HL Deb 22 June 1990 vol 520 cc1206-29

1.40 p.m.

Baroness Ewart-Biggs

My Lords, I beg to move that this Bill be now read a second time. Before anything else perhaps I may say how happy I am that this debate has attracted two maiden speakers from whom I expect a great and important contribution to this debate. I know how much we all look forward to what they have to say.

The Bill before us is the result of a Private Member's Bill introduced in another place by my honourable friend Mr. Douglas Henderson. Its purpose, subject to certain exemptions, is to allow people to see their own medical and other health records. Personally, I am happy to be in a position to present this Bill. Over the years I have shown a certain doggedness about promoting the cause of accessibility to information. In November 1986 I initiated a debate in this House about general accessibility to information and I was delighted to be able to support the Bill, which later became the Access to Personal Files Act, when it was introduced in May 1987 by the noble Lord, Lord Tordoff, who will be taking part in this debate.

However, at that time we very much regretted the fact that medical records which initially were included had to be dropped from its scope. I remember ending my speech on that occasion by saying that we were happy to have the Bill accepted but that we regarded it as a Mini and that we hoped the Mini would grow and grow and finally become a Rolls-Royce of a Bill about access to information. I am happy to be able to say that the Bill now before us has grown very much and is coming along nicely towards developing into the Rolls-Royce that we who are interested in freedom of information would like to see.

The Bill addresses an odd inconsistency under the Data Protection Act. We now have a right of access to computerised medical and other records on ourselves but we have no right to see manually held medical records, though other forms of manual records in the areas of housing, social work and education have been, or are about to be, opened up. The Bill establishes a right of access to non-computerised health records subject, more or less, to the same safeguards that apply to health records under the Data Protection Act. The Bill has been the subject of detailed discussions with health Ministers and I am very happy to be able to say that it enjoys the support of the Government.

Before describing the Bill I should like to explain why I believe it is so necessary and how it provides an important new freedom for people. After all, we are encouraged to take more responsibility for our own health. We increasingly want to know what to do to keep ourselves healthy and to aid and assist our recovery when we are ill. We want to be able to discuss our treatment with the doctor, to understand what we are being asked to consent to, to know the risks, alternatives and chances of success. This Bill will help us to do that.

Of course, access to the written record is not an alternative to discussion with the doctor but I believe it may help to make that discussion more informed and more equal and therefore become a much more natural process between doctor and patient. The Bill will allow access for those who ask for it but it will not force the record on anyone who does not want it. Therefore, it will not affect people who prefer to leave the doctor to decide what to tell them or who even want to be shielded from the truth.

The Bill will help if the doctor is not fully responsive to the patient's needs or is overprotective. A survey published this April in New Woman magazine found that 44 per cent. of people said that their doctor did not always fully explain their condition and treatment and 15 per cent. said they never received the necessary information. The survey also found that 94 per cent. of people would rather be told the truth about a serious illness but that four out of five doctors said that they would lie if the illness was terminal or if they thought that the person could not cope. Both statistics seem to be in conflict, one with the other.

A survey last year by the Campaign for Freedom of Information found that a growing number of doctors already allow access to records if the patient asks, and many of them support this legislation. One general practitioner said: I am very keen that the patient has access to the same information as I do because that way we both deal with the same problem". Another doctor said: Patients are far less demanding and welcome being treated as adults". He also said that it helps to overcome patient paranoia if they know exactly what is going on and know that they have the whole truth. Many doctors said that access would help clear up misunderstandings and misconceptions. Therefore, a great benefit of openness is that it will help improve the accuracy of records. Again, that is another important reason for having this Bill.

One general practitioner who monitored records forwarded to him on his new patients found that one in four of the records omitted the information which the doctor regarded as valuable or essential to patient care. Records had failed to include the existence of conditions such as open heart surgery, rheumatic fever, kidney failure and hysterectomy. One woman who was allowed to see her records found that they only covered the last nine years. She discovered that the bulk of her records had been retained by her former GP. It was only as a result of her efforts that the lost records were found. They had been kept by the former GP. The woman suffers from a serious neurological condition but her current doctor was totally unaware of the investigations that had been carried out. It was only because the patient was allowed to see the records that it was discovered.

There is little doubt that access would help the patient to detect such mistakes and that is something one would expect the doctor to appreciate as much as the patient. Finally, openness will act as a safeguard against possible casual, ill-considered personal comments that are sometimes found on medical records. Such comments may remain on a patient's record for life and may unfavourably affect the way in which subsequent health staff think and regard the patient. The right of access may make those who keep records think rather more carefully about what they write.

Some doctors may be concerned that openness will inhibit them in recording opinions on matters which the patient may find unpalatable. It has been suggested that doctors may be reluctant to record suspicions that a patient has, say, an alcohol problem. If the patient has the right to see his notes the doctor may prefer not to include that in his notes. However, I wonder how helpful to the patient it is to record such suspicions but conceal them from the patient. Surely the doctor would raise his concern in a tactful way; otherwise, how else could the doctor offer help? The notes would then reflect that it had been done and perhaps also record the patient's response. That would then come as no surprise to the person if he asked to see his records.

I now briefly outline the Bill's main provisions. It applies, as I said, only to manually held records on the health of an individual which had been made by, or on behalf of, a health professional in connection with the care given to that individual. "Health professional" is defined in Clause 2(1). The term embraces not just doctors but dentists, opticians, pharmacists, nurses, midwives, health visitors and a variety of others. Both National Health Service records and those kept in private practice are covered. This Bill does not apply to information recorded before its commencement apart from a minor provision in Clause 5(2) which operates only at the record holder's discretion.

Clause 3(1) specifies who may apply for access. That would be the patient—him or herself—or the patient's authorised representative. Subject to certain safeguards the parent of a child under the age of 16 or, in Scotland, the parents of a pupil, can apply. The child itself may also apply provided he or she is capable of understanding the nature of the application. That is the position under the Data Protection Act.

The Bill also provides for applications to be made on behalf of persons incapable of managing their own affairs. After the death of the patient the records relevant to a claim for negligence can be applied for by a person entitled to bring such a claim. That is usually a dependant. Applications will be made in writing to the holder of the record, who must reply within 40 days. However, where the request is limited to information recorded in the past 40 days, Clause 3(5) requires that the response must be made within 21 days. That provides quicker access for the patient seeking information about his or her current treatment.

The applicant will be able to inspect the record and obtain a photocopy on payment of copying costs. The applicant is entitled to an explanation of any unintelligible terms. If the applicant asks only for information recorded in the past 40 days, no fee can be charged for access. If a patient wants information about current treatment he will not be charged. However, in other cases a fee at the same level as that under the Data Protection Act can be charged. That is currently £10.

Clauses 4 and 5 deal with exemptions. Information can be withheld where, in the record holder's opinion, access would cause serious harm to the patient or to someone else. The serious harm test also appears under the Data Protection Act and in the legislation covering access to social work and housing records. Information about or provided by some other identifiable individuals other than a health professional, is also exempt. The information will be made available if that person consents.

One of the changes resulting from the Government's amendments in another place has been to remove the original requirement that a patient should be told when exempt information is withheld. The patient is no longer entitled to know. I personally regret that. However, that reflects the position under the Data Protection Act. A parent may have access to a child's records with the child's consent. If the child is incapable of giving consent the parent can have access provided that access is in the child's best interests. That recognises that sometimes the interests of parent and child may differ.

For example, the parent may want the information to strengthen his or her case in a divorce dispute. Even where access is granted that information which the child gave in the expectation that it would remain confidential from the parent—for example, in discussing problems at home or possible child abuse—would not be disclosed. The Bill gives the Secretary of State power to make further exemptions by regulation should these be found necessary later.

Clause 6 allows the applicant to seek the correction of inaccurate information. If the record holder accepts that the information is inaccurate he must make the necessary correction. If he does not, he must note on the record that the applicant disputes the information. The patient cannot compel the doctor to alter the record against the doctor's better judgment unless the patient successfully appeals through the Bill's appeals' procedure.

Clause 7 requires health authorities and other NHS bodies to take advice from the appropriate health professional before making any decision which requires him to form an opinion; for example, whether access would cause serious harm to someone. Normally, the advice from the doctor responsible for the patient's care would be sought. Where the patient is not under a doctor's care the clause lays down alternative arrangements based on those found under the Data Protection Act. Anyone who believes that an exemption has been abused or that the record holder has failed to comply with a requirement of the Act, would have a two-fold right of appeal under Clause 8. In the first instance the appeal would be through an internal procedure to be laid down in regulations. Presumably, they would be operated by health authorities, family practitioner committees and other NHS bodies. If having gone through this procedure the applicant remains dissatisfied he or she would ultimately be able to appeal to the court.

Clause 9 attempts to prevent a third party, such as an employer, compelling someone to obtain his or her medical records and to hand them over to that third party. Any term of contract which attempts to require that would be unenforceable. That does not interfere with the present ability of an employer or insurer to keep a medical reference from the patient's general practitioner provided they have the patient's consent.

Finally, the Bill will come into force in November 1991. It does not apply to Northern Ireland. Can the Minister say whether it will be implemented in the Province by an Order in Council? I hope that the Minister is listening to my only question. I cannot see why the people of Northern Ireland should be denied this particular right.

I end by saying that this measure strengthens the rights of the individual. It will help people to become more self-reliant. It is a valuable measure which has very wide public support. I fear that it comes to this House rather late in the parliamentary timetable. It has already been the subject of very detailed discussion with Government and the professions. I believe that the Bill contains the necessary safeguards. I hope that it will be acceptable to your Lordships and that noble Lords will wish to see it on the statute book with the minimum of delay.

Moved, That the Bill be now read a second time.—(Baroness Ewart-Biggs.)

1.56 p.m.

Baroness Cumberlege

My Lords, I rise to speak in this debate in the knowledge that your Lordships are always generous, gentle and kind to new Members of your Lordships' House and that in particular maidens are to be cherished. I say maidens because I am aware that the noble Baroness, Lady Hollis, is also addressing your Lordships for the first time this afternoon. Perhaps I may say how much I am looking forward to her contribution on this and on future occasions since I know her to be an eloquent speaker. She has experience in many fields which I feel sure will be of great value to your Lordships' House, as it has been in another debating chamber in the city of Norwich.

I have grown up in the National Health Service. I have chaired a district health authority and now I chair a regional health authority. I am very much aware that the spirit of glasnost has not been as fervently embraced in medical circles as it has been elsewhere. Perhaps it is a little strange that the records of part replacements, breakdown and repairs and servicing for the only thing that we can truly call our own should not be open for our own personal inspection and indeed not yet for our own safe keeping.

We choose our doctors but they fill in our records. I suggest that there is merit in knowing what is written and whether it is accurate; a point very ably made by the noble Baroness, Lady Ewart-Biggs, in introducing the Bill. An example was brought home to me very clearly the other day. An acquaintance of mine who is expecting a baby for the first time had her age noted as 35 when in fact she is 25. This clerical error triggered off a whole range of interventionist and inappropriate medical care which she did not want. It was only when she was able to persuade her doctor to show her the notes that the error was discovered and she was able to have the kind of care that she wanted and which was more appropriate to a person of her age.

I believe that many doctors feel that medical records actually belong to them. Undoubtedly they are used very often as an aide mémoire for their eyes only. I understand from medical colleagues that it is not uncommon to find O/E, NOD and NAD on an elderly person's notes. I understand that on translation those initials stand for "On examination; nice old duck, nothing abnormal detected". It is also not uncommon to find in the right-hand corner of notes used in family planning clinics F/F, meaning feckless and fertile. Under the provisions of the Bill we shall lose such medical quips. I believe that few will grieve for them and that their loss will be more than recouped through consumer satisfaction.

I appreciate the argument that there are some sensitive matters which should not be disclosed to patients but which may need to be written on the notes. I am sure that the noble Lord, Lord Walton, who has had a distinguished career in the medical profession, culminating in the presidency of the General Medical Council, will highlight some of those areas.

Two examples come easily to my mind; first, a tentative diagnosis when perhaps a doctor wants to put in the record something like cacinoma but does not wish to reveal it to his patient and his or her family for fear of the distress that it may cause, and, secondly, an opinion, perhaps of suspected child abuse, which is deemed relevant but which, if revealed, could be damaging to the dynamics of a family, possible causing break-up. However, similar challenges have already been faced by social services departments which have been obliged to open up their records. Indeed some departments have been running the system for three years. Their experience has shown that records are now factual, accurate and a useful tool of communication, not only between professionals but, perhaps more importantly, between clients and social workers.

There is growing recognition that people want to take more responsibility for their own lives. And, to be quite frank, the Secretary of State, through his agents, the health authorities, is a careless guardian of our records. When I chaired the Brighton health authority we found in a survey that at any one time 20 per cent. of X-rays were missing. Yet in Portsmouth, when an obstetrician, Mr. Frank Murray, ran a pilot scheme whereby women held their own records, out of 11,000 cases only three files were lost. One was destroyed in a house fire, the second lost in a flood. The third—the loss of which noble Lords may think was a little careless—was eaten by the dog.

For the 10 years that I have worked in the NHS, medical records have loomed large as a cause of irritation between the people we serve and medical staff. But this Bill, which contains correct safeguards for special cases, is in line with other legislation. It will remove one annoyance that can spoil the trust between people and their doctors. Perhaps I am hopeful enough and young enough to look forward to the future when we shall be considering the wisdom of letting people keep their own records. That might encourage a few hypochondriacs and a few health bores but it would lift a huge load off the NHS. I realise of course that the Bill does not go that far at the moment and that a more courageous step at this time would probably be unacceptable to the medical profession whose co-operation in implementing the Bill we so clearly need.

In conclusion, perhaps I may be bold enough at the very outset of my time in your Lordships' House to commend this admirable though modest measure which I have long hoped to see on the statute book.

2.4 p.m.

Lord Walton of Detchant

My Lords, it is my very pleasant duty on behalf of the whole House warmly to congratulate the noble Baroness on her thoughtful, perspicacious and enjoyable maiden speech, which was so charmingly and splendidly expressed and so lucid in every moment. She has had a most distinguished career in the National Health Service as chairman of the Brighton Health Authority, now as chairman of the South-West Thames Regional Health Authority and as a past chairman of the National Association of Health Authorities. But she is someone of many parts, having contributed not only to the health service, to which her contributions are beyond praise, but also to local affairs in her own county. Indeed if I were to recite or to attempt to recite the many offices which she has held, the many important distinctions that have been conferred upon her, I would be in danger of detaining your Lordships for far too long. We know that she will contribute outstandingly to future debates.

The noble Baroness lists as her recreations other people's gardens. But I would judge that she is so well organised and so splendidly efficient a person that she looks after her own garden with an efficiency equal to that with which she has served the nation and the health service. We look forward to hearing much more from her in the months and years to come.

I am advised that the General Medical Council considers that the overall objective of the Bill is worth while. It is the General Medical Council's view that the doctor/patient relationship is founded on a mutual trust which can be fostered only when the information is freely exchanged between doctor and patient on the basis of honesty, openness and understanding. It would wish to encourage any practice which contributed towards such a beneficial exchange of information. That is certainly a view that I share.

The opportunity for patients to correct any inaccuracies which might find their way into their medical records would be an obvious gain as would anything which discouraged doctors from recording comments which might be their personal opinion but which did not properly belong in an individual's medical records. However, the proposal might bring some losses as well as very substantial gains.

The introduction of a statutory right of access will inevitably lead to some changes in the essential character of medical record keeping. Many things may improve but there is a risk that if patients can demand access to everything written about them by doctors, whether factual or speculative, some doctors may feel inhibited from keeping full and frank records to the ultimate disadvantage of both. There is a fear that that could encourage a defensive attitude on the part of some doctors not only towards the preparation of written records but towards the practice of medicine itself, with doctors increasingly mindful of the possibility of future litigation. Moreover, anything which affects the comprehensiveness of medical records will have implications for the emerging arrangements to establish, throughout the profession, a system of medical audit by way of peer review which, particularly in general practice, will need to rely heavily upon the scrutiny of full patient case notes.

I am told that at two recent meetings the GMC endorsed the view taken by its committee on standards of professional conduct and medical ethics—a committee which has three lay members—that the decision as to whether patients should have a right of access to their records was one for society as a whole and therefore a question to be decided ultimately by Parliament. The council's concern, and mine, is to ensure that any such decision is taken in the light of full public debate and of consideration of the likely losses, as well as the potential gains, of introducing changes such as those proposed in the Bill.

Perhaps I may now draw your Lordships' attention to two particular provisions of the Bill which I believe might benefit from further detailed consideration. The first relates to the exclusion of the general right of access, to any part of the record which, in the opinion of the holder of the record, would disclose information likely to cause serious harm to the physical or mental health of the patient or any other individual". I am told that the GMC's standards committee was greatly disturbed by the lack of consideration of the question of what response a doctor may or should make to a patient who asks whether—and, if so, for what reason—any information has been withheld from a record to which access has been granted. On the one hand, the knowledge that information has been suppressed, without any explanation of the reason, may well be much more distressing to a patient than to receive no information at all. On the other hand, for a doctor to seek to mislead patients, directly or indirectly, into believing they had received an unexpurgated copy of their records when this was not the case would run totally counter to the spirit of data protection/access legislation and would militate against an atmosphere of trust between doctors and patients.

I accept that an earlier provision in the Bill, requiring patients to be told when something is withheld from what they are shown, has now been dropped following the passage of an amendment in another place. However, that does not solve the basic difficulty. The consequences could be potentially serious, not so much for doctors as for patients, especially perhaps for those suffering from a mental condition causing them to lack insight and to suspect others of writing down derogatory information about them.

The second matter which I think calls for clarification is the introduction, through amendments to the Bill which were tabled on behalf of the Government in another place, of provisions which would actually prohibit the granting of access to records in some circumstances. At present doctors enjoy discretion as to whether or not to let patients see their records. I have heard no explanation of the proposed provisions regarding circumstances in which access shall not be given without regard to the doctor's opinion as to the desirability of granting such access.

For example, in the case of patients who are under the age of 16 years, or who are incapable of managing their own affairs, it seems that a doctor who obtains information in circumstances where the patient expects that that information will not be disclosed to any third party who may be empowered to apply for access to the record—such as a parent or a court-appointed guardian—would actually be prohibited from subsequently acceding to the application for access made by such a third party, even if the doctor were to judge it to be in the patient's best interest to allow the application.

I understand that the GMC's approach to the disclosure of confidential information is that there can be no absolute guarantee that a doctor will maintain professional confidence in all circumstances. However, a doctor who takes a decision to disclose information without the patient's consent must be prepared to justify that decision. I wonder whether the relevant amendments to the Bill are intended to indicate that Parliament believes that it is improper for a doctor to disclose information about a patient to relatives, or other interested third parties, in any circumstances. I am sure that that is not the intention, but I believe that that point should be clarified.

The proposition that a doctor should not have discretion to allow such persons access to the record seems to raise that possibility. However, I also note that the Secretary of State may by regulations lay down other circumstances in which the record holder will not be allowed to grant access to records. I should like to ask what other circumstances may be envisaged and with what justification.

Whatever Parliament should decide, I am informed that the General Medical Council will advise doctors to comply fully with the requirements of the law. However, I believe that it is in everyone's interests that there should be a full debate before arrangements are finally introduced which would significantly change some of the ways in which medicine is practised.

I have one final point upon which I would welcome the Minister's views. It relates to the requisite period provided in Clause 3(2) within which the holder of a health record must give access to it, if access is appropriate. That requisite period runs from the date of application, which is 21 or 40 days depending upon the circumstances. The profession is concerned that the date of the application might not be construed as the date upon which the doctor received it. A single-handed practitioner might go on holiday for two or three weeks or might be away for some time due to illness. The locum would not be the holder of the record and could not act on that doctor's behalf. The doctor could then find himself or herself inadvertently in breach of the Act. I hope that the Minister will be able to give us an assurance that the requisite period will run from the date of receipt of the application by the record holder. With those comments, I support the Bill.

2.15 p.m.

Baroness Hollis of Heigham

My Lords, I am glad to be able to make my maiden speech on a Bill so ably moved by my noble friend Lady Ewart-Biggs, and following the eloquent and persuasive speech of the noble Baroness, Lady Cumberlege, whose richness of experience in the health service we all admire and few of us can emulate. If it is not impertinent for a maiden speaker to congratulate a previous maiden speaker, perhaps I may also say how much I welcomed and enjoyed her remarks. It is also a pleasure to make a maiden speech to a maiden Bill which I hope your Lordships will agree is transparently virtuous. It is a Bill attested to in its support by some 70 organisations ranging from the Royal College of Nursing to the Townswomen's Guild, some 80 per cent. of GPs surveyed and some 90 per cent. of their patients. It is a Bill, in other words, with a wide track of support.

The Bill is consistent with all-party social policy on at least two counts. It brings, as my noble friend Lady Ewart-Biggs and the noble Baroness, Lady Cumberlege, have said, health service manual records into line with computerised records. It also brings health service records into line with those of housing, the social services, local government, and, shortly, education, all of them equally sensitive services and all of them services that need to network their information and to share it with their clients if the most effective counselling and support is to be offered.

The Bill withholds information that a doctor judges would pose serious harm to the patient, and it exempts information which is held on manual records before the Bill's implementation—a principle of no retrospective legislation which I understand we hold dear. That means that the Bill protects the patient's best interests and perhaps the doctors past idiosyncrasies. What could be more virtuous than that?

I support the Bill on two broad grounds. Perhaps I may spend a moment in speaking to each of them. The first is that of utility, and the second that of rights. On utility, doctors see some 150 patients a week. It is not surprising if errors creep into the record. When patients move home and GP, their notes follow them as do sometimes the notes of their father or neighbour or another patient with the same name. Teetotallers are told to give up drink; and hepatitis may not be recorded. Yet those records are a paper shadow which follows us through the health care system all our lives. It is essential that they are correct. The patient's scrutiny will help to ensure that they are correct.

When many years ago I first chaired the housing committee in the City of Norwich we held confidential files on tenants. In one of them was a newspaper cutting which showed that a tenant had been charged with a serious offence. The file did not contain the cutting which showed that he had been acquitted of that offence. That might have deformed our letting policy to the tenant's detriment and without his knowledge. Similarly, another file contained the casual comments of a male rent collector on the housekeeping standards of a lone parent. In a form of almost cultural colonialism at a stroke it turned a struggling, deserted mother into a potential problem family. We opened up and cleaned out those records and thereby made them more properly professional and objective, which I am sure is what will happen in medicine.

We may not again see a doctor writing a prescription for Valium in which he wrote to the chemist, "Take as you please, as nothing I say will make any difference". That of course ended up on the medicine bottle. I have experiences similar to those of the noble Baroness, Lady Cumberlege. There were other records such as the initials in a certain doctor's file: PBM, NFN. Did PBM stand for post bronchial meningitis? We hope not. Was NFN an abbreviation for non-fatal necrosis? Probably not. No, my Lords, PBM stood for "poor biological material". NFN, I blush to say, was "normal for Norfolk". I regret that the noble Earl, Lord Ferrers, is not here to share my unease at such initials.

With access to his records, a patient will also acquire more information about his health. As my noble friend Lady Ewart-Biggs said, three-quarters of the parents of mentally handicapped children and a large number of patients with coronaries, cancer or multiple sclerosis symptoms believed that doctors withheld information from them. They may not have been right; but they needed to know, and they needed to know that the full information was available if they were to plan their care. Even where doctors fully brief their patients, it is difficult for people under stress and under the weather to recall even a fraction of what they have been told. Yet to hold and read the records in a waiting room beforehand or to take a copy home with them to discuss with their family—especially if they are elderly—may be both reassuring and allow them to absorb the information that they need in peace and quiet and in their own time.

Patients thereby become more effective partners in their own health care, Anti-natal clinics regularly expect women now to hold their own obstetric records. Fears have been expressed about whether this is an appropriate strategy for psychiatric patients. Yet I was taught, when I was a member of the regional health authority, that getting patients to understand their illness may itself be part of their treatment. In a fascinating study in 1988 of two locked wards, it was found that in one ward patients had access to their records and counselling on them. The patients in that ward experienced anger occasionally, sadness very often. But it was not in doubt that they and the staff thought that they had benefited.

However, above and beyond these arguments of utility, lie the second cluster of arguments on which I suggest the Bill should be supported. That is, citizens' rights. Again as the noble Baroness, Lady Cumberlege and my noble friend Lady Ewart-Biggs, said, at the heart lies the question: whose records are they? Are they the doctor's or the patient's? Are they the doctor's aides-mémoire or are they the patient's paper shadow through the health care system?

The Bill presumes a patient's property in his or her own health and therefore in the records of his or her health. It thus assumes that patients are moral adults in the most profound sense, that they are healthy and not sick; adult and not dependants; citizens and not merely passive recipients of care.

Not all doctors will find that thought necessarily comfortable. I sympathise. When the Data Protection Act was introduced, I was chairman of the examining body at my university. We had to make available to students all the information that existed about examinations. We were quite sure that giving them that information would fetter our free and unbridled judgment; interfere with our discretion; and that students would be the poorer for not having our discretion and our free and unfettered judgment. Nonetheless, we were a law-abiding university, at least in the faculty. As a result, we took still greater care with our grades. We drew up guidelines; we tried to explain how medical evidence was deployed, how discretion was exercised. What seemed impossible on Monday, was in place on Tuesday and working on Wednesday. Now we could not think of going back to mystifying students with the examination procedure, and no longer treating them as adults and partners in their own education.

As in education, so in local government which has rightly become more citizen-centred. We see—and rightly so—local citizens sitting on local committees. They enjoy a transfer of knowledge and therefore of power in determining the services to which they are entitled. As we know, knowledge is empowering and enabling. The same applies to health, to our bodies and to ourselves. Noble Lords would hardly have expected a maiden speech on this topic from this side of the House without a reference to Nye Bevan, who founded the National Health Service. As Nye Bevan said, the purpose of power is to give it away. This Bill, by sharing the power of knowledge, offers a partnership between doctor and patient between consenting adults. That is why I am happy to make my maiden speech in support of the Bill.

2.25 p.m.

Lord Brightman

My Lords, it is my enviable privilege and my very great pleasure to be the first to congratulate the noble Baroness, Lady Hollis of Heigham, and to be the second to congratulate the noble Baroness, Lady Cumberlege, on their elegant, instructive and witty maiden speeches. I should add that this is also my own maiden exercise of that privilege.

As your Lordships will know, the noble Baroness, Lady Hollis, has wide experience in public office. She was a member of the East Anglian economic planning council, the regional health authority and the regional advisory committee. Later she was a member of the Norfolk County Council. She is currently a national commissioner for English Heritage. I hope that she will regard it as within her remit to preserve your Lordships' House totally intact!

Friday is not always a popular day for attending your Lordships' counsels. However, on this occasion I am more than glad that I did so. I am sure that all your Lordships feel the same. It has been well worthwhile. I am sure that I speak for all your Lordships when I say that we look forward to many further occasions when we may have the pleasure of listening to the stylish contributions to our debates of the two noble Baronesses.

I now turn to the Bill which I welcome. I intend to speak only on one short point which has already been mentioned by the noble Lord, Lord Walton. It is a minor point. I wish to make the suggestion that the draftsmen might be asked to consider this point before the Committee stage. As your Lordships know, Clause 3 deals with the right of access to medical and health records. Clause 3(4), (5) and (6) contain certain time limits. Those time limits are all measured from what is described as the "date of the application".

By virtue of Clause 11, an application has to be made in writing. Therefore one has to ask oneself, as did the noble Lord, Lord Walton, what is meant by the date of the application in that context. There are three candidates as regards an explanation. The date of the application could mean the date the application is signed. That will probably be the date which appears on the application. It could mean the date when the application is placed in the post, as appears to be the law in the case of certain applications for vehicle licences. It might also mean the date when the application reaches the holder of the medical records, and that is the date that I would favour. However, I suggest that that is a point which might be considered by the draftsmen and clarified in Committee.

2.30 p.m.

Lord Rea

My Lords, I too shall be very brief. As another medical member of your Lordships' House I want to endorse my noble friend Lord Walton's approval of the Bill. I also applaud most warmly both of the maiden speeches that we have had the pleasure of hearing. They have fulfilled the criterion of being non-controversial but have by no means lost bite, humour or wisdom in fulfilling that criterion.

The need for the Bill has been very well outlined by my noble friend Lady Ewart-Biggs. The Bill as it stands is the result of much detailed co-operative work between the original sponsor, Doug Henderson MP, the British Medical Association and the Department of Health, and I am sure also the General Medical Council.

An essential provision of the Bill, as mentioned by my noble friend Lady Hollis, is Clause 5(1)(b) which in general disallows access to health records made before the commencement of the Act. As my noble friend said, it thus fulfils the need to avoid retrospective legislation. Up until now opinions recorded by health professionals have been written in the confident expectation that they would not be seen by the patient concerned except with the permission of the doctor, nurse, or whoever it may be. Whether justified or otherwise—a derogatory remark is seldom if ever justified—a carte blanche opportunity for patients to skim through past records to pick up scurrilous remarks could lead to bad feeling and possibly to tedious litigation. It is not very difficult to agree with that important subsection of the Bill.

I freely admit to writing remarks in patients' notes which could be held to be derogatory, or, to be more polite, idiosyncratic as my noble friend described it, in the past. If a patient talks excessively and exceeds the appointment time I might have recorded that the patient was irritating, boring, or suffered from verbal diarrhoea. From now on the proper form must be to record perhaps that they appear to be tense or anxious and to speak under intense verbal pressure.

There are some difficulties, of course. For example, my noble friend Lord Walton and the noble and learned Lord, Lord Brightman, mentioned there will be some difficulty about what to record and what not to record. I am thinking, for example, of the word "garrulous". It is almost an accepted part of medical terminology but some patients might very well object to being so labelled. Certain Members of your Lordships' House might feel that way.

One lesson that I learnt quite early in my medical career was to be very careful about what I wrote in referral letters, particularly if the letter was to be handed to a patient who was to go to a consultant for a hospital referral. Those letters were inevitably read, even if sealed. I have always been very careful to use objective, inoffensive terminology and to avoid judgmental remarks in those letters. From now on that should be the criterion for all medical notes and letters. It does not mean, however, that potentially difficult or painful information must be left off the record. Obviously, it cannot, but health professionals must be prepared to justify everything that they write down to the patient or the patient's family. Sometimes, advice—for example, to stop smoking or drinking—does not have as great an impact when given verbally as when it is written down.

There are one or two points of detail which the British Medical Association still thinks are in need of clarification. They have been covered by previous speakers including my noble friend Lord Walton and the noble and learned Lord, Lord Brightman, so I do not need to expand on them. Reference has been made to the date of application and I wish to ask the noble Baroness to expand on that point so that the date of receipt might become the date from which the period starts.

Clause 5(3) states that access to the health record shall not be given to the parent of a child or to the court or the representative of a deceased person when access would disclose information that had been given in confidence to the health professional concerned. To me that seems appropriate. A child may often confide in a doctor since that doctor, nurse or other health professional may be the only responsible adult to whom that child has access and it is right that that confidence should be retained. The doctor or other health professional would be in the best position to judge whether giving that information in the record will be in the child's best interests and similarly in the interests of a deceased person's reputation or estate.

In conclusion, this is a useful piece of legislation. I should like to see it as a step on the road to an increased holding of patients' records by the patients themselves, as the noble Baroness, Lady Cumberlege, suggested. That has certainly been done with success in far less sophisticated societies than ours. Mothers in African villages have been shown to look after their records much better than hospitals and far fewer of them are lost. Experiments are being done in this country with that form of record keeping and they should be expanded. I commend the Bill to the House.

2.38 p.m.

Lord Tordoff

My Lords, I find myself in some difficulty. As a member of the usual channels, I am aware that I must set certain good examples to the House. One of the examples that I must set is to follow the rule that only the immediately succeeding speaker after a maiden speech is supposed to comment on that maiden speech, so I must confine myself to saying that I have never felt quite so upstaged in the Chamber in my life. Noble Lords will be spared at least two-thirds of the speech that I had intended to make, given the remarks made by the two noble Baronesses this afternoon.

It is a great pleasure to support the noble Baroness, Lady Ewart-Biggs, in presenting the Bill to the House. She rightly said that I enjoyed her full support on the two occasions when I had the pleasure and privilege to bring freedom of information Bills before the House. They were the Access to Personal Files Bill 1987 and the Access to Medical Reports Bill 1988, both of which were initiated in another place by my honourable friend Mr. Archy Kirkwood.

At the time of the 1987 Bill, the Government were not ready to accept legislation in relation to access to medical records and preferred a voluntary approach. We all understood that. It was quite right and proper that one should obtain the agreement of the medical profession. However, after much discussion, I think that now we all agree that the time has come to put these matters on to the statute book. One is glad that the Government are in a position to support the legislation: I am sure that the noble Baroness is doubly glad of their support.

As has been said, we should start from the premise that People have the right to know the state of their own bodies and that only in exceptional circumstances should they be denied that knowledge. It seems to me that the Bill pitches the balance just about right in relation to those two propositions. It will encourage honesty and greater accuracy if patients have the opportunity to check the information on their records.

When I presented the Access to Medical Reports Bill, I gave an illustration which perhaps I might instance again today. A certain government Minister tried to obtain details of her own medical record with regard to the last occasion on which she had had a smear test. At the time she was examining some wonderful new equipment. She asked to have that information dug out of the equipment: it was incorrect. She said, "Try again". Again, it was wrong. In the end it was found that the Minister's National Health Service number was wrongly recorded within the system. The lady in question was Mrs Edwina Currie. After that, we got some action.

One cannot expect doctors to be perfect in this matter of keeping records. Indeed, they do not pretend that they are perfect. I should not dare to use the following words were they not a quotation from the professor of general practice at Manchester University who in 1986 wrote in the British Medical Journal: With a few honourable exceptions, medical records (hospital or general practice) are a disgrace … Perhaps sharing records would inculcate much needed discipline in the profession's record-keeping". That statement should not be taken as a slur on the medical profession. It is a fact of life that the ability of patients to check their records will be a help not only to them but to the doctors.

Some hesitation has been evident in the views expressed. I listened with interest to the noble Lord, Lord Walton of Detchant. It is a matter of getting the balance right. My feeling is that the Bill has it as right as it can be. However, I think that we need some reassurance from the Government Front Bench—today if possible—on the interpretation that the Government expect to be laid on some of the words of the Bill.

The noble Lord, Lord Walton, referred to cases in which the health record should not be given to a patient. I took the liberty of asking for the views of the British Medical Association. It sees the problem but says: Our interpretation is that the Bill does not impinge on the doctor's discretion. He or she would not be prevented from revealing such information verbally about a child if he felt that disclosure was in the best interests of the child. Perhaps the Minister will reinforce that view as a proper interpretation of the Bill as the Government see it.

There are worries on all sides about the date at which the application shall be deemed to have been laid before the medical or health practitioner. I remember that this subject came up during the Access to Medical Reports Bill. Again the difficulty was solved by a statement to the effect that it was the date on which it was received by the practitioner. I hope that the Minister can give that reassurance again today.

It would be unfortunate if we had to come back at a later stage to amend the Bill. In the light of the very tight parliamentary timetable, it is important that the Bill goes forward if possible unamended. I hope that those reassurances from the Government and the noble Baroness, Lady Ewart-Biggs, herself will go a long way to dispel the disquiet that may be felt in certain circles.

With those few remarks I commend the Bill to your Lordships. Perhaps I may be extremely naughty and say how much I enjoyed the two maiden speeches.

2.45 p.m.

Lord Ennals

My Lords, I have never been to Ascot but I know that many noble Lords and noble Baronesses go there for Ladies Day. It would be nice if some of them had come here today because undoubtedly it has been Ladies Day in the House of Lords. It has been an historic event. The Bill was presented by a noble Baroness; two noble Baronesses have made their maiden speeches; and another noble Baroness will reply to the debate. My researchers tell me that during the centuries of history of your Lordships' House it is the first time that such an event has occurred.

What a team they have been! I am not a Chief Whip and have no notions, but I shall refer to the noble Baronesses by name. My noble friend Lady Ewart-Biggs has made a remarkable contribution since she became a Member of this House. She has been active in many areas; for example, in family issues, child welfare and moral and social problems. She has also been concerned with poverty and the new under class in Britain and involved internationally with UNICEF, overseas development and human rights. I cannot think of such a relatively new Member of this House who has made her mark so well both here and overseas. The Bill is her fourth Private Member's Bill and she has presented it extremely well.

I congratulate my noble friend Lady Hollis of Heigham in our city of Norwich in our county of Norfolk. I first realised her sound judgment in 1972 when she helped to secure my nomination as Labour candidate. I thought, what sagacity, judgment and timing she possessed. She has a wide knowledge and experience of housing, education, health, welfare and all aspects of government, local and national. As regards the Labour Party, the noble Baroness first came to national attention as adviser to the late Tony Crosland when he was Secretary of State for Education.

The noble Baroness, Lady Cumberlege, has made a major contribution to policy formation and management within the National Health Service. She was both a district and regional health chairman. However, she will be remembered in the service as a whole more for her contribution in her report on nursing and the community and for her chairmanship of the National Association of Health Authorities. If, in some way, the noble Baroness, Lady Hollis, is responsible for my being here, I should like to think that I can claim some responsibility for the noble Baroness, Lady Cumberlege, being here. As Secretary of State I first persuaded her to accept responsibility within the National Health Service and she has made an outstanding contribution.

Both speeches were examples of their kind. They contained charm, elegance, personal attraction, a sense of humour and appositeness. We wish to hear a great deal more from both noble Baronesses. We have been a little short on some Benches—I am thinking in particular of the Benches opposite—of experts on the health service. However, it is lovely to have a new influx of Members, although unfortunately at a time when the health service Bill has almost completed its passage through your Lordships' House.

Last night I had a dream. I had gone to heaven and was suddenly touched on the shoulder by an awesome figure; it was St. Peter. He said, "David"—we were on Christian name terms—"in Britain the people are sad and are in distress. They are tired of a male chauvinist government led by a woman. They want to try an experiment in reverse; they want to have a female government led by a man. Please submit your list of Ministers". I replied, "Peter, I have the list of Ministers pinned inside my ermine gown". "Read on", he said. I began, "Baroness Castle". He said, "She's not yet one of us". I said, "The noble Baroness, Lady Ewart-Biggs". "Of course", he said. I then mentioned the noble Baronesses, Lady Hollis and Lady Cumberlege. St. Peter said, "Who are they?". I said, "Read Hansard tomorrow morning".

After four minutes I have not left a great deal of time for the Bill but little is needed to be said by me. It is a major step forward in the freedom of information. I congratulate my noble friend Lady Ewart-Biggs, and Douglas Henderson in another place, for picking it up and adding this new dimension. The noble Baroness has long had an interest in accessibility of information, and has supported the Bill which was initiated by the noble Baroness Tordoff. There have been questions of mistaken identity—

Lord Tordoff

My Lords, if the noble Lord will forgive me, perhaps I may intervene. Just for the sake of the record, it may be Ladies' Day but the noble Baroness Tordoff is still, noble or not, a Lord!

Lord Ennals

My Lords, I do apologise. It is so easy to make these mistakes at moments of tension and pressure.

Lord Tordoff

My Lords, I am not sure that that helps!

Lord Ennals

My Lords, it is the best that the noble Lord will get. However, I apologise most sincerely.

There are many cases of mistaken identity. One hears of the patient who was described as suffering from a duodenal ulcer. In fact the patient's mother had the ulcer in 1947 but the letter about her had become mixed up in the file. A student was described as being prone to convulsions following an operation to remove a brain tumour, but the GP had sent the University Health Centre someone else's notes by mistake. There are many such cases. If the Bill improves the quality of information and the ability of a patient to understand his own condition, as I believe that it will, that is its importance.

So often in the past we have felt that we have been left in the dark. People have not treated us as human beings who need to know. If one has health problems—and I have had many and continue to have them—one needs to know if one has to face up to those problems.

One or two minor problems arise. I was grateful to the noble Lord, Lord Walton, and the noble and learned Lord, Lord Brightman, for mentioning problems referred to by the General Medical Council—and they must be treated seriously. I too had seen what the Council had said, and the BMA. I thought that the noble and learned Lord, Lord Brightman, was right. Perhaps there could be a short meeting with the professions, the noble Baroness and noble Lords. If agreement can be reached, I agree with the noble Lord, Lord Tordoff, that it would be nice if we could have assurances so that we did not have to have a protracted Committee stage, and possibly no Committee stage. The noble Lord spoke as a Chief Whip and I therefore associate myself with that hope.

Some concern was expressed about Clause 2 of the Bill which refers to clinical and child psychologists. There was some worry about the definition of a clinical or child psychologist. I do not believe that there is basis for real concern but I know that it has been expressed. I said that I would raise it so that the Minister can make some comment at the appropriate moment.

I believe that the Bill is entirely to be welcomed. It is refreshing that it has come to us in this way. It is a good example of people taking time to get matters right. I wish that the other Bill with which we have been dealing was a further example of that. I believe that the noble Baroness has consulted and obtained the support needed. She has brought us together for a Bill that we all welcome. I warmly support her initiative.

2.54 p.m.

Baroness Blatch

My Lords, the noble Earl, Lord Longford, when speaking informally with me the other day, referred to having overheard I suspect a rather chauvinistic noble Lord saying that this place is becoming too heterosexual. I take it that the remark was made in response to the number of lady Peers.

The Earl of Longford

My Lords, someone told me that homosexuals did not feel at home here. As one who supported the Wolfenden Report when it was published, when no one would touch it, I was upset by that news.

Baroness Blatch

My Lords, I took the remark as being a slip of the tongue and that it was a response to the number of ladies entering the Chamber. I have to say, along with many other noble Lords today, that we have had a veritable feast of maidens this morning. My noble friend Baroness Cumberlege gave a very lucid, sensitive and perceptive speech bringing to bear a wealth of experience in a most effective way. Along with others I acknowledge her outstanding contribution to the National Health Service and other public offices.

The noble Baroness, Lady Hollis of Heigham, who is not only a friend but a fellow East Anglian, also brought to bear a wealth of experience of local government, education and the health service; she delivered her speech with a delightful wit and an enormous amount of information was contained within it.

Both noble Baronesses called upon a positive reservoir of practical information in support of the Bill. Their contribution to the debate has been most valuable. The richness, sensitivity and wisdom, delivered with such great style by both noble Baronesses, will add much to debates in the Chamber. Without hesitation I can say that all noble Lords look forward to their involvement in our future debates.

A number of questions were posed to me and if the noble Baroness, Lady Ewart-Biggs, will forgive me, and with her agreement, I will respond to them. The noble Lord, Lord Walton of Detchant, and the noble and learned Lord, Lord Brightman, queried how the date of application would be determined. My information is that the application is made when the person to whom it is addressed receives it. Legal advice on that question is a matter of interpretation. If the application is made in a letter, properly addressed, stamped and posted then the onus would be upon the addressee to show that it had been delivered. I defer to the greater legal expertise of the noble and learned Lord, Lord Brightman, but that is my understanding of the position. If I have not properly explained it I will write to the noble Lords.

The noble Lord, Lord Walton, also asked how a doctor was expected to respond to a patient who asked whether any information was being withheld. Clause 5, which denies the patient access if he or she could be seriously harmed by the information contained in the record, is similar to a provision which already protects patients under the Data Protection Act 1984. I am not aware that that question has caused any problems regarding computer-held records. I see no reason why it should do so when the information is manually recorded. However, how a doctor handles the question can be left to his or her discretion. Telling the questioner that access provided for under the Act has been allowed cannot be seen to be misleading.

The noble Lord, Lord Walton, also asked how a doctor's discretion to disclose information is maintained when he or she is prohibited from disclosing to a third party information which a patient has given on the expectation that it will not be so disclosed. The Bill does not prohibit the disclosure of information to a third party in circumstances where the doctor currently has a discretion to disclose information. Clause 5(3) provides that a third pary has no right under the Bill to access in those circumstances. Equally, it does not prohibit the doctor from giving access. In many cases such disclosure would be a breach of confidentiality, but in exceptional circumstances a doctor could decide, as at present, that the need of the third party seeking information outweighed the duty of confidentiality.

Clause 5(3) states: Where an application is made … access shall not be given under subsection (2)". That does not bite upon the wide clinical discretion of a doctor to act in the best interests of his patients.

The noble Baroness, Lady Ewart-Biggs, specifically asked about Northern Ireland. I entirely take her point that the principles of access should apply throughout the whole of the United Kingdom. I shall pass on that point to my right honourable friend who can extend the Bill's application when it becomes an Act by an Order in Council.

I am glad to confirm the Government's support for the Bill and congratulate the sponsors for their success in getting the Bill this far. The Bill is consistent with the principle of access by individuals which has been established under the Data Protection Act and subsequently confirmed by the Access to Personal Files Act 1987 and the Access to Medical Reports Act 1988.

The Bill is intended to give people the right to have access to their own health records whether in the public or the private sector. The Government have been consistent in maintaining the principle that patients should have greater access to their health records. The issue was last formally before Parliament in 1987. Medical records were then excluded from the provisions of the Access to Personal Files Act as a result of extensive lobbying by the medical profession which persuaded Members of this House and another place that non-statutory access arrangements concluded in co-operation with the profession had advantages over a statutorily-provided access.

The Government therefore undertook to enter talks with the medical profession to see what could be achieved. After discussions which extended over two years with representatives of the medical profession a draft code on non-statutory access to health records was produced. This document was circulated widely for comments. The only reservations about the principle of access were raised by the medical profession itself. For this reason the Government concluded that agreement could not be reached on a non-statutory code which would match the expectations of the public and which would have the unequivocal support of the medical profession.

On 23rd February when the Bill was presented in another place for Second Reading my honourable friend the then Parliamentary Under-Secretary of State confirmed the Government's support for the principle of access and that we would not object to the Bill. As initially presented in another place the Bill contained a number of technical deficiencies and one or two points which were felt to be inappropriate. I am glad to advise noble Lords that co-operation between the sponsors and my department has enabled these problems to be overcome and this has resulted in the Bill which is before us today.

The provisions of the Bill are of great concern to the medical profession and its views on the advisability of allowing patients access to their own health records have been widely circulated. The Department of Health recognises that there is legitimate concern here and the Parliamentary Under-Secretary of State for Health saw fit to bring these to the attention of Members in another place when he stated on 23rd May, while the Bill was in Committee: I wish to refer to the attitude of the medical profession. Sir Robert Kilpatrick, president of the General Medical Council, has confirmed to Ministers that the profession will not seek to oppose the will of Parliament on the issue. That is not to say that the General Medical Council is without deep concern about the changes to the character of medical records, which it feels are likely to follow the implementation of the Bill. The General Medical Council believes that those provisions are likely to lead to a lack of frankness in the written record to the ultimate disadvantage of both patient and doctor. It believes that the Bill will encourage a defensive attitude not only towards the preparation of written records, but towards the practice of medicine itself, with doctors being increasingly mindful of the possibility of future litigation. It also thinks that it could lead to doctors preferring to discuss with their colleagues important matters about a patient's health rather than preparing a full written record. The apprehensions of the medical profession must be brought to the Committee's attention, as they represent potential losses to the doctor-patient relationship. The Minister confirmed the Government's acceptance of the Bill and having put on record the medical profession's concerns, he went on to say: I must also tell the Committee that the Government believe that gains will flow from the enactment of the legislation and that they will include greater accuracy in record keeping, a higher trust in the medical profession and an enhancement of the doctor-patient relationship. Ultimately, the House must decide where the balance of the argument lies, but the Government's attitude is clear. All those points have been well put in the debate today.

Having emphasised the Government's position on the principle of access, I should also like to make clear that we shared some of the concerns expressed by the profession, particularly with regard to preserving the patients' interests and advising on access to records. I am glad that the sponsors of the Bill were more than willing to respond in a positive way in taking these issues on board. We now have a Bill the principal aim of which is to secure access to personal health information (subject to safeguards to protect individuals) by the people about whom that information has been recorded. It is clear that the aim of the Bill is widely supported, both in the country as a whole and in Parliament.

Reference was made to a possible meeting. Noble Lords will understand that I am standing in today for my noble friend Lady Hooper and I will pass that request to my noble friend because it is important that as much clarification should be brought to bear before the Commitee stage. I strongly urge your Lordships to give this Bill your support and not to impede its progress on to the statute book.

Lord Brightman

My Lords, before the noble Baroness sits down, perhaps I may say that in my opinion the date of application would be construed by a court as meaning the date when the application was received by the holder of the record to whom it is addressed. I would not regard it as essential to amend the wording in order to clarify any ambiguity.

Baroness Blatch

My Lords, that point is noted.

3.5 p.m.

Baroness Ewart-Biggs

My Lords, I should like to say how happy I am at the most favourable response that there has been to this Bill. Anyone who may have anticipated that it would be a rather dry subject would have been wrong. I do not think I have ever spent a Friday morning in your Lordships' House having a more enjoyable time or listening to better speeches. I am not going to pay any more compliments to the maiden speakers because I believe that every adjective has been used. They might get swollen heads if any more adjectives were used. I very much appreciated and enjoyed what they said in support of this Bill, and the way in which they said it.

I am so happy that there was complete agreement on the principle of the Bill: that we should move forward in increasing accessibility to information on account of the dangers of errors and because of the principle of citizens' rights.

I anticipated the few questions and anxieties that were raised, in particular about the date on which applications under the Bill are taken to be received. I am most grateful to the noble and learned Lord, Lord Brightman, who said that he is satisfied that the time starts on the date the application is received. I hope that the noble Lord, Lord Walton, will be happy with that.

I was also very glad to hear that my noble friend Lord Rea is already contemplating improving his drafting style for his patients' records. That is a very good beginning. I am also most grateful to the noble Baroness, Lady Blatch, for giving the history of the co-operation and search for agreement as regards this very complex and sensitive area, and how that was achieved. I am also grateful that she will pass on the message about the possibility of a meeting to clear up any remaining doubts or anxieties, as my noble friend Lord Ennals suggested. I shall be very happy for that to happen. As the noble Lord, Lord Tordoff, said, we would prefer not to have amendments at Committee stage because there is a certain urgency about returning this Bill to the other place. As every speaker has agreed that it is an important and valuable Bill, I am quite sure that we would be very sad to lose it. I thank all noble Lords for making very valuable and attractive speeches. I ask the House to give this Bill a Second Reading.

On Question, Bill read a second time, and committed to a Committee of the Whole House.