least because of our concerns about the operation of NICE, particularly in regard to the discharge of its responsibilities in respect of appraisal of new health technologies and therapies. I was led to table the amendment by the experience of patients and patients' organisations in respect of the appraisal of beta interferon and copoxone. I do not want a long discussion about it because I think it is more appropriately debated elsewhere. However, that case signals why, although the legislation that established NICE may well contain regulations and obligations concerning the involvement of patients, the provisions have not translated into practice. As a result, many people outside the House have experienced a very unsatisfactory set of arrangements in respect of that appraisal and fear that that practicewhich has also entailed the wholesale rewriting of the rules in regard to appraisalshas led to great concern about the way in which NICE is discharging its duties.
For that reason alone, let alone some of the arguments that have been put forward by Conservative Members, we feel that it would be of benefit to have special health authorities included in the Bill so that they too can be part of the new empowerment agenda that the Government are advancing.
Mr. Swayne: I am not entirely sure that I follow the Minister's logic. I cannot understand how special health authorities do not provide a service direct to patients any more than health authorities do. Once the primary care trusts have been set up, in what way would a health authority provide services more directly to patients than a special health authority? I do not understand the distinction that he is drawing between the two. If one falls within the provisions of the clausethe requirement to consult, particularly with respect to the planning of servicesI do not understand why the other should not.
Mr. Denham: I would like to respond to the point raised by the hon. Member for Sutton and Cheam regarding the National Institute for Clinical Excellence. Like him, I do not wish to get into a debate about beta interferon. NICE would probably state that it had made considerable efforts, during its appraisals, to consult with patients' organisations and to seek the views of patients. We need to draw a distinction between that and any inevitable disappointment there may be at the conclusions that have been reached, or at the fact that no conclusion has been reached. It would be difficult to mount a case that NICE has not attempted to involve patients in its work, although there is, undoubtedly, always scope for improvement.
Mr. Burstow: Just for the record, the Minister says that it would not be possible to advance a case to that effect. Does he accept that in respect of the appraisal of the disease-modifying treatments for multiple sclerosis, the appraisal committee specifically refused to take personal testimony from patients at its hearings?
Mr. Denham: For good reasons, the Government have not been drawn into detailed discussions about NICE and beta interferon. We have eschewed comment until the appraisal is over. However, I understand that NICE received evidence
Mr. Hammond: Will the Minister give way?
Mr. Denham: No, I will not, because I am still answering the previous intervention. I have hardly started.
I believe that NICE would state that it took evidence from appropriate patients' representatives, but I do not want to go further into a detailed discussion about beta interferon at this stage.
Mr. Hammond: Before the Minister moves on, will he give way?
Mr. Denham: I was going to answer the point made by the hon. Member for New Forest, West. Health authorities are a key part of the local provision of services. They may not be, except in certain specialist areas, direct providers of services, but they undoubtedly have a key role in shaping the provision of services at local level. For that reason they should fall within the provisions of clause 9, alongside the other direct providers of patient services.