SCHOOL MEDICAL RECORDS (Hansard, 15 October 1976)

§ Baroness MASHAM of ILTON
My Lords, I beg leave to ask the first Question which stands in my name on the Order Paper.

§ Lord WELLS-PESTELL
My Lords, it is for the Area Health Authority to decide where the school medical records are kept. The decision would normally be taken by the Area Specialist in Community Medicine—that would be the Child Health section. These records are confidential but, with parental consent, teachers are informed about health matters relevant to a pupil's performance and general welfare.

§ Baroness MASHAM of ILTON
My Lords, while thanking the Minister for that very unsatisfactory Answer, may I ask whether he is aware that not long ago a child in Darlington collapsed during a P.E. lesson from a heart complaint and the teacher had not a clue that this problem existed? Who would be responsible—the Education Department or the National Health Service—if there were a lasting disability?

§ Lord WELLS-PESTELL
My Lords, the noble Baroness is very unfair when she says that it is an unsatisfactory reply. She should look at the Question and she should look at the Answer and she would find that the Answer is indeed an answer to her Question. With regard to the matter which the noble Baroness has raised, if she had knowledge of it she could have told me beforehand and I should have done my best to find out exactly what had happened. It so happens that neither my Department nor the Department of Education and Science had any knowledge of the matter. If the noble Baroness will send me information about it I will certainly find out what is the situation and let her know.

§ Lord ALEXANDER of POTTER-HILL
My Lords, is the Minister aware that there is great and growing concern in the Education Service about the deterioration in the standards of the school health service since it was transferred to the National Health Service? Does not the Minister think that the stage has been reached where it is desirable 651 to undertake inquiries in order to try to secure much more effective cooperation between the National Health Service and the Education Service so as to avoid the deterioration which is taking place and to improve standards, which was the purpose of the transfer of the service two years ago?

§ Lord WELLS-PESTELL
My Lords, the noble Lord has raised an entirely different matter which has no bearing on the Question. I am not prepared to say that there has been a deterioration in the service. There are regular medical inspections and their whole purpose is to find out any physical or mental defects in a school child and, where there are physical defects, for the doctor to get together with the teachers so that the teachers know what these defects are. If, however, the noble Lord is saying that there has been a marked deterioration in the school health service I am sure that we should like to have some facts so that we can explore the matter.

§ Lord LOVELL-DAVIS
My Lords, will my noble friend the Minister tell the House, in the light of his Answer to the noble Baroness, whether there is any requirement to ensure that teachers are informed of a child's medical history where it might affect the child's education and, if not, in view of its importance to the child's education and also its physical and mental well-being, whether he will ask his right honourable friend as a matter of urgency to ensure that such information is available?

§ Lord WELLS-PESTELL
My Lords, if the school medical officers come across a situation where the health of a child is likely to be a factor in relation to certain things that the child is required to do at school they are required to pass on this information to the teacher. However, the question of confidentiality arises, and time and time again your Lordships have raised the question of the breach of confidentiality. Therefore it is done, but it is done with the parents' consent.

§ Lord LOVELL-DAVIS
My Lords, may I follow what I said before, in view of what the noble Lord has just said, by asking what directions have been given about medical confidentiality in order to 652 make sure that the maximum amount of information is available in the school?

§ Lord WELLS-PESTELL
My Lords, I would not use the word "directions"; I would say that advice has been given that school medical records and their contents must be kept confidential and they must be retained in a secure place. Having said that, in my view there is a clear obligation on the school medical authority—the doctor—if he finds something wrong with the child, to seek the parent's consent to pass that information on to the teacher or teachers concerned.

§ Lord ELTON
My Lords, am I right in deducing from the original Answer given by the noble Lord that the place where the records are kept—which is what the Question is about—varies from authority to authority? May I ask whether he recalls the many co-operative exchanges we have had across this table in which we have agreed that we should work towards a uniformity of practice in order to enable children at risk of non-accidental injury to be identified and protected? And may I further draw his attention to the first of the summary recommendations in the Maria Colwell report, which was directed towards enabling the field workers to know where the records relevant to the school children were kept? Can he put all that together and see that there is some means of correlating the two sources of information and responsibility?

§ Lord WELLS-PESTELL
My Lords, the noble Lord is working on the assumption that there has been a breakdown in communication or arrangements. There is no evidence of it at the moment. As I have said, we had no knowledge of this particular situation and had we been given some information about it we would have inquired into it. The records are normally held in the school clinic or in the office of the principal school medical officer and sometimes within the medical inspection room in the school. None of those three areas will be very far away and it is not always possible to say that in every school they must be in the same place.

Lord EILTON
My Lords, may I ask the noble Lord to accept that the question 653 has nothing to do with the case that was raised in the supplementary question? Our concern, as is his, is one of prevention, and would he use this occasion as a means of furthering the efforts which he already has in hand of getting a nationwide standard of practice in child care?

§ Lord WELLS-PESTELL
Most surely, my Lords.

§ Baroness MASHAM of ILTON
My Lords, if I may ask one last quick supplementary question I should like to ask the noble Lord what contact exists between the school health doctor and the GP, and how is a child like Maria Colwell safeguarded when the parents do not send their child to school on the day of the inspection?

§ Lord WELLS-PESTELL
My Lords, with regard to the latter part of that question, my understanding of the situation is that some inquiry is made to find out why the child did not attend, and then arrangements are made for it to attend subsequently. If there is some kind of emergency that is dealt with. With regard to co-operation between the school medical officer and the GP I should have thought that the general practice in medicine—which many of us know fairly well—is that when one doctor in a particular situation is dealing with what could he called a child within the family dealt with by the GP, the information would be passed on.

§ Lord PLATT
My Lords, in reference to the Minister's rather unexpected reply to the supplementary question put by the noble Baroness, Lady Masham of Ilton, does the Minister agree that an answer may be unsatisfactory for at least one of two reasons: either because it has not replied to the question or because the answer in itself seems to the questioner to be a very unsatisfactory one, although entirely correct factually?

§ Lord WELLS-PESTELL
My Lords, I do not accept that my Answer was unsatisfactory in relation to the Question.

§ Lord PLATT
I thank the noble Lord.

§ Lord CLITHEROE
My Lords, would the noble Lord accept that my noble friend the Baroness has raised a very important question?

§ Lord WELLS-PESTELL
My Lords, I am not denying that. What I am saying is that the noble Baroness must have known about this particular matter when she tabled her Question. The Question has been tabled for some time. Had the Government been informed of the nature of and reason behind the Question I could have come to your Lordships' House today and given a full report on it.

§ The LORD PRIVY SEAL (Lord Peart)
My Lords, I think we have had a good run on this and the noble Baroness wishes to ask a second Question.