HC Deb 14 February 2001 vol 363 cc361-81

?.—(1) The Secretary of State may by regulations make such provision for and in connection with requiring and regulating the transmission, holding, processing or otherwise dealing with prescribed patient information as he considers necessary or expedient for the purpose of maintaining disease registers.

(2) In this section— disease registers" means those registers of incidence of specified diseases as the Secretary of State shall by regulation prescribe; prescribed patient information" means patient information specified in or determined in accordance with regulations made by the Secretary of State under this section; processing", in relation to information, means the use, disclosure or obtaining of the information or the doing of such other things in relation to it as may be prescribed by regulations.

(3) Regulations made under this section shall not be made unless a draft of the statutory instrument containing the regulation has been laid before, and approved by a resolution of, each House of Parliament.'.—[Dr. Fox.]

Brought up, and read the First time.

Dr. Liam Fox (Woodspring)

I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker (Mr. Michael Lord)

With this it will be convenient to discuss the following amendments: No. 1, in page 58, line 17, leave out clause 62.

No. 33, in clause 62, page 58, line 18, at end insert "identifiable".

No. 34, in page 58, line 38, at end insert— '(d) "identifiable patient information" in relation to subsection (1) means patient information in a form which allows the patient to be identified'.

No. 35, in page 58, line 38, at end insert— '(e) regulations under subsection (1) may not prohibit or restrict the processing of patient information which is not identifiable patient information.'.

No. 15, in page 58, leave out from beginning of line 39 to end of line 26 on page 59 and insert— '(3) The Secretary of State may by regulations make such provision for the collection, holding, processing, transmission and publication of patient information as he considers necessary for the purpose of maintaining disease registers.'.

No. 30, in page 60, line 3, at end insert— '(8A) The Secretary of State shall establish an Expert Advisory Committee to advise him in connection with any regulations he proposes to make under this section, and shall consult the Expert Advisory Committee prior to making any regulations under this section. (8B) The Secretary of State shall appoint a chairman of the Expert Advisory Committee established under subsection (8A) above who shall be empowered to appoint such persons as appear to him to represent relevant expert bodies to the committee.'.

Dr. Fox

The debate continues a discussion that we held in Committee. The question that we asked remains to be answered: do the Government aim to protect patients or the NHS and Ministers? Clause 59 in the original Bill is now clause 62, which allegedly clarifies matters but merely makes them murkier.

The Government claimed that new powers were needed to protect patients from abuse of the information that was held about them. They have not defined how such information could be used against patients or explained how the powers would affect its legitimate use, for example during drug trials. We tried to obtain clarification of the Government's arguments and assertions in Committee, but to no avail.

The Secretary of State's powers to divulge data at his discretion do not appear in the Government's national plan for the NHS. They have been included without consultation—surprise, surprise—as a method of restoring the attempted prohibition on the collection of anonymised data from retail pharmacists that the Court of Appeal rejected in December 1999. We debated that case at length in Committee. The Government claim that the Bill closes a legal loophole, without defining it. The court ruled that there was no loophole and the judge stated that the law of confidence cannot be distorted for the Department's purpose.

In the Committee's 12th sitting on 8 February, the Minister stated: The clause does not outlaw independent reports on NHS services and it is not an attempt to restrict medical research. A fundamental point is that it does not signal any change to the Government's view about the importance of patient consent. That is a key point in today's debate. Informed consent is crucial to the Government's view of how a modern NHS should work. We cannot move to a patient-centred service if patients are not informed, consenting participants in the services they receive."— [Official Report, Standing Committee E, 8 February 2001; c. 477–78.] However, the Minister failed to respond to the point that the clause grants the Secretary of State powers that future Secretaries of State could implement in a manner that is far more hard line than the Government's intentions as outlined by the Minister. His constant defence was, "We may have the powers, but we will not use them." That is unacceptable.

The Minister found it difficult to accept that the Bill's contents are what matters. Once a power is established, it can be used. We want greater clarification of the powers and when they can be used. New clause 1 seeks to achieve that.

British pharmaceutical companies could be at a severe disadvantage because of restrictions on research. Many expressed that concern to members of the Committee and other hon. Members. Access to anonymised data is essential to their work in developing new drugs and monitoring the safety and effectiveness of existing drugs. The restrictions would especially affect their fulfilment of regulatory obligations, including those that deal with adverse event monitoring and product withdrawals. In Committee, I quoted the words of one firm; they bear repeating tonight. NDC Health Information Services stated: Commercial access to non-personal data provides considerable benefits to all concerned; the loss of this access will result in less efficient health care and less funding for medical research without any concomitant benefits to either government, health providers or patients.

If the Government continue to deny the effect of their decisions, it is incumbent on Ministers to explain why, not content with abolishing community health councils, they have introduced a clause that gives future Governments massive scope to prevent independent scrutiny of the NHS. It is part of a consistent approach by Ministers to running health care.

6.15 pm

Ministers must also explain contradictions. In a speech to patients groups in January, the Secretary of State said: The days have gone when the NHS could act as a secret society. It cannot operate behind closed doors. It cannot operate in the dark. It has to take patients into its confidence. Yet clause 62 allows him to disclose identifiable information to third parties without patients' consent and despite their objections. The Minister can introduce as many regulations as he likes, but the decision ultimately lies with the Secretary of State. He has the right to produce identifiable data, even when that is not in the patient's interest, if he believes that it is in the public interest or the wider health interest. That is unacceptable. Explaining the provision's operation in practice is not the same as defining it in the Bill. New clause 1 attempts to make the provision more explicit.

A letter to The Times on 1 February was signed by Sir Donald Irvine, president of the General Medical Council; Dr. Ian Bogle, chairman of the British Medical Council; Robert Boyd, chairman of the Council of Heads of United Kingdom Medical Schools; Denis Pereira Gray, the chairman of the Academy of Medical Royal Colleges; and James Johnson, chairman of the Joint Consultants Committee. They are top people, who are well respected and represent almost the whole spectrum of those who practice in medicine. The letter stated: We agree with Alan Milburn that we cannot accept the benefits of medicine, science or research regardless of the wishes of patients or their relatives. No one would have a problem with that. It continues: However, Clause 59 of the Health and Social Care Bill threatens patient confidentiality by giving the Secretary of State for Health wide and ill-defined powers to determine what information should be disclosed in the public interest or for the improvement of patient care, without patients' consent. We believe that any decision to override the citizen's right to privacy should be exceptional and must only be made—other than in an extreme medical emergency—after rigorous parliamentary scrutiny rather than by order of a Secretary of State. The Bill does not appear to provide for this.

We raised those issues in Committee. None of the Minister's assurances has persuaded us or, I believe, the groups that wrote to The Times that the provision makes for a better system. The fear of its use at the whim of a future Secretary of State provokes anxiety.

Perhaps our most important debate in Committee and tonight is on disease registries. We considered the Bill's impact on cancer registries in particular. Despite our reservations about the Secretary of State's power to require the publication of unanonymised data, we acknowledge the need for action to protect specific registries, including cancer registries.

No hon. Member should take disclosure of information without consent lightly. If the Secretary of State can do that in the interests of improving patient care", or "in the public interest", he must justify granting such sweeping and unprecedented powers to override the cornerstone of patient confidentiality between health professional and patient.

We are concerned—as were hon. Members on both sides of the Committee—that disease registries, including those relating to cardiac disease and cancer, should be able to continue their valued work. The Government's acceptance that decisions regarding the application of the subsection should be subject to affirmative resolution in both Houses of Parliament was a concession, but it does nothing to alter the basic facts.

The clause establishes sweeping powers far beyond what is required to ensure the continued viability of disease registries. That point was also raised in the amendments tabled for the British Medical Association by the Liberal Democrats in Committee. By dealing with specific applications of the subsection on a case-by-case basis, the Government find themselves in the position of permitting everything pending future exclusions. Why not provide clarity by stating what is permitted, as we have done in new clause I?

The Minister's comments in Committee appeared to be an attempt to establish procedure on the hoof. The proposals for the scrutiny of applications are at best opaque and at worst obscure. That is particularly disappointing because there had been broad cross-party agreement on the necessity of maintaining disease registries. If the Government wish to develop and consult on proposals for wider measures, they should do so, rather than seek to rush through ill-thought-through ideas without any semblance of consultation. As I said, that is an unsatisfactory way to legislate.

Mr. Bercow

Does my hon. Friend agree that although the Government might not have devoted a great deal of thought to their proposals, they hale thus far certainly devoted a great number of words to them? I am pleased to see new clause 1, which pithily sets out the basis of what Her Majesty's Opposition would like to insert into the Bill in only 151 words, in contrast to the two and a half pages of unreconstructed and inexplicable verbiage on pages 58 to 60 of the Bill.

Dr. Fox

It is becoming habitual for me to agree with every word that my hon. Friend says. He has encapsulated the simple idea that if the Government mean something by the legislation, they ought to say it in the Bill. This part of the Bill has been drawn far too widely. If the Government's intention is as the Minister explained in Committee, that should be in the Bill.

The Minister's comments in Committee demonstrated the lack of thought that had gone into the subsections of clause 62, formerly clause 59. Other hon. Members and I highlighted in Committee instances in which the law could either be unworkable or render existing practices unworkable. The Minister spoke frequently of the need to ensure that regulations were adequate and correct. The degree of thought that he now recommends should have occurred before the framing of the Bill rather than during the final days of Committee.

Adequate thought has still not been given to the matter, and no satisfactory response has been given to the concern of GPs that the powers in the clause could make it mandatory for them to pass on identifiable patient information against their will, or against what they believe to be their patients' best interests. Will the Minister explain how that provision is sustainable in the face of principle 10 of the NHS plan, which states that the confidentiality of individual patients must be protected? The two concepts do not sit side by side.

The definition of patient information provides the Secretary of State with the power to ban the use of important and beneficial non-personal data, yet it also allows him to share identifiable health data at his own discretion. The clause states that the Secretary of State will use his powers "in the public interest", but that could easily become an excuse for the suppression of politically inconvenient data.

The explanatory notes suggest, as an example, that regulations to prohibit the use of anonymised patient information that is being used for a purpose which is detrimental to the operation of the NHS could fall within this definition. That could lead to situations in which cancer charities, among others, would not be able to conduct surveys of postcode rationing. This attempt to squeeze the life out of independent criticism of the NHS is reminiscent of the matter of the community health councils, which we shall discuss with the next group of amendments.

Last year, the Government abolished the patients charter in favour of a glossy brochure called "Your Guide to the NHS". A Government who are willing to use public money to publicise their party's health policies are a Government who would be willing to use possible restrictions on data to suit their party political policies.

I can make no better summary of the problems that we are trying to address in new clause 1 than to quote a letter to The Guardian signed by the president of the Royal College of Physicians, Sir George Alberti, as well as by the chairman of the Royal College of General Practitioners, the director of the World Health Organisation Uppsala monitoring centre, the chairman of the Patients Association and the chairman of the Depression Alliance. I quoted the letter in Committee, but it certainly bears being put on record again. It was written by people who are well respected in their field, and who cover the whole spectrum of the practice of medicine, of patient groups and of those who have devoted their lives to patient care. They state: We wish to voice our serious concerns relating to Clause 59 of the Health and Social Care Bill, currently making its way through Parliament. It is the view of many in the medical community"— I would say that it is almost a unanimous view— that this clause would seriously threaten the ability of patient organisations, academics and the pharmaceutical industry to undertake important research and analysis, based on anonymous healthcare data, to improve the quality of patient care. As it stands, the Bill provides the Secretary of State with such sweeping powers as to allow him to curtail or prohibit the collection of anonymised patient information, however derived, and conversely require or regulate the release of confidential information, without the patient's consent, for reasons that he judges appropriate. Remarkable as it may sound, these measures have been barely raised either in or out of parliament and were not included in the Government's National Plan. It is our view that independent collection of information on the NHS enables analysis of information that the NHS does not collect or cannot provide easily to patient organisations, academics, public health bodies and the pharmaceutical industry. We have witnessed the value of such data in scrutinising the performance of the NHS and improving healthcare. We urge the Government, in the spirit of open government, to withdraw this clause until adequate consultation has taken place. Only then can we reach an informed consensus about what controls are required both to protect patients but nonetheless allow access to anonymised information so necessary in monitoring and improving patient care.

Despite our pleas in Committee, we have been given nothing that makes it clear that the Government will incorporate a better definition into the Bill, so that Parliament and the courts will understand exactly what this information is to be used for. We need a better definition that will allow us to ensure that the provision is not at some point abused.

New clause 1 tries to tie down this part of the Bill to the purpose for which most of us believed it was to be used, involving one of the most important aspects of maintaining disease registries. If the Government do not accept the new clause, we can only believe that they want wider powers for reasons that go beyond those they gave in Committee as the justification for this part of the Bill. I commend new clause 1 to the House.

Dr. Brand

I declare an interest as a clinical practitioner, in that I work as an independent contractor to the health service as a general practitioner. It is relevant to make that declaration, as I would not like to be in conflict with the Secretary of State.

Renumbered clause 62 gives the Secretary of State powers to override the wishes of patients on the control of clinical data. I can tell the Secretary of State that most of my colleagues would join me in saying that the wishes and desires of their patients far outweigh any powers that any Secretary of State may care to take to himself or herself. Even the theoretical powers that the Secretary of State may be adopting could be profoundly unsettling for a profession that cares for patients above all, and could make the work of clinical practice a great deal more difficult.

Dr. Fox

To make the point even more explicitly, does the hon. Gentleman accept that, under the Bill, he and other practising doctors could find themselves in conflict with the Secretary of State for not providing data about a patient, or with the General Medical Council for providing it? Does he agree that that would be an unacceptable position for any practitioner?

Dr. Brand

That illustrates the position fairly clearly—and it would be a brave Secretary of State who took on a doctor acting in the interests of his patient. I hope that such circumstances never arise, but the Bill contains the potential for them.

6.30 pm

We accept that there is a problem with the maintenance of existing disease registers, especially cancer registers. In the past, consent was assumed far too frequently. In my view, it would be impractical to refer to people on existing registers in order to obtain formal consent to enable us to continue the excellent work that has been going on for decades, and has done so much to help us to understand the epidemiology and treatment of cancers and other diseases. However, I do not think there is any justification now for not asking for patients' consent at the time of the onset of their illness, or when they may be entering a register. Even after the probing in Committee, I still cannot understand why the Minister must take potentially wide-ranging powers if the aim is to maintain an important register and to deal with the anxieties of the Data Protection Registrar.

A problem has been created by, I think, parliamentary draftsmen rather than Ministers. There was an opportunity to introduce a bit of legislation, and the Government clearly needed an NHS Bill before the election. They looked at what they should put in the legislation that they envisaged, and this is part of that. There is a real problem with, for example, the existing cancer registries, but rather than concentrating on that the Government said, "Here is an opportunity to create a few more sweeping powers". There was then a great outcry.

Dr. Howard Stoate (Dartford)

As the House will know I, too, am a medical practitioner, and the regulations will therefore impinge on me to a large extent. Clause 62(5) states: Regulations under subsection (3) may not make provision requiring the processing of confidential patient information for any purpose if it would be reasonably practicable to achieve that purpose otherwise than pursuant of such regulations". Does the hon. Gentleman accept that the power will be used under the Bill only if it is impracticable to obtain information in any other way—in other words, by patient consent?

Dr. Brand

This is fascinating—it is what the legislation says, but the judge of whether the condition is fulfilled will be the Secretary of State, who will consult both Houses.

The Government, almost shocked by their own temerity in wishing to take these powers, obviously felt that they must put the brakes on. I appreciate the fact that they have done something quite unusual in requiring affirmative resolutions from both Houses, but that has happened only because they recognise that the powers they have given themselves are so ridiculous. They are far too wide and they are totally unnecessary.

Mr. Bercow

I do not want to criticise the hon. Gentleman, who is making an important point and speaks with some medical expertise. However, although I understand what he says about the parliamentary draftsmen, there is no way in which we can exonerate Ministers on the basis of errors of commission or omission by draftsmen: the Minister of State is responsible for what transpires.

Does the hon. Gentleman agree that clause 62(2)(c) is a model of ambiguity? It blathers on about level five on the standard scale, or such other level as is prescribed", and goes on to refer to other procedures for enforcing any provisions of the regulations. Why on earth can we not be told about those arrangements in the Bill?

Dr. Brand

As often, that was a valuable intervention. I think that there is a shared responsibility. It was noticeable that the only people who showed any enthusiasm in Committee were the officials, who agreed with every word that the Minister said. The rest of us shook our heads in some surprise.

It is clear that the Minister should take a small step—an interim step—to deal with the concerns about existing disease registers. I cannot understand why the Minister has taken the opportunity to assume powers in a completely different issue, that of anonymised data. By definition, that is not patient-identifiable information. It seems that the Government want an opportunity to reverse a slight that they may have experienced when they lost a case in the High Court. [HON. MEMBERS: "Henry VIII"' My memory does not go back as far as Henry VIII, and I do not understand the exact purpose of the "commercial" clause.

In Committee, I asked the Minister for a definition of "commercial". He referred me to the Town and Country Planning Acts, but they concern commercial premises rather than commercial activities. This is an important point. A good deal of research in this country is funded by drug companies and others in the health care field-not for altruistic reasons, but because they hope they will gain some commercial advantage. I am not saying that commercial activities are always benign: I think it improper for a drug company to try to work out the individual prescribing pattern of a particular general practice or a particular general practitioner in order to target its promotion. We have received briefing from some commercial organisations, and I can assure the House that their activity is not designed to drive down drug costs; it is designed to increase their share of the drug market, often through the prescribing of their expensive patented drugs as against generic drugs.

I can see that the Secretary of State might want to consider a way of dealing with the need for information on NHS activities to be made freely available. All audit and a good deal of local government information is dependent on access to anonymised information. However, I do not think that what we are discussing makes sense.

Dr. Stoate

I appreciate the hon. Gentleman's point about audit, but we are talking about "prescribed commercial purposes". Audit is not commercial; it is for the good governance of the national health service, and for allied purposes. The provision relates specifically to the use of anonymised patient data for profit.

Dr. Brand

It depends on how the data are collected. I do not know my medical colleague's practice well, but I know that he has long been concerned with medical education, postgraduate education and training, as I have. I know how many training activities depend on a degree of sponsorship, and it is important to ensure that sponsorship does not corrupt the activities of the practice; but we are talking about a commercial activity nevertheless.

I understand why the Minister might be tempted to take powers, but I think he has adopted the wrong route. The most important step that he could have taken, as a Minister responsible for national health information, would have been to say that non-patient-identifiable information should be covered under freedom of information provisions, and accessible to all. That would make narrow commercial interests disappear, because it would not be in the interests of companies to produce the information—but the overall trends relating to drug use would still be explored, because that would be in the interests of if not just one drug company, drug companies generally.

I am profoundly unhappy about clause 62. As I said in the debate on the programme motion, it is ludicrous for the Government to propose such a provision before their own working party on patient confidentiality and associated issues has even reported _Although I welcome the fact they are establishing a formal body to advise them, there is already such a body and they have not waited for its advice before rushing us into legislation.

I think that it would be sensible for the Government to rethink clause 62, and I am glad that I am not the only one who thinks so. At the last Committee sitting, I gave a list of people who feel as I do. Since then, however, the list has grown from four to 11 signatories, representing a wide range of patient interests rather than commercial interests.

Should the House not divide on new clause 1, I would certainly seek to press amendment No. 15 to a Division. As the hon. Member for Buckingham (Mr. Bercow) said, that amendment is extremely elegant and cost-effective, with only 32 words.

Sir George Young (North-West Hampshire)

I hope that someone who is not a registered general practitioner may participate in the debate on this group of amendments.

Although the Government have tabled a very large number of amendments since the Committee rose last Thursday, they have not tabled any amendments to what was clause 59, now clause 62, which was the section of the Bill where I thought that they came under most sustained attack and were on the thinnest ice. I am very sad that they have not found an opportunity to meet some of those anxieties by tabling amendments of their own to new clause 62.

When I initially went through the Bill, before I went on to the Standing Committee, clause 59 was not one that immediately was drawn to my attention. At that stage, no one had written in about clause 59. Admittedly, it had not been in the NHS plan. It was only when the debates in Standing Committee began that letters came in.

The Government, in their definition of patient information, have managed to upset two wholly different groups of people. On the one hand, the Secretary of State has the potential power to ban the use of important and beneficial non-personal data, which has upset the pharmaceutical companies; on the other, the Government also allow sharing of identifiable health data without the subject's consent, which has of course upset the patient organisations.

Like the hon. Member for Isle of Wight (Dr. Brand), I have received representations from the chairman of the Patients Association, the director of the BMA Foundation for Aids and the director of the National AIDS Trust. They say that they have continuing concerns that clause 62 gives the Secretary of State unprecedented powers to collect patient data without consent. It is an attack on patient confidentiality. The Government has not made a proper case for overriding patient consent, even for the cancer registries. The chairman and directors also say, as my hon. Friend the Member for Woodspring (Dr. Fox) said, that the Government are embarking on legislation without a due process of public consultation. They also criticise the Government for drafting clause 62 very broadly and allowing expedient use of identifiable patient information at the discretion of the executive, subject only to clawback safeguards", which they find ineffectual.

Therefore, the Government are not only being attacked by patients' representatives for their definition of patient information, they are being criticised by the pharmaceutical companies for potentially prohibiting the use of anonymised data. Although those data are of commercial value, they are also of real benefit to academics, research institutions, consumer organisations, doctors, pharmacists and patients. In debate in Committee, the Minister, although he tried valiantly, never really justified the very wide definition of patient information in a manner that would allow him to forbid the use of anonymised data, which I believe are of wide benefit.

The assumption has been made that even the use of data without personal identification is, according to the explanatory notes, not in the interests of patients". I ask the Minister to have another go at defining in the interests of patients" in a manner that will reassure the House that he does not seek to ban the use of anonymised information that could be of beneficial use by identifying drugs that have application but, for whatever reason, are not being prescribed in certain parts of the country.

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: The existing legal framework concerning the control of information relating to patients is complex and contains some uncertainties. 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 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 for securing that, where prescribed patient information is processed by a person in accordance with the regulations, anything done by him in so processing the information shall be taken to be lawfully done despite any obligation of confidence owed by him in respect of it. 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 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 wet e 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 Lo 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 disease registers' means those registers of incidence of specified diseases as the Secretary of State shall by regulation prescribe. 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 patient information specified in or determined in accordance with regulations made by the Secretary of State under this section. Again, we are giving the Secretary of State latitude but, first, the Secretary of State must prescribe that information in legislation or regulation, which needs to be scrutinised by the House. The same definition applies to "processing".

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.

Mr. Denham

This is an important debate on an important matter. It is a shame that, so far, it has not lived up to the importance of the subject.

I think that the characterisation of the clause that has been advanced is not justified by what is in the Bill or by the Government's intentions. As I hope to make clear, the debate has not assessed properly the debate outside the House about the use of patient information. Contributors to that debate have said that the Bill should not contain the proposals that it does contain, or that the proposals should be different, or that they should not be introduced now, and so on.

7 pm

As I said in Committee, the Government are starting from a position in which the use of non-anonymised patient information in the NHS is widespread, and has been so for years. The problem that we must tackle is to establish the principle of informed consent on the use of patient information from a starting point that has not made the use of informed consent the principle by which the NHS is guided.

The Government's task with this clause is to find the best way to move as quickly as possible to deal with a problem that was never tackled by the previous Government. They tolerated it, and never criticised its existence, but everyone accepts that the situation is different now. I do not entirely blame the previous Government, because there has been a sea change in attitudes towards the handling of patient information, both among the public and members of the medical profession. I could criticise the previous Government for many things, but it would not be fair to judge Ministers of 10 or 15 years ago by the standards of today. The standards applicable to a lot of the issues to do with patient consent were different then.

I have described the Government's task with the clause. It had to be accomplished at a time when we were not entirely in control of the time scale. That is why the hon. Member for Isle of Wight (Dr. Brand) was wrong to say that we should have waited.

As everyone knows, the General Medical Council, exercising its responsibilities as a professional self-regulatory body, last summer issued guidance that had an immediate impact on the collection of data by cancer registries. As I said in Standing Committee, it issued further guidance in November in response to the ensuing debate. That guidance appeared after the publication of the NHS plan, and said that the professional obligation would not be asserted until October 2001.

If the Government had not taken the earliest possible opportunity, represented by this Bill, to put a proper statutory framework around the use of patient information, I have every reason to believe that the GMC would have felt under a professional obligation to carry through its advice. That would have had an immediate impact on the operation of cancer registries and other activities. The Government are therefore not in control of the time scale, which is why I believe that we are right to go ahead with the proposal and why it would have been wrong to wait.

The hon. Member for Isle of Wight referred to work in the Department on the use of patient information. That work is part of a different exercise looking at all the changes that need to be made across the NHS to put our use of information on a satisfactory basis. We will not have the results until later this year, but it is right for us to get right the statutory framework contained in the Bill.

Dr. Fox

I understand that the Minister is genuine in what he says about what the Government's wish for the Bill, but why has the clause drawn so much criticism from such a wide range of bodies? They cannot all have misinterpreted what the clause is capable of, so surely this is a fault in the drafting. It is not the intention of the Government but the use to which the provisions could be put that has caused such widespread anxiety among the many groups mentioned in the debate.

Mr. Denham

There is disagreement outside the House, as well as in it, about the relevant issues. For example, Professor Martin Vessey of the department of public health at Oxford university wrote to me about the work that he carried out with Dr.—now Sir—Richard Doll in the 1960s investigating the links between leg vein thrombosis, pulmonary embolism and women who had been using oral contraceptives. He wrote about the necessity of using patient data at the time.

I have received a letter from Leslie Davis of the National Perinatal Epidemiology Unit, in which he states: I support clause 59 in providing support for the continuation of important transmission of health information. It will give the NHS and other key agencies guarding the health of the public the temporary ability to maintain critical flows of public health information. We have received correspondence from Dr. Monica Roche and Professor David Foreman of the United Kingdom Association of Cancer Registries. The letter states: We are writing on behalf of the United Kingdom Association of Cancer Registries to ask for your support in ensuring that clause 59 of the Health and Social Care Bill is passed. Without this enabling legislation the national system for monitoring cancer will have collapsed by the end of the year. The attached briefing note goes on to explain why the approach adopted in the Bill is necessary. Sir Richard Doll from the clinical trials service unit and the epidemiological studies unit at the university of Oxford has written to state: It is, we believe, important for the future health of people in this country that a legislative framework should exist that ensures that public health surveillance and medical research can continue when they require information that is available in patients' medical records, without the need to obtain individual patients' consent for their use when this is impractical. In so far as clause 59 will permit this for bona fide research workers on a confidential basis, we strongly support it. I could continue with examples from other correspondence, but the point is not simply that the correspondence illustrates that there is a debate in the medical profession about how to approach this matter. I do not think that there is a debate about informed patient consent, but there is a debate about how we move from where we are, and the practices that have been developed over many years, and reach a better system in the future.

I chose the correspondence that I did because, with the exception of the cancer registries, they referred to activities that fall outside the definition of cancer registries. I gave other examples in Standing Committee. That is why I believe that the approach adopted in the Bill, which has many built-in safeguards, is better than attempting to list or predict in a narrow way in the Bill all the acceptable uses of information.

Dr. Brand

The Minister has used very valid examples, and they all involve bits of research where problems can be overcome by anonymising the clinical data. That is why it is so relevant to say that the outcome of his own working party's research on confidentiality and the processing of clinical data should be available before we decide about what should be the proper legislative proposals that the Minister needs. If the Minister would accept amendment No. 15 or new clause 1, his anxieties over cancer registries would be overcome and he would have time to reflect on whether he needs to take powers that are as wide as those contained in the Bill. We have no doubts about the Minister's intent, but we have great worries about what is in a Bill that does not mention patient confidentiality anywhere.

Mr. Denham

I think that the hon. Gentleman has simply—and inadvertently, I am sure—not really looked at the Bill and the safeguards that it contains. He asserts that all the examples that I gave involved work that could be undertaken with anonymised patient data. I do not have confidence that the hon. Gentleman is right about all the research that I mentioned, or about other legitimate, important and pressing research that might be undertaken.

I hope that, in tilt not too distant future, the NHS IT systems will be fully in place, so enabling electronic patient records to be kept and anonymised patient data to be used routinely. However, I am not sure that we have reached that point yet. That is why the Bill contains two important safeguards that have been included from the outset.

First, the Bill limits the use of the powers to medical purposes where there is a benefit to patient care and public health. Secondly, it limits their use to circumstances in which there is no reasonably practical alternative. The latter is not a once-and-for-all test, and does not mean that once a particular activity slips past the test it is there for ever and a day, because the Secretary of State is required by the Bill to review each set of regulations every year.

Therefore, any activity will have to pass the "practical alternative" test and, as I explained in Standing Committee, it must be looked at by an advisory group. That group will involve organisations such as the GMC, the BMA, research councils, patients' organisations and others. If they advise the Secretary of State that there is no reasonably practical alternative, the Secretary of State then has to make regulations. He then has to consult on the regulations.

That is not an end to the matter because those regulations have to come before Parliament, not, as is so often the case, through the negative resolution procedure, but under the affirmative resolution, which requires a positive vote by both Houses of Parliament. Even if that is achieved, the following year and every year after that, the Secretary of State has to satisfy himself, no doubt by taking advice, that the conditions that led him to believe that anonymised data should not be used no longer apply.

That is a pretty robust set of safeguards, but the hon. Member for Woodspring (Dr. Fox) painted a picture of the Secretary of State getting out of bed one morning and making up his mind on this matter, as if that were an end to it. That is so far from the truth that it is outrageous. Such caricatures are one of the reasons for the amount of concern about the Bill.

On the second issue, which was raised by several hon. Members, including the right hon. Member for North-West Hampshire (Sir G. Young), I suspect that there is simply a difference of opinion in the House, as there was in Committee. We were concerned about the activities of a company called Source Information. We believed that its processing of anonymised patient information led, or was likely to lead, to a targeted marketing effort that was not beneficial to the NHS, so we sought to restrict its activities. We lost that case in court on the basis that there had been no breach of confidence, and we are not attempting to overturn that judgment in the Bill. However, we are, as the judge invited us to do, taking the necessary powers to restrict such activity in future.

It is clearly ridiculous to suggest that this Government, who have published more information about the NHS than any previous Government, are engaged in an exercise to suppress information or criticism. I accept that the hon. Member for Woodspring thinks that in the distant future he might be Secretary of State and that he would use the legislation differently. He invited me to use the precautionary principle to deny him that power. However, it is necessary to take action to protect the interests of the NHS, and with the amendments that were made in Committee, the Bill is a proportionate response to that need.

Since the debate in Committee, the Association of Medical Research Charities has written to us to say: We welcome the Government amendment to subsection two of this Clause which has addressed some serious concerns about the application of the law. AMRC believes that there is merit in including in the Bill a Clause that allows the appropriate use of anonymised patient data for the purposes of research but also makes provision for clear and robust safeguards. That is what I believe we are doing.

Dr. Fox

As I said in opening the debate on the new clause, we believe that in its major provisions this Bill is centralising and authoritarian. Clause 62 is such a provision, and that is why we tabled new clause 1.

There are two main objections to clause 62. It allows the Secretary of State to control anonymised data for reasons that he may determine in future, and rather than detailing when information can be used, the Bill says that the Secretary of State knows best and will exclude its use where he sees fit.

As the hon. Member for Isle of Wight (Dr. Brand) pointed out, the Bill will force doctors to divulge identifiable patient data against patients' will, which is entirely unacceptable. My right hon. Friend the Member for North-West Hampshire (Sir G. Young) rightly said that in Committee the Government came under sustained attack on clause 62. The Minister gave us a long explanation of the mechanics that he believed would provide safeguards, yet nothing has been added to the Bill to make it more explicit or enforceable.

My hon. Friend the Member for Lichfield (Mr. Fabricant) said that what matters is not what happened in the past or even the Government's intentions, but what could be done within the scope of the Bill. That is what worries Members of the House and the many outside groups who have written to us. As the hon. Member for Isle of Wight said, we are legislating even before the end of the Government's consultation process on patient information. That is a bad way to make law; the Bill is bad law, and at some point Ministers will return to the House to reconsider it. It is nothing less than the nationalisation of patient data, and we oppose it. I should like to press new clause 1 to a vote.

Question put, That the clause be read a Second time:—

The House divided: Ayes 167, Noes 306.

Division No. 124] [7.14 pm
Ainsworth, Peter (E Surrey) Cran, James
Allan, Richard Curry, Rt Hon David
Amess, David Davey, Edward (Kingston)
Ancram, Rt Hon Michael Davies, Quentin (Grantham)
Arbuthnot, Rt Hon James Davis, Rt Hon David (Haltemprice)
Ashdown, Rt Hon Paddy Day, Stephen
Atkinson, Peter (Hexham) Duncan, Alan
Baker, Norman Emery, Rt Hon Sir Peter
Baldry, Tony Evans, Nigel
Ballard, Jackie Fabricant, Michael
Beggs, Roy Fallon, Michael
Beith, Rt Hon A J Fearn, Ronnie
Bercow, John Flight, Howard
Beresford, Sir Paul Forth, Rt Hon Eric
Blunt, Crispin Fowler, Rt Hon Sir Norman
Body, Sir Richard Fox, Dr Liam
Boswell, Tim Gale, Roger
Bottomley, Peter (Worthing W) Garnier, Edward
Bottomley, Rt Hon Mrs Virginia George, Andrew (St Ives)
Brady, Graham Gibb, Nick
Brake, Tom Gidley, Sandra
Brand, Dr Peter Gill, Christopher
Brazier, Julian Gillan, Mrs Cheryl
Breed, Colin Gorman, Mrs Teresa
Brooke, Rt Hon Peter Greenway, John
Browning, Mrs Angela Grieve, Dominic
Bruce, Malcolm (Gordon) Gummer, Rt Hon John
Burnett, John Hague, Rt Hon William
Burns, Simon Hamilton, Rt Hon Sir Archie
Burstow, Paul Hammond, Philip
Butterfill, John Hancock, Mike
Cable, Dr Vincent Harris, Dr Evan
Cash, William Harvey, Nick
Chapman, Sir Sydney (Chipping Barnet) Hayes, John
Heald, Oliver
Chope, Christopher Heath, David (Somerton & Frome)
Clark, Dr Michael (Rayleigh) Heathcoat-Amory, Rt Hon David
Clarke, Rt Hon Kenneth (Rushcliffe) Hogg, Rt Hon Douglas
Horam, John
Collins, Tim Howard, Rt Hon Michael
Cormack, Sir Patrick Howarth, Gerald (Aldershot)
Cotter, Brian Hughes, Simon (Southwark N)
Hunter, Andrew Robertson, Laurence (Tewk'b'ry)
Jack, Rt Hon Michael Roe, Mrs Marion (Broxbourne)
Jackson, Robert (Wantage) Russell, Bob (Colchester)
Jenkin, Bernard St Aubyn, Nick
Johnson Smith, Rt Hon Sir Geoffrey Sanders, Adrian
Sayeed, Jonathan
Jones, Nigel (Cheltenham) Shephard, Rt Hon Mrs Gillian
Keetch, Paul Shepherd, Richard
Kennedy, Rt Hon Charles (Ross Skye & Inverness W) Simpson, Keith (Mid-Norfolk)
Smith, Sir Robert (W Ab'd'ns)
Key, Robert Smyth, Rev Martin (Belfast S)
Kirkbride, Miss Julie Soames, Nicholas
Laing Mrs Eleanor Spelman, Mrs Caroline
Lait, Mrs Jacqui Stanley, Rt Hon Sir John
Lansley, Andrew Steen Anthony
Leigh, Edward Streeter, Gary
Letwin, Oliver Stunell, Andrew
Lewis, Dr Julian (New Forest E) Swayne, Desmond
Lidington, David Syms, Robert
Livsey, Richard Taylor, Ian (Esher & Walton)
Lloyd, Rt Hon Sir Peter (Fareham) Taylor, John M (Solihull)
Loughton, Tim Taylor, Matthew (Truro)
Luff Peter Taylor, Sir Teddy
Lyell, Rt Hon Sir Nicholas Thomas Simon (Ceredigion)
McCrea, Dr William Tonge, Dr Jenny
McIntosh, Miss Anne Tredinnick, David
MacKay, Rt Hon Andrew Trend, Michael
Maclean, Rt Hon David Tyler, Paul
McLoughlin, Patrick Viggers, Peter
Major, Rt Hon John Walter, Robert
Malins, Humfrey Waterson, Nigel
Webb, Steve
Mates, Michael Whitney, Sir Raymond
Michie, Mrs Ray (Argyll & Bute) Whittingdale, John
Moore, Michael Wilkinson, John
Moss, Malcolm Willetts, David
Nicholls, Patrick Willis, Phil
Oaten, Mark Wilshire, David
O'Brien, Stephen (Eddisbury) Winterton, Mrs Ann (Congleton)
Ottaway, Richard Winterton, Nicholas (Macclesfield)
Page, Richard Yeo, Tim
Pickles, Eric Young, Rt Hon Sir George
Prior, David
Randall, John Tellers for the Ayes:
Redwood, Rt Hon John Mr. James Gray and
Rendel, David Mr. Geoffrey Clifton-Brown.
Adams, Mrs Irene (Paisley N) Belts, Clive
Ainger, Nick Blackman, Liz
Ainsworth, Robert (Cov'try NE) Blizzard, Bob
Allen, Graham Boateng, Rt Hon Paul
Anderson, Rt Hon Donald (Swansea E) Borrow, David
Bradshaw, Ben
Anderson, Janet (Rossendale) Brinton, Mrs Helen
Armstrong, Rt Hon Ms Hilary Brown, Russell (Dumfries)
Ashton, Joe Browne, Desmond
Atkins, Charlotte Buck, Ms Karen
Austin, John Burden, Richard
Bailey, Adrian Burgon, Colin
Banks, Tony Byers, Rt Hon Stephen
Barnes, Harry Campbell, Mrs Anne (C'bridge)
Battle, John Campbell, Ronnie (Blyth V)
Bayley, Hugh Campbell-Savours, Dale
Beard, Nigel Cann, Jamie
Beckett, Rt Hon Mrs Margaret Caplin, Ivor
Begg, Miss Anne Cawsey, Ian
Bell, Martin (Tatton) Chapman, Ben (Wirral S)
Bell, Stuart (Middlesbrough) Chaytor, David
Benn, Hilary (Leeds C) Clapham, Michael
Benn, Rt Hon Tony (Chesterfield) Clark, Rt Hon Dr David (S Shields)
Bennett, Andrew F Clark, Paul (Gillingham)
Benton, Joe Clarke, Charles (Norwich S)
Bermingham, Gerald Clarke, Eric (Midlothian)
Berry, Roger Clarke, Rt Hon Tom (Coatbridge)
Best, Harold Clelland, David
Coaker, Vernon Howarth, Rt Hon Alan (Newport E)
Coffey, Ms Ann Howarth, George (Knowsley N)
Cohen, Harry Howells, Dr Kim
Coleman, Iain Hoyle, Lindsay
Colman, Tony Hughes, Ms Beverley (Stretford)
Connarty, Michael Hughes, Kevin (Doncaster N)
Cooper, Yvette Humble, Mrs Joan
Corbett, Robin Hutton, John
Corbyn, Jeremy Iddon, Dr Brian
Cousins, Jim Illsley, Eric
Cox, Tom Jackson, Ms Glenda (Hampstead)
Cranston, Ross Jackson, Helen (Hillsborough)
Crausby, David Jamieson, David
Cryer, John (Hornchurch) Jenkins, Brian
Cummings, John Johnson, Alan (Hull W & Hessle)
Cunningham, Rt Hon Dr Jack (Copeland) Jones, Mrs Fiona (Newark)
Jones, Helen (Warrington N)
Curtis-Thomas, Mrs Claire Jones, Ms Jenny (Wolverh'ton SW)
Darling, Rt Hon Alistair
Darvill, Keith Jones, Jon Owen (Cardiff C)
Davey, Valerie (Bristol W) Jones, Dr Lynne (Selly Oak)
Davidson, Ian Jones, Martyn (Clwyd S)
Davies, Rt Hon Denzil (Llanelli) Jowell, Rt Hon Ms Tessa
Davis, Rt Hon Terry (B'ham Hodge H) Joyce, Eric
Kaufman, Rt Hon Gerald
Dawson, Hilton Keeble, Ms Sally
Denham, Rt Hon John Keen, Alan (Feltham & Heston)
Dismore, Andrew Keen, Ann (Brentford & Isleworth)
Dobbin, Jim Kelly, Ms Ruth
Dobson, Rt Hon Frank Kemp, Fraser
Donohoe, Brian H Kennedy, Jane (Wavertree)
Doran, Frank Kidney, David
Drew, David Kilfoyle, Peter
Drown, Ms Julia King, Andy (Rugby & Kenilworth)
Dunwoody, Mrs Gwyneth Kumar, Dr Ashok
Eagle, Angela (Wallasey) Ladyman, Dr Stephen
Eagle, Maria (L'pool Garston) Lammy, David
Edwards, Huw Laxton, Bob
Efford, Clive Lepper, David
Ellman, Mrs Louise Leslie, Christopher
Ennis, Jeff Levitt, Tom
Etherington, Bill Lewis, Ivan (Bury S)
Fisher, Mark Liddell, Rt Hon Mrs Helen
Fitzpatrick, Jim Lock, David
Fitzsimons, Mrs Loma Love, Andrew
Flint, Caroline McAvoy, Thomas
Flynn, Paul McCabe, Steve
Foster, Rt Hon Derek Macdonald, Calum
Foulkes, George McDonnell, John
George, Rt Hon Bruce (Walsall S) McFall, John
Gerrard, Neil McGuire, Mrs Anne
Gibson, Dr Ian McIsaac, Shona
Gilroy, Mrs Linda McKenna, Mrs Rosemary
Goggins, Paul Mackinlay, Andrew
Golding, Mrs Llin McNamara, Kevin
Griffiths, Jane (Reading E) McNulty, Tony
Griffiths, Nigel (Edinburgh S) MacShane, Denis
Griffiths, Win (Bridgend) Mactaggart, Fiona
Grocott, Bruce McWalter, Tony
Grogan, John McWilliam, John
Gunnell, John Mahon, Mrs Alice
Hain, Peter Mallaber, Judy
Hanson, David Mandelson, Rt Hon Peter
Harman, Rt Hon Ms Harriet Marsden, Gordon (Blackpool S)
Healey, John Marsden, Paul (Shrewsbury)
Henderson, Doug (Newcastle N) Marshall, David (Shettleston)
Hendrick, Mark Marshall, Jim (Leicester S)
Hepburn, Stephen Martlew, Eric
Heppell, John Meacher, Rt Hon Michael
Hesford, Stephen Meale, Alan
Hewitt, Ms Patricia Merron, Gillian
Hinchliffe, David Michael, Rt Hon Alun
Hodge, Ms Margaret Michie, Bill (Shef'ld Heeley)
Hoon, Rt Hon Geoffrey Milburn, Rt Hon Alan
Hope, Phil Miller, Andrew
Hopkins, Kelvin Mitchell, Austin
Moffatt, Laura Soley, Clive
Morgan, Ms Julie (Cardiff N) Southworth, Ms Helen
Morris, Rt Hon Ms Estelle (B'ham Yardley) Spellar, John
Squire, Ms Rachel
Morris, Rt Hon Sir John (Aberavon) Starkey, Dr Phyllis
Steinberg, Gerry
Mullin, Chris Stewart, Ian (Eccles)
Murphy, Denis (Wansbeck) Stinchcombe, Paul
Murphy, Jim (Eastwood) Stoate, Dr Howard
Murphy, Rt Hon Paul (Torfaen) Strang, Rt Hon Dr Gavin
Naysmith, Dr Doug Stringer, Graham
O'Brien, Bill (Normanton) Stuart, Ms Gisela
O'Hara, Eddie Taylor, Rt Hon Mrs Ann (Dewsbury)
Olner, Bill
O'Neill, Martin Taylor, Ms Dari (Stockton S)
Organ, Mrs Diana Taylor, David (NW Leics)
Pearson, Ian Taylor, Rt Hon John D (Strangford)
Perham, Ms Linda Temple-Morris, Peter
Pickthall, Colin Thomas, Gareth R (Harrow W)
Pike, Peter L Timms, Stephen
Pond, Chris Tipping, Paddy
Pope, Greg Todd, Mark
Pound, Stephen Touhig, Don
Prentice, Ms Bridget (Lewisham E) Trickett, Jon
Prentice, Gordon (Pendle) Turner, Dennis (Wolverh'ton SE)
Primarolo, Dawn Turner, Dr Desmond (Kemptown)
Prosser, Gwyn Turner, Dr George (NW Norfolk)
Purchase, Ken Turner, Neil (Wigan)
Quin, Rt Hon Ms Joyce Twigg, Derek (Halton)
Rammell, Bill Twigg, Stephen (Enfield)
Raynsford, Nick Vaz, Keith
Reed, Andrew (Loughborough) Vis, Dr Rudi
Robertson, John (Glasgow Anniesland) Walley, Ms Joan
Ward, Ms Claire
Robinson, Geoffrey (Cov'try NW) Wareing, Robert N
Roche, Mrs Barbara Watts, David
Rogers, Allan White, Brian
Rooker, Rt Hon Jeff Whitehead, Dr Alan
Rooney, Terry Wicks, Malcolm
Ross, Ernie (Dundee W) Williams, Rt Hon Alan (Swansea W)
Rowlands, Ted
Roy, Frank Williams, Alan W (E Carmarthen)
Russell, Ms Christine (Chester) Williams, Mrs Betty (Conwy)
Ryan, Ms Joan Wills, Michael
Sarwar, Mohammad Winnick, David
Savidge, Malcolm Winterton, Ms Rosie (Doncaster C)
Sawford, Phil Woodward, Shaun
Sedgemore, Brian Woolas, Phil
Shipley, Ms Debra Wray, Janes
Singh, Marsha Wright, Anthony D (Gt Yarmouth)
Skinner, Dennis Wright, Tony (Cannock)
Smith, Rt Hon Andrew (Oxford E) Wyatt, Derek
Smith, Miss Geraldine (Morecambe & Lunesdale)
Tellers for the Noes:
Smith, Jacqui (Redditch) Mr. Jim Dowd and
Smith, John (Glamorgan) Mr. Mike Hall.

Question accordingly negatived.

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