HC Deb 19 November 1976 vol 919 cc1754-64

Lords amendment: No. 33, in page 8, line 45, at end insert— '"(4) The Board shall make no recommendation which (were it to be carried into effect) would or might require any medical or dental practitioner to disclose to any person any information obtained by him in confidence from any patient (whether resident or non-resident and whether private or not) and the Secretary of State shall not carry into effect any recommendation which would or might require any such disclosure

Mr. Moyle

I beg to move, That this House doth disagree with the Lords in the said amendment.

In saying that we disagree with the Lords, we do not disagree that there is a problem here and that in principle the confidentiality of medical records should be preserved. We merely disagree with the concept that it should be protected by such an inflexible method as legislation.

Clause 6 makes provision for the Health Services Board to bring forward proposals for common waiting lists containing both private and National Health Service patients and ensuring that admission to health facilities is on the basis of medical priority only.

Obviously there will have to be a great deal of discussion of the various ailments from which the patients are suffering to assess the degree of medical priority. I understand the desire of doctors and patients to ensure that, as far as possible, confidential medical information is not freely bandied about in the process. The Government recognise that anxiety.

However, the proposal by their Lordships that this should be done by adding subsection (4) to the clause, is not the appropriate way of going about it. There are many occasions in the Health Service on which confidential information about patients and in-patients' records have to be considered to assess clinical requirements. We have been content, as a House and a country, to rely on the code of ethics of the professions dealing with this problem. The Government's view is that it is best to rely on the judgment of the professions as to how far they may go in this matter by using their judgment based on their general code of ethics.

Although we feel that there is a problem in principle here which has to be solved, we would prefer to leave it to the professions. We feel that it would be wrong to bind the Health Services Board tightly by a legislative provision where such a move has never before been thought necessary to protect the interests of patients or the profession.

Mr. Boscawen

I find that a disturbing and disappointing statement. I do not want to go over the very long debate we had on the whole waiting list problem in Committee and the further long debate we had in the other place about the worst manifestation of a deteriorating service in the public sector—the appalling waiting list problem.

It is a terrible reflection on this country that 44,000 people have been waiting for more than a year for non-urgent operations. We ought to be concentrating on and doing something about that problem. We should not be concentrating on this sideshow of a Bill which will not improve the waiting list problem.

There is no division in the House in the argument that blatant queue-jumping with the aid of a cheque book when there are no other factors involved is totally unacceptable. The Opposition have always agreed that. However, we do not agree that this Bill is the right way to overcome the problem. Government supporters must realise that the basis of medical priority alone will create considerable difficulties now that it is being written into a statute. It does not matter what is put in the statute. Medical priority will always include social grounds. Social grounds have always been taken into account by doctors and hospitals making up their waiting lists, and they will continue to be.

A new situation will arise now. The Bill may mean that in a common waiting list situation there will be a dispute about why one patient is put before another in a certain hospital. As a result, there will be pressure on doctors to reveal their reasons for placing that patient ahead of another patient on the waiting list. This is a new situation, and it may be necessary in the future to safeguard the long-established rights of members of the medical profession and others engaged in health care in terms of the complete confidentiality between patient and doctor and patient and nurse which has always been taken for granted in the past but which may be disputed under pressure in the future.

The Government should think again about this issue. A good deal of dispute could arise in the future in trying to introduce a common waiting list. We all know that it will be very difficult. The waiting list problem is immensely complicated. It does not offer an easy solution, and we do not want to make it worse by bringing pressure to bear on doctors. I do not believe that they will abuse the situation. They will not conceal deliberately the reason why a patient has been put ahead of another patient on the list. It is a great pity that we have spelt this out in the Bill, because dispute is bound to arise.

Mr. Moyle

I am not sure how the hon. Gentleman can argue that the situation will be a new one. Regrettably, we have waiting lists now. Sometimes they are much too long. But doctors have to assess the priorities of people on the waiting list, anyway. They have managed to do so within the terms of their present code of ethics. Most people are on a common waiting list, in any event.

Mr. Boscawen

There is a new situation. We are interposing an outside independent board to set up a system of a common waiting list. That board will have to police its common waiting list and decide how it shall work. Somewhere, at some time, someone is bound to dispute it. In that dispute, there is bound to be cause for the doctor to reveal why he placed an individual in a certain position of the list, either on the day of the operation or during the month or year. There is a new situation. I hope that the hon. Gentleman will recognise it and realise that, if the Bill goes through as it is, the Government will have to answer for the consequences.

2.15 p.m.

Mr. Leslie Spriggs (St. Helens)

I wish to draw attention to the existing situation in the St. Helens and Knowsley area health authority district where I am informed that a private hospital is under construction at a time when nursing levels in other hospitals in the area are at a dangerously low level.

Apart from professional people in the National Health Service such as doctors, nurses and ancillary workers, we have a situation where, if the Minister is encouraged to accept any amendments to the Bill as it is at present, standards of care are in danger of being adversely affected. Hon. Members representing constituencies in the area are worried already about what those standards are likely to be in the future should an amendment be accepted which will affect the intake of nursing staff and others. In my view, my hon. Friend ought to resist with all his strength any amendment to this clause.

Mr. Boscawen

I appreciate that the hon. Gentleman is trying to help the Minister, but I do not see how my amendment dealing with confidentiality can upset the doctors and nurses in that area. I think that it will have the opposite effect, because they want it.

Mr. Spriggs

If I have followed the hon. Gentleman's argument, any amendment to the Bill will enable other authorities such as private health authorities to compete for the necessary staff to man new hospitals in the area.

Mr. Pavitt

I am very glad to hear that my hon. Friend the Minister of State is resisting this amendment. As the hon. Member for Wells (Mr. Boscawen) rightly pointed out, this part of the Bill which their Lordships seek to amend is one of the most constructive provisions. It arises because of the lack of success of the former Minister of State in his strong attempts to negotiate with the medical profession to secure common waiting lists without the need for legislation. For that reason, the whole of this clause is vitally necessary.

As a layman, I very much resent the idea that a doctor should not be accountable for his decisions over a wide range of matters including the way in which his waiting list is prepared. The essential objective of this amendment from the Lords is to argue that, because of the need for confidentiality in respect of both the clinical and the social reasons why a doctor selects one patient for admission before another, for some reason we cannot rely on the common sense of the medical profession whose members have been doing this for years and, therefore, need to write some provision into the statute to give them protection. From my knowledge of the medical profession, I know that this is nonsense. From the time that they qualify, automatically they have this responsibility to their patients. They do not need to have words written into legislation providing for confidentiality to be maintained.

Mr. Patrick Jenkin

I cannot think that the hon. Gentleman has read the amendment from another place. It is not that the doctor is being required to preserve confidentiality. It is that other people should not be entitled to make recommendations requiring the doctor to breach the confidentiality. It is entirely the other way round.

Mr. Pavitt

It is precisely because I have read the amendment that I intervene.

As for the common waiting list problem, in the past the way in which a person has been admitted for in-patient or out-patient treatment has rested solely on the clinical decision of the doctor concerned. As the hon. Member for Wells (Mr. Boscawen) said, when a number of candidates are waiting for admission for hernia or varicose vein operations, other conditions need to be considered.

If we are to have the kind of National Health Service that we want, we must have a hospital service which is based on team work and not on the old system where the consultant was God Almighty. Their Lordships are seeking to preserve the pre-eminence of the past where the only person making any decision was the consultant—not even his registrar or his team. Once again the Lords are trying to preserve this outdated system.

Inevitably there will be many pressures, not least from the community health councils, for a fairer waiting list system. At present, the case-hardened consultant has a quick way out if faced with 10 patients with equal claims. He can base his decision on who can pay the bill. That saves him many problems. As usual, the Lords are proposing an amendment which is unnecessary and which complicates the Bill. It proves the case for abolishing the House of Lords.

Mr. A. P. Costain (Folkestone and Hythe)

I hope that the Minister will think again. Surely hon. Members appreciate the importance of confidentiality between patient and doctor. The whole process depends upon it. Unless we accept the amendment, the patient will always wonder, however well meant the doctor, whether the Board, which will include laymen, might insist upon the doctor breaking confidentiality by telling it from what the patient suffers. It will break down the most important confidence between patient and doctor. Confidentiality must be retained and no one should be allowed to overrule it.

Mr. Rooker

The confidence between patients and doctors which was created by the passing of the Bill in the form in which it left the House has now been destroyed by the Lords. Patients know that doctors can put pressures on them to jump the queue by paying the bill.

One of my constituents will considerably benefit from the Bill so long as the amendment is not passed. I shall not name her because her case is being considered by the Birmingham Area Health Authority. Hon. Members will know that general practitioners are sometimes also hospital consultants.

My constituent is a lady in her sixties who is having trouble with her eyes. Her family doctor referred her to the Birmingham Eye Hospital, where he is consultant. One of her eyes is deteriorating rapidly. Two years ago, her family doctor told her that both eyes would be treated together when that was necessary. That was her GP in his capacity as consultant. She did not see him between September 1975 and September this year, and she was told that the reason for the 12-month delay was the industrial action by consultants. I do not know why that should have caused such a long delay.

My constituent's daughter visited her GP from time to time during that year, told him that her eye was deteriorating and collected prescriptions for her. In September this year my constituent had an appointment to see her own GP at the Birmingham Eye Hospital. The lady is now blind in one eye. Her GP, in his role as consultant, told her that it would be two years before treatment could be given. But he added that he could deal with it in six months if she could pay £400 or £500. Where is that the doctor's medical priority? That story should convince the ragbag of the Opposition and the Lords that the Bill must remain as it was when it left this House.

It is disgraceful that a doctor-cum-consultant should behave in that way. I do not know whether he is fit to be a GP if that is the way in which he makes decisions. He has blackmailed this lady and told her that she will have to wait two years unless she can cross his palm with silver worth £400 or £500.

Mr. Spriggs

Many Labour Members believe that that GP is not fit to be a doctor.

Mr. Rooker

I will if necessary say that outside the House after the health authority reports. I intend to send the facts of the case to my right hon. Friend the Secretary of State when the area health authority comes up with an answer, whatever it may be. Perhaps in the meantime medical priorities will change and my constituent will be treated under the National Health Service and that will be the end of the problem.

Mr. Kilroy-Silk

Does my hon. Friend accept that we all have cases such as that? I am sure that Opposition Members could quote them, too, if they chose. The case graphically demonstrates that unless we eradicate all vestige of commercialism from the National Health Service, abuses such as this will continue. It is an argument in favour of ensuring that there is no taint of profit or commercialism within the Service, and that all cases should be dealt with in the strict terms of medical priority.

Mr. Rooker

It would be outrageous for the Lords amendment to be retained. Corrupt practices will be encouraged because doctors will not have to disclose information. The myths about the ethics of the medical profession that we hear of from the Opposition are rubbish. I am not tainting all doctors, because the great majority are good servants to their patients, but there are some who are not.

I have quoted one example, but there are others. I am sure that Opposition Members could give examples, but they do not want to do so. Perhaps they have an interest in not doing that. They, too, must receive letters from their constituents. This is not a party matter.

The only way to solve the problem is to take decisions of that kind out of the hands of the doctors. I have every confidence in a board of independent people laying down medical priorities. I am confident that such a board would make decisions fairly. It would take away from the doctors the taint of corruption and blackmail of the elderly, sick, poor and needy. In the case I mentioned, the lady was never asked whether she could afford £400 or £500. The doctor wanted to screw £400 or £500 out of my constituent for her to jump the queue.

That is not medical priority. I invite the right hon. Member for Wanstead and Woodford (Mr. Jenkin) or the hon. Member for Reading, South (Dr. Vaughan) on the Opposition Front Bench to refute what I have said, but they do not rise. They clearly have a vested interest in silence today. We have already seen that with six Divisions in three and a half hours and virtually no debate.

There is no great opposition to the Bill. No case for the amendment is advanced. Why do we go through this charade, with all the propaganda outside the House, with Conservative Members saying that they want the doctors to decide, that matters of confidence between them and their patients are of supreme importance? They say "We have made that case in Parliament. We went to the House on Friday 19th November, the last but one day of the Session, and fought to the death to protect confidence between doctor and patient."

2.30 p.m.

Half the Opposition are missing when the Divisions are called. Tory Members are moaning because they want to be away by 5 o'clock, and therefore they do not want to debate this amendment. No one seeks to intervene in my small contribution, even when I invite comment on my view that the amendment would add to the corrupt practices in the medical profession.

When I explain the position of my constituent who is blind in one eye and describe what has been said by her GP, wearing his other hat as a consultant, Tory Members laugh. I shall be interested in the reactions of my constituent, the doctor and the area health authority when they receive copies of today's Hansard. I shall also be interested in the reaction of the local Press. The hon. Member for Birmingham, Edgbaston (Mrs. Knight) is not here today. She has plenty of complaints about the Birmingham Eye Hospital and the waiting lists. She is always making a case in the local Press about lack of NHS facilities.

We have no case to answer against disagreeing with this Lords amendment.

Mr. Patrick Jenkin

If the facts turn out to be as the hon. Member for Birmingham, Perry Barr (Mr. Rooker) stated them—and he admitted that he would not say outside the House what he has just said until he had ascertained the facts—I believe that he has very good grounds for referring the doctor in question to the General Medical Council. No Conservative Member has ever sought to deny that there are abuses or to defend them. On the contrary, our argument all along has been that in order to check the abuses to which the Select Committee drew attention the Government have taken a sledgehammer which will do grave damage to the NHS and the NHS patient.

There is no need for the Bill in order to deal with the abuse that the hon. Gentleman described. If he had sat through the many hours of debate in Committee, and had read the Official Report of the debates in another place, he could not have said what in fact he said. To charge the Opposition with heedlessness of the interest of the NHS or the NHS patient is sheer impudence.

Mr. Pavitt

On a point of order, Mr. Deputy Speaker. I am a little concerned, on grounds of medical priorities, about the hon. and learned Member for Ruislip-Northwood (Mr. Crowder). I hope that he is quite well, because I think that, to judge by his appearance, he is no longer with us.

Mr. Deputy Speaker

I am happy to say that the health of hon. Members is not the responsibility of the Chair.

Mrs. Renee Short

I was interested to hear the right hon. Gentleman admit, for the first time from the Conservative Benches, that such abuses as were mentioned by my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) exist. His hon. Friend the Member for Reading, South (Dr. Vaughan) has never admitted that one of the ways in which doctors pressure patients to go private and pay fees is to allow the waiting list to mount. The case quoted by my hon. Friend is symptomatic and typical of hundreds and hundreds of similar cases. If the right hon. Gentleman says that the Bill is unnecessary to deal with that kind of abuse, how would he deal with it?

Mr. Jenkin

I hardly think that at this stage in the Bill's passage it would be appropriate for me to respond to the hon. Lady's question. She was here for the Second Reading debate, so she will know that I was extremely frank then about the results of the study undertaken by her Select Committee. I have said all along that the Bill is not the way to deal with the matter. It is not necessary to get rid of the geographical whole-time consultant in order to eliminate the abuses. It is sheer rubbish for the hon. Lady to suggest that we have today said for the first time, in answer to the hon. Member for Perry Barr, that there are abuses. I invite her to study the Official Report of the Committee stage.

Mr. Stan Thorne (Preston, South)

The Opposition did not say it in Committee.

Mr. Jenkin

Of course we did. The hon. Gentleman knows perfectly well that what I have said all along is that it is absolute folly to force consultants to divide their time between the NHS hospitals and the private clinics outside simply to get rid of the few black sheep. I welcome the fact that the hon. Member for Perry Barr said that it was only a tiny minority of doctors who engaged in these undesirable practices. The whole arrangement set up by Aneurin Bevan 30 years ago is to be swept out of the window to deal with that tiny minority. That is rank bad government. The Government should never have yielded to this pressure.

Mr. Ennals

The right hon. Gentleman was not prepared to answer the question put by my hon. Friend the Member for Wolverhampton, North-East (Mrs. Short). We are dealing with the matter of common waiting lists. Does the right hon. Gentleman accept that once the Bill become law, and common waiting lists have come forward from the Board, the injustice described by my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) will not be possible, and that this legislation will have brought that about?

Mr. Jenkin

As I told the right hon. Gentleman on Report, if he had introduced a Bill to deal with abuses and to establish an inquiry into the feasibility of common waiting lists he would have found himself with an agreed measure. We did not divide against Clause 6 in Committee. We spoke in favour of it, and my hon. Friend the Member for Wells (Mr. Boscawen) made a penetrating and profound speech analysing the whole question of waiting lists. To pretend at this late stage that the Opposition have condoned the abuses is utter nonsense, and the right hon. Gentleman knows it. He should not be supporting his hon. Friends below the Gangway in that kind of slur on the Opposition.

Question put:—

The House divided: Ayes 283, Noes 248.

[For Division List No. 428 see c. 1833]

Question accordingly agreed to.

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