HC Deb 17 February 1966 vol 724 cc1673-88

10.30 p.m.

Mr. W. R. van Straubenzee (Woking)

I beg to move, That an humble Address be presented to Her Majesty, praying that the Public Health (Leprosy) Regulations 1966 (S.I., 1966, No. 12), dated 10th January, 1966, a copy of which was laid before this House on 17th January, be annulled. These Regulations to which I am drawing the attention of the House concern the method by which the disease of leprosy is notified medically. I realise that I should incur the wrath of the Chair if I were to go at all wide. Nevertheless, perhaps I may be allowed to say briefly by way of general introduction that I suppose the disease is one of the oldest known to mankind and certainly one of the oldest which have been known to those of us who are in the House at the moment, for we will have heard of it literally in the course of all our lives, largely from a biblical connotation.

It is interesting to recall the dramatic story of the second Book of Kings of the captain of the host of the King of Syria, Naaman, who was told by Elisha to wash seven times in the Jordan, and to reflect that if he was doing that in the Thames in 1966 and if Elisha was a qualified medical practitioner he would come within the ambit of these Regulations against which I am now praying.

These Regulations, I repeat, are concerned with the notification of disease. As I understand it—and I hope the Parliamentary Secretary to the Ministry of Health, for whose presence at this late hour I am very much obliged, will correct me if I go wrong on any question of fact—the present law relating to notification of the disease is contained in the Public Health (Leprosy) Regulations, 1951. I think it was in that year, in Statutory Instrument 1036, that the disease for the first time became notifiable. Nor is it difficult to see the reason, for, by and large, this is not, mercifully, an indigenous disease. It is not one which affects permanent residents in this country.

I believe the last indigenous case of leprosy died in Shetland in 1798, and, since we no longer have any Scottish Members present, I am able to make that assertion without fear of being knifed in the back. Therefore, I say quite simply and without making any point about it that this is a disease overwhelmingly connected with those who come into this country. Under the Regulations of 1951—they are the Regulations which are at present in force—

Sir Douglas Glover (Ormskirk)

If I may interrupt my hon. Friend, those who come into this country may be British citizens who contracted the disease while serving abroad. It does not mean that they came to this country for the first time.

Mr. van Straubenzee

Yes, I understand that. I am merely seeking to make the point that it is not, generally speaking, a disease which those permanently resident in this country contract—at least, not at the present time.

Under the 1951 Regulations, broadly speaking, any medical practitioner coming up against a case of leprosy has the duty of reporting it direct to the Chief Medical Officer of the Ministry of Health. That is the present situation. The medical officer of health for the district in which the patient is, is not notified, at least in theory.

The major change made by the 1966 Regulations, those which we are now discussing, is that every case of leprosy discovered and reported to a qualified medical practitioner will be notified not direct to the Ministry but to the medical officer of health in the district in which it is reported. I am putting the matter in shorthand. I am not going into the refinements of sending notices to the area in which the patient lives, and so on. The medical officer of health is under duty, under these Regulations, to send a copy of that notification at once to the chief medical officer of the Ministry of Health. That is the first change.

The second change is that by these Regulations many important and far-reaching powers of the Public Health Acts are made available to medical officers of health in respect of leprosy. I need only draw attention to Part I of Schedule 1 for that to be seen at once. A number of cases are there set out—I do not want to waste time in repeating them—in which important powers under the Public Health Acts are now made available in respect of leprosy.

I say at the outset to the Parliamentary Secretary, so that we may know our point of disagreement, if there be one, that we on this side firmly support the new notification procedures. We believe that the Ministry of Health is right in bringing these forward. We certainly support the mobilisation of the powers of the Public Health Acts in respect of leprosy. I do not want the hon. Gentleman to be under any misunderstanding from me about that.

It is more the method by which the notifications are made that I should like to explore. For example, Regulation 9, headed "Confidentiality", governs the method by which a medical officer of health sends a report to the Ministry. It states: Every certificate or copy required to be sent to or by a medical officer of health in pursuance of section 144 of the Act as applied by these regulations or regulation 7 of these regulations shall be sent in such a manner that during its transmission its contents cannot be observed, and the information contained in any such certificate or copy shall not be divulged to any person except so far as is necessary to comply with the requirements of any enactment applied by these regulations. My first question to the Parliamentary Secretary is to ask why he is, apparently, erecting a wall of secrecy round these Reports. This requirement is not contained in the 1951 Regulations, which contain nothing comparable. I am well aware that under those Regulations the medical officer of health reported direct to the Ministry of Health, and yet one would have thought that it was perfectly appropriate for similar stringent provisions to be included in those Regulations for medical practitioners to be under strict instructions not to make the contents of reports known to anyone. The hon. Gentleman will realise that it must place the House upon inquiry when he asks for that sort of power concerning a disease of this kind.

There may be a perfectly good answer to this, but it makes one anxious that in some way the Ministry is trying to be secretive over this important disease. This goes right against the trends of modern medicine. To give a rough analogy, I suspect that when history comes to be written, it will be said that the late Richard Dimbleby's greatest contribution to mankind, beyond even the magnificence and pleasure he gave in his broadcasts, is that he will perhaps have been the first public figure to take the stigma out of cancer and so enable medical science to get to grips with it in the early stages. Therefore, it seems to me that to erect a wall of secrecy round this disease, in which, after all, there is no shame whatever—as there is not in any other medical condition, at first sight—at least, is questionable. That is my first point.

The other notifiable diseases are, broadly speaking, dealt with by the Public Health Officers Regulations, 1959. They are directly relevant to our discussion tonight, because those Regulations are quite specifically mentioned and modified in those now before us.

The relevant Regulation of the 1959 Regulations specifically mentioned is 15(3). By that, the medical officer of health of a district is very properly required to make a weekly report of infectious diseases to the Minister. That duty is set out in Regulation 15(3), and I do not need to go into it in detail. He is required to make a return of the number of infectious diseases and of the cases of food poisoning and suspected food poisoning notified to him during the week.

So my second question to the Parliamentary Secretary is, why do we not simply apply those existing Regulations of 1959 to leprosy? Why do we not make leprosy a notifiable disease and require medical officers of health to report weekly in the way for which the Parliamentary Secretary has powers to call? They are already there. They have long been there, and there is no problem about it whatever.

It may be that he will reply to me that it would not be sufficient, and that leprosy, as with certain other serious diseases, is of such magnitude that he must require to be notified more quickly. That must be his judgment, but, if that is his reply, I would say to him that he has the power to do precisely that already. If he will be good enough to look at Regulation 15(7) of the same Regulations, he will find that there is a duty laid upon medical officers of health "forthwith" to report to him …any case of plague, cholera, smallpox, yellow fever, louse-borne typhus or louse-borne relapsing fever or any serious outbreak of disease or food poisoning in the district". In cases of those very serious diseases, it is right that the Minister should be notified immediately. Those Regulations exist. The power is there, and, subject to the Parliamentary Secretary's reply, I do not see why we could not place leprosy in precisely the same category and simply say that in future No. 15(7) of the Regulations of 1959 shall apply, and the Minister will be reported to "forthwith". The hon. Gentleman is upon inquiry to explain to the House why he takes a very special course in the case of leprosy.

The fourth question with which I should like him to deal is this. In No. 15(5) of the Regulations of 1959 there is a requirement that a medical officer of health shall make an annual report. I rather think that the technical position is that the medical officer of health is not by law bound to make that report public but that invariably he does so. Hon. Members will be familiar with the practice, having seen such annual reports published in their local newspapers, and they are the subject of considerable interest.

I should like to ask the Parliamentary Secretary whether, once we have agreed to the Regulations now before us, the statistics of leprosy, area by area and district by district, will be known to us through the reports of the medical officers of health, and whether they will be collated at the centre. He will know that, at the moment, all we have to go on is the Annual Report of the Chief Medical Officer of Health, the latest one of which is that for 1964. I do not propose to detain the House by reading it. At page 49 it makes a short comment on the number of leprosy cases in the year.

As a result of these Regulations, will there be an annual report by medical officers of health, and will those reports be collated at the centre and reported to the House? It is important to recall that we are not dealing with small numbers. I think that it comes as a nasty shock to many of us to learn that there are more cases of leprosy in this country than we had appreciated. As far as I am able to ascertain—the Parliamentary Secretary with his infinitely greater facilities will correct me if I am wrong—the last published figures are contained in a reply by his right hon. Friend the Minister to my hon. Friend the Member for Birmingham, Selly Oak (Mr. Gurden) on 1965, when the right hon. Gentleman said that as at 5th July, 1965, there were 330 cases of leprosy in England, an increase of 106 on the figure at 31st December, 1960, though, to keep the balance, it is only fair to make it clear that a number of those cases are quiescent.

I come back to my essential questions to the Parliamentary Secretary, and I hope he will agree that I have not sprung them on him. By these Regulations, he is requiring notification of leprosy to be in a different form from that for any other notifiable disease. That it should be notified to medical officers of health is accepted without question. That the powers of the Public Health Acts should be available to him is accepted without question. What we are probing tonight is why he has apparently erected this wall of secrecy around this particular disease.

It is right that anyone speaking from this side of the House should avoid anything in the way of theatrical comments or statements about this disease. It must be made quite clear that the disease is neither highly infectious nor highly contagious, but at the same time it must be said that, so far as I am told, there is no known curative drug, and of course the fact that people are able to travel much more easily and quickly than they were puts us on inquiry to a greater extent than would have been necessary in previous years.

The Minister may, therefore, take it as axiomatic that we accept the need for an "early warning system", if I may coin a phrase. I accept that something of this kind is necessary, but at the moment, subject to the hon. Gentleman's reply, he is placed on inquiry as to the apparent secrecy with which he is surrounding the actual notification. That is the purpose of the Prayer.

10.50 p.m.

Sir Douglas Glover (Ormskirk)

I suppose that all hon. Members who have something they particularly want to say are very grateful when circumstances arise when they are able to say it. I rise not as a party politician but in order to pay tribute to one of my ex-constituents—I regret to say that he must have got tired of his Member of Parliament, because he has emigrated to some other constituency in the south of England—who was one of the bravest men I have ever come across. He also did his Member of Parliament more good than any other constituent of mine.

This man was a quiescent leper. Before I met him, like most other members of the population, I regarded leprosy—as it was referred to in the Middle Ages—as the unmentionable disease. I agree with most of the comments made by my hon. Friend, and, in particular, I ask whether this secrecy is necessary. My ex-constituent was a leper, and was not ashamed of it. He realised that he had been unfortunate in his service overseas. The medical profession told him that it was quite in order for him to move among other members of the community, and he came among us, with all the deformities that come with this disease, not ashamed but quite prepared to accept it.

He did me an enormous amount of good. Before I met him, if I had been asked to visit a colony of lepers I would have been frightened. He altered my whole outlook, and made me realise that contracting leprosy was just the same as getting any ordinary disease. I am not suggesting that there is anything wrong in the Ministry's requiring notification, but the Ministry should think very seriously about the fact that there are still some diseases which are unmentionable. They remain unmentionable because no one mentions them.

I strongly agree with what my hon. Friend said about Richard Dimbleby. He did a tremendous job as a public commentator on television, but probably the greatest service he did was to bring an unmentionable disease into the open. From now on it will be discussed far more freely than it has ever been discussed in the past.

There are over 300 lepers in this country. Anybody who was given the opportunity of meeting one of those lepers at this moment would be frightened to death of doing so, because of the veil of secrecy that has been drawn over this disease. The degree of secrecy surrounding this disease causes those people who have it—even those who have the quiescent form—to keep it secret, unless they have a lot of courage, because to make the fact known means losing their friends. These Regulations are increasing the bad effects of this veil of secrecy.

If, in 1966, we really want people to notify diseases without pressure—if we want them to accept the fact that nearly all diseases are, if not curable, at least controllable, provided the people concerned are not frightened to notify them—we must get rid of this veil of secrecy. By saying that leprosy is a special case the Ministry is, in effect, saying that there are diseases which are so objectionable to the public that all communications about them must be sent under a cloak of secrecy, and that this disease is unmentionable.

This is exactly what I would think medical science would want to do away with. The person who travels abroad and by some mischance contracts leprosy should be in no worse position than the person who travels abroad and gets what is known as "Spanish tummy". I admit that that is a much more prevalent disease, but it is contracted only from going into the climate and atmosphere in which it exists. We should make it clear that these are just the problems with which medical science wants to grapple. Nobody unfortunate enough to contract one of these diseases needs to have any sense of shame.

Any attempt to make the notification of such a disease secret must have great objections, as it would carry into the future an implication that anyone with the disease should feel ashamed. If it had not been for my constituent, who opened my mind to this problem and to this disease, I probably should not have spoken in the debate. I wanted to pay tribute to him, because he did me more service from a medical point of view than anybody else. Admittedly, he was quiescent and so able to go among people, but his courage was an inspiration to all afflicted people. He would have hated the thought that his disease was being given a cloak of secrecy, which is the effect of these Regulations.

10.56 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Charles Loughlin)

I am grateful to the hon. Members for Ormskirk (Sir D. Glover) and Wokingham (Mr. van Straubenzee) for the restrained way in which they have dealt with the problem inherent in the Regulations. As the hon. Member for Wokingham said, some people make exaggerated statements about the extent and nature of the disease.

I join both hon. Members in paying tribute to the late Richard Dimbleby for the way in which he brought home to the public the essential fact that there is nothing to be ashamed of, no matter what disease one contracts, whether it be mental or physical. The quicker this approach is inculcated into the general public, the better it will be for the health of the whole nation.

The Regulations replace those made in 1951, which provided for the notification of cases of leprosy direct to the chief medical officer of my Department. Since then we have felt that sufferers from leprosy would benefit if notification arrangements were made to fit in with the general arrangements which govern the notification of diseases under the Public Health Act, 1936, and the Regulations made under Section 143 of that Act. The normal notification procedure under that Act is for medical practitioners to notify the medical officer of health of the local authority. Where that local authority is not also the health authority, a copy of the notification is also sent to the county council. The authorities can bring into play the full health and welfare service, so that the patient can get precisely the kind of service which he requires.

Under the Regulations now being superseded, these services are not readily available to sufferers from leprosy, as notification is to the Chief Medical Officer of my Department and the medical officers of health of local authorities are not immediately informed. It is true that Dr. Cochrane, who was the Ministry's consultant adviser in leprosy until the end of 1965, took a personal interest in all cases and followed them up. Nevertheless, it has now been concluded that even though there are not a great number of cases—at present there are 333 such cases—it is preferable to put their follow-up on a more regular basis.

The figure of 330 cases in this country was given, and I understand that the statistics provided by my right hon. Friend gave that as the figure, which is three different from the figure I mentioned. It might be thought that an increase of three in six months is rather substantial. However, I have examined the figures for the past 15 years and I notice that they have had a tendency to fluctuate. For example, in 1958 there were 303 cases. One might claim that, on that basis, there had been a considerable rise in a rather short period.

We have not only introduced the normal means of notification, but also set up a special Panel of Leprosy Opinion. The members of the Panel, who are all distinguished experts in leprosy, will be prepared to assist medical officers of health and doctors in clinical charge of patients with problems of diagnosis, potential infectivity and management of the cases and their immediate contacts. It will be seen, therefore, that instead of having Dr. Cochrane himself following up cases where he felt that that was necessary, we have a Panel of Leprosy Opinion—perhaps not the best title for such a body—composed of distinguished people who will be responsible in various parts of the country, to ensure that the coverage is sufficiently wide.

Mr. Harold Gurden (Birmingham, Selly Oak)

Would the hon. Gentleman confirm that the figures are high because this disease is imported into this country?

Mr. Loughlin

We know that this is not an indigenous disease. It comes from, among other places; parts of the Continent of Europe, certain Asian countries, certain Mediterranean islands and parts of Russia.

Sir D. Glover

May I help the hon. Gentleman on this point?

Mr. Loughlin

I do not need any help. I could list the countries, but at this late hour I do not wish to weary the House. We must be careful about our approach to this problem. The hon. Member for Wokingham made the legitimate point that it is not an indigenous disease and that there is a greater possibility of infection because of the increased amount of travelling that is now done. The trouble is that once one starts talking about this or that disease being brought into the country one has an emotive approach to the problem. I do not want to indulge in polemics on this issue. We have had a useful debate. Let us be careful how we handle this aspect of the problem.

We have also, as the hon. Gentleman said, taken the opportunity of new Regulations to make available to local authorities the appropriate powers contained in the Public Health Acts of 1936 and 1961—specified in the part of Schedule I to which he referred.

Both hon. Members referred to the question—which I accept is deliberately part of the Regulations—of the need for confidentiality. I should say at the very outset that I do not want to see any secrecy in the sense that I want to avoid a free and frank discussion of leprosy, which is a disease for which no one is responsible. It is because of the exaggerated horror in which the public often hold the disease that confidentiality is essential if patients are to be encouraged to come forward and take advantage of the advice and treatment available to them.

This is a fairly important point. We have to try to get them to take full advantage of the service, because although I am not too sure that there is a known drug that will cure the disease in advanced cases, it is curable if it is treated in the early stages. We have therefore made a special effort to preserve confidentiality. In Regulation 9 we require that information transmitted should be sent in such a manner that the contents cannot be observed, and that it should not be divulged to any person unnecessarily.

In a further effort to preserve confidentiality, we have arranged that medical officers of health should not send weekly and quarterly returns of notifications of leprosy, as they do of other notifications, to the General Register Office, which publishes figures for each local authority. I want to emphasise this, because we take precisely the opposite point of view to that which has been advanced on the question of confidentiality. We think it essential to have the maximum degree of confidentiality, and we do not ask medical officers of health to make the return they normally make of other notifications, in case it should lead to local inquiries which would uncover the name of the sufferer. But to ensure that my Department continues to be fully informed on the incidence of leprosy throughout the country, a medical officer of health has to send a copy of the certificate of notification to the chief medical officer of my Department.

These arrangements, of which the new Regulations form an integral part, are designed to ensure that cases of leprosy are discovered and helped towards cure, and that the remote chance of their infecting others is still further reduced—

Mr. van Straubenzee

I am most obliged to the hon. Gentleman, if I may say so. He has been most helpful to the House, as always. Would I be correct in understanding that, for reasons which he believes to be substantial, leprosy will be the only notifiable disease in respect of which this secrecy provision will apply? Is that right?

Mr. Loughlin

I think that is right, and the reason why it is right is that we are somewhat afraid that we are in a phase where, unless we exercise a great deal of discretion, we shall discourage rather than encourage sufferers from leprosy to come forward for treatment. That is why we make this exception.

Sir D. Glover

This is not valid, as I understand the disease, because someone who has contacted leprosy or who is developing the disease would probably go to the doctor in the first instance thinking that he was suffering from something entirely different. Such a person is not inhibited from going to the doctor because he has leprosy. He is inhibited from going to the doctor or discussing leprosy because society goes on talking as though it were an unmentionable disease.

Mr. Loughlin

That is true. I agree that this is one of the great problems with leprosy. The disease not only has a very long incubation period of up to five years, but in the early stages it is very difficult to diagnose. I take the hon. Gentleman's point; I look forward to the day when leprosy can be accepted in the same way as we accept that we have a cold. This ideal situation has not yet arrived. I believe that this is the only way in which we can encourage sufferers to come forward and be treated.

The hon. Member for Ormskirk says that a victim of leprosy may well not know that he has leprosy; he will consult his doctor thinking he has something entirely different. A patient who consults his doctor thinking that he has something different and who then finds that he has leprosy but that it is not necessary for him to have in-treatment may well be driven from the doctor and be prepared to do without treatment rather than disclose that he is a victim of leprosy. There is a considered opinion in the Department on how to meet this. We do not do these things because we are perverse in any way. We can only make our judgment. It is a question of balance whether the approach of the hon. Gentleman will be right or whether the approach of my Department will be right.

I think that the approach that we are taking is in keeping with the current medical opinion of what is likely to happen if there is any departure from confidentiality. We may be wrong, but somebody somewhere has to make a judgment. In a sense, I hope we are wrong, because if we could say that we were wrong in trying to ensure confidentiality it would mean that we were getting to the point in time when there would be the healthier attitude of complete acceptance.

The biggest contribution which we can make to ensure that there is no risk of the disease spreading is to create the right kind of climate of opinion in which fear of social discrimination and racial antagonism is absent. In such an improved climate of opinion, patients will come forward more readily and measures can be taken where necessary to guard against the possible spread of the disease and to cure the patient. We ought to be absolutely clear and keep this matter in proportion and make a determined effort to emphasise that, contrary to all the loose talk which is so often heard, leprosy is not a highly infectious disease and that, except where there is gross overcrowding, there is little likelihood of its spreading in this country.

The hon. Member for Wokingham asked me some questions about the Public Health Officers Regulations. In my view, it is not likely that cases of leprosy will be included in the detailed reports made under those Regulations. Here, we come back to the very issue which we have just been discussing, the issue of confidentiality. The hon. Gentleman asked also why we did not use Regulation 15(7) of the Public Health Officers Regulations instead of the confidentiality provisions. It would have been possible to add leprosy to the list in this paragraph, but we have previously provided for direct reports of leprosy under the 1951 Regulations. To use the 1959 Regulations would represent a change in the method to be followed, and we have for this reason stuck to the principle of specific Regulations.

I hope that no one will misconstrue what the hon. Gentleman said in referring to plague, cholera, smallpox, yellow fever and relapsing fever. No one should think for a moment that leprosy is in any way analogous to these diseases. They are entirely different. They are diseases such that, if we had 333 sufferers from them in this country, we should be in a most serious situation because we should have epidemics of each of them. I mention this because I do not want it to be thought that one can speak in the same breath of leprosy and of plague, cholera and the other diseases.

Mr. Gurden

By what he said about encouraging people to come forward to report that they are suffering from leprosy, does the Parliamentary Secretary imply that there may be quite a large number of people yet undiscovered suffering from the disease?

Mr. Loughlin

No, I do not imply anything of the sort. This is going back to the point I was making prior to answering some of the questions asked by the hon. Member for Wokingham. I have already referred to the long incubation period of leprosy. Let us not fool ourselves into believing that all the people suffering from leprosy are of a different colour from ourselves. There have been some wonderful white missionaries who have fallen victim to leprosy. It is very difficult indeed to contract leprosy by infection. It is very doubtful that any white person in this country living in normal housing conditions could ever contract leprosy. But the incubation period is very long and the disease is often very slow to show itself. That is the point I was making.

I think I heard the hon. Member for Wokingham mutter—I do not mean it offensively—a reference to food poisoning when I was speaking of the other diseases. Here we have the same position. If there is an infectious carrier in an hotel or eating house, in practice there can quickly be an epidemic in the area. But these are epidemic diseases. Leprosy is not.

We believe that we are dealing with this subject in the proper way. We are seeking to ensure that there is not a spread of the disease and we are offering all the services required to meet the situation should the disease show itself in a particular area. We believe that confidentiality, because of the emotive nature of even the word "leprosy", is necessary at this stage.

I hope that, in the light of my explanation, the hon. Gentleman will withdraw his Motion.

11.21 p.m.

Mr. van Straubenzee

I am certain that the House is obliged to the Parliamentary Secretary for the painstaking way in which he has answered and which has been of great assistance. Perhaps I might be allowed briefly to say that I make no point whatever about the numbers. I join warmly with him in that. He gives the present figure of 333 and I do not want to bandy across the Floor argument as to whether there is an increase or a decrease over any period in a year. It is merely helpful to have his authoritative statement on it.

It is helpful to know about the panel of advisers throughout the country, which will very much reassure public opinion. It is clear from the debate that the point of difference centres around what the hon. Gentleman calls "confidentiality" but what, I am afraid, in all friendliness, I must call secrecy.

The hon. Gentleman deployed with his usual skill his argument in favour of "confidentiality". He says that it is necessary because of the exaggerated horror of the disease. I respectfully say to him that, just because there is this horror of the disease, he should desist from erecting a wall of secrecy around it. However, he has generously said that he might be wrong about this.

I respectfully tender some advice to him. The hon. Member for West Bromwich (Mr. Foley), as Undersecretary for State for the Home Department, has been given particular responsibility for the problems of persons coming into this country, and a very distinguished and broad-minded member of the Government he is. He is a personal friend of mine. I hope that the hon. Gentleman will consult the hon. Member for West Bromwich and see whether he feels that this wall of secrecy round the disease—a disease which, as the hon. Gentleman says, is closely associated with people coming to this country—falls within the sort of climate of opinion that the hon. Member for West Bromwich is seeking to create.

I must honestly say that, on this point, we are not convinced by the powerful arguments which the Parliamentary Secretary has put before us.

Mr. Loughlin

I want the hon. Gentleman to be absolutely fair. We are seeking only to ensure that this information will not go to another person unnecessarily. We are not being secretive about it. We are merely ensuring that the information concerning a patient is not exhibited in such a way that unauthorised people could see it. I do not think there is anything "secret" about that. I think this is the sort of relationship that a doctor and patient have.

Mr. van Straubenzee

The hon. Gentleman also said, in answer to an interjection, that leprosy had been selected exclusively for this treatment. Surely it is as important that someone with smallpox or cholera should be under no limitation whatever in coming forward quickly for medical attention as it is for a sufferer from leprosy.

I remain yet to be convinced that the mere reporting to a medical officer of health will destroy the essential confidential nature of the relationship between doctor and patient. At this late hour we have to leave that discussion with the warning that this may well be something to which we have to return, in spite of the full and helpful way in which, I freely admit, the Parliamentary Secretary has answered the debate.

On that basis, I beg to ask leave to withdraw the Motion.

Motion, by leave, withdrawn.