§ 3.35 p.m.
§ LORD REIGATEMy Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
§ The Question was as follows:
§ To ask Her Majesty's Government whether they will confirm that the reports on in-patients in hospital prepared by the medical or psychiatric social workers will remain the exclusive property of the hospital concerned and the area health authority and not divulged to the local authorities without the written consent of the patient.
§ LORD WELLS-PESTELLMy Lords, as the noble Lord knows, hospital based social workers are now employed by local social services authorities. The custody of social work reports is under the control of the social worker concerned and the disclosure of their contents is a matter of professional ethics for the social worker, in consultation in appropriate cases with other members of the hospital team.
§ LORD REIGATEMy Lords, will the noble Lord agree that the present confidentiality of these reports, which may include reports on psychiatric conditions, should be limited so far as possible to the clinical team who may be working on them?
§ LORD WELLS-PESTELLMy Lords, it depends entirely on the nature of the reports. Medical case notes about a patient, which may include a contribution by a person who is not employed by the Health Service, remain the property of the hospital authority.
§ LORD PLATTMy Lords, in view of the very great importance of confidentiality, which worries many of us more and more, and especially the importance 236 of psychiatric reports, may we have a rather more positive reply to the Question of the noble Lord, Lord Reigate?
§ LORD WELLS-PESTELLMy Lords, I thought I had given a positive reply, in the sense that I said that where a report forms part of the medical notes it remains within the jurisdiction of the hospital authority. But, in the last analysis, one has to bear in mind that when a patient leaves hospital and returns to the community he very often requires assistance from the local social worker. If the real purpose of social work is to do what is best for the client, then the medical social worker and the local social worker in the community should be able to get together to discuss how best to support that person in the community.
§ LORD REIGATEMy Lords, will the noble Lord accept that this is really a very unsatisfactory situation, and one which will cause widespread concern? Is he aware that in many cases the reports prepared are part of the clinical notes? Is he also aware that there are other matters included in these social reports which are not suitable for divulging to others working in the local authority, of which the patient may not even be a citizen?
§ LORD WELLS-PESTELLMy Lords, with very great respect I thought I had answered that point. I say very clearly that when a person leaves a hospital and returns to his or her community needing further support, presumably the medical social worker will then suggest to the patient that he or she may need further help in the community. If there were any matter which the medical social worker felt that the other social worker should know about, presumably he would seek the assistance of the patient to pass that information on.
§ BARONESS WOOTTON or ABINGERMy Lords, would the Minister make absolutely clear that he is not only getting the assistance of the patient but that he will not divulge the information without the patient's consent, which is what the Question asked?
§ LORD WELLS-PESTELLMy Lords, I do not think that any professional social worker would disclose information about a patient returning to the community without the patient's consent. In the last analysis one must realise that 237 social workers outside the hospital setup are well aware of the professional ethics involved, and I think it must be left to the professional ability of the people concerned.
§ LORD DOUGLASS OF CLEVELANDMy Lords, if the noble Lord feels that no professional worker would divulge the information he possesses, what is wrong with making it legal that he should not?
§ LORD WELLS-PESTELLMy Lords, I think it would be a pity if we tried to deal with this matter by some form of legality. I think we ought to keep in the forefront of our minds the fact that if a person needs help after leaving a hospital we ought to be concerned with what is best to help that particular person. It is a matter, surely, for the local authority social worker to get together with the medical social worker, so that they can decide how best to deal with the situation. It might interest the noble Lord to know that there are discussions taking place at the present moment between the British Medical Association and the British Association of Social Workers on this very point.
§ LORD GEORGE-BROWNMy Lords. may I ask my noble friend whether he has not got it wrong? Many of us on these Benches, and I imagine on the other Benches, think that when it comes to giving this kind of detailed information, which has been collected under a special relationship, it ought not to be done by somebody the noble Lord calls "we". It should be done only if the patient, (a) knows that it is being done, and (b) says, "I do not mind that it should be done". This is not a matter of legality. May I ask my noble friend whether this is not a matter of protection of a person's personal privacy? If it is not the practice at the moment, will he at least tell us that he will consider the reasonable concern that I and many of my noble friends are showing about this matter. Privacy is becoming the last thing that some of us in this House ought to defend.
§ LORD WELLS-PESTELLMy Lords, with great respect to my noble friend, I thought I had dealt with this very clearly. I thought I had made it perfectly clear that, if it is a matter about which there has to be discussion between the medical social worker and the local authority 238 social worker, it is surely a matter for the medical social worker to seek the views of the patients. As to whether information contained in the patient's case notes ought to be disclosed to the local authority social worker—
§ LORD GEORGE-BROWNNo——
§ LORD SHEPHERDMy Lords, I must intervene. We have been on Questions for 28 minutes. The House will agree with me that an important matter is being questioned here, but I think we are unlikely to reach a satisfactory conclusion. I wonder whether those noble Lords who have expressed an interest could meet my noble friend immediately after Questions, or at some other suitable time, to pursue it, and then if necessary raise it again on the Floor of the House. I recognise the importance of this matter, but I think we have to take into account the amount of business.