Access to Health Records Bill (Hansard, 4 July 1990)

§ Baroness Ewart-Biggs

My Lords, I beg to move that this Bill be now read a third time. Without wishing to take up more than a few minutes of your Lordships' time, I want to reiterate my thanks to all noble Lords who have made such constructive contributions to the debate on this Bill. I particularly wish to express my gratitude to the Minister and to the noble Baroness, Lady Blatch, who have given the Bill both great encouragement and a fair wind.

I wish to raise two points which have not been mentioned to date. Naturally, I do not expect the Minister to respond to those points, but I hope that they may be borne in mind when regulations or departmental guidance are drawn up. My first point concerns appeals. The Bill provides a two-stage process for appeals on the part of someone who believes that the requirements of the legislation are not being met. Initially a complaint would have to go through an internal complaints procedure to be laid down in regulations. Only when that procedure is exhausted will such a person be entitled to appeal to the court. My concern is that the internal procedure should not involve excessive delay and that there should be a time limit by which a decision on the complaint must be reached. I raise this matter because the health service already has various complaints systems. Sometimes, however, it takes more than a year to deal with complaints. I understand that steps are being taken to speed matters up.

The regulations under the Bill may well use or adapt existing procedures. Under the Bill complaints issues will be relatively simple compared with, say, those dealt with by the clinical complaints procedure used by health authorities where grave allegations, perhaps about the cause of a patient's death, may be 2164 investigated. In the present context we are dealing with people who merely want to see their own records and who will still be waiting to see them while an internal appeal takes place. I hope it will prove possible to specify a time limit by which an appeal must be dealt with, and perhaps to say that if no decision is reached by that time the applicant will be deemed to have complied with the requirements of Clause 8(2) and will be free to take the complaint to the court.

My second point concerns the requirement in Clause 7 that a health authority or other health service body must consult "the appropriate health professional" before reaching any decision about withholding information. The Bill's definition of "the appropriate health professional" suggests that if the patient is under the clinical care of a doctor the health professional to be consulted is that doctor, even if the records that are sought are those of another health professional such as a health visitor, midwife or member of the nursing staff. However, those records may not be under the control of the doctor. The doctor may not normally see or contribute to them and may not know whether the information within them has already been discussed with the patient. It would make sense in those circumstances for the decision on access to depend on the advice of the health professional to whom the records belong. I raise this matter as a point which I hope may be addressed when the time comes to draw up guidance on the procedures to be followed in implementing the Bill.

Although I know there is a strong competitor for your Lordships' time at the present moment, I believe this to be a useful Bill. It is an important step forward in the long march towards establishing greater freedom of information. I believe that its provisions will create better understanding and greater trust between doctors and their patients.

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)

My Lords, in giving the Bill their support the Government have always been aware of the reservations expressed by and on behalf of the medical profession on access to records. It is right that those concerns should be subject to public debate, as they have been in this House. I believe that on the whole points raised by your Lordships on Second Reading which required clarification from the Department of Health have been met either during that debate or in subsequent correspondence. However, the noble Baroness has now mentioned a couple more points which I shall be happy to respond to. I should also like to take this opportunity to thank my noble friend Lady Blatch for holding the fort, as it were, on Second Reading.

We have said that as regards opening up nursing records, we shall undertake consultation with the appropriate health professional. In that case the professional would be the health visitor and not a doctor. The health visitor may however seek the advice of a doctor before allowing access if the nursing record contains information which has been 2165 extracted from medical records, or otherwise received from a doctor.

On the question of using hospital complaints procedures as an appeal mechanism against a refusal to allow access to health records, we intend to use the hospital complaints procedures to review appeals. There is no apparent reason why inordinate delays should develop. However, our guidance to the National Health Service will propose specific time limits for action. We anticipate that both those issues will be covered by guidance and that the people concerned will be consulted before the guidance is finalised. I hope that that assurance is helpful to the noble Baroness, Lady Ewart-Biggs.

It may also be useful if I comment on a matter which exercised your Lordships during the debate at Second Reading relating to the question of when an application for access is deemed to have been made. I understand that that question was resolved. The Bill provides for a patient's right of access to be excluded in certain circumstances. In order that that provision can be exercised properly a thorough knowledge and understanding of the applicant's medical history is required. The exclusion should therefore be determined by the holder of the record only after careful consideration. That would indicate that in all fairness the holder of the record must be given the prescribed time to respond, starting from the time when the application is brought to his or her personal attention.

On a more general point, and in response to doubts expressed by the noble Lord, Lord Rea, that the provisions of the Bill could well induce him to second thoughts when as a practising doctor he prepares his notes since what he records could be seen by his patient, I remind your Lordships that the provisions of the Bill, once enacted, will take effect from November 1991. That long lead time should give health professionals plenty of opportunity to adapt to the new regime. It should also allow for it to begin with the support of everyone concerned. We hope that that will be very much the case. It will also allow training to be organised and procedures implemented.

The principal aim of the Bill is one which, as has been said, the Government are happy to support. It is clearly one which also has wide public support. I am happy to be able to congratulate the noble Baroness, Lady Ewart-Biggs, on bringing the Bill successfully through this House and I wish it well.