HL Deb 29 June 1992 vol 538 cc626-40

5.1 p.m.

Lord Carter rose to ask Her Majesty's Government what steps they are taking to protect patients, including the mentally disordered, in National Health Service hospitals and other health care establishments from intrusion by the media.

The noble Lord said: My Lords, the purpose of the Question on the Order Paper and this short debate is to draw attention to the need to protect patients, including the mentally disordered, who are in NHS hospitals or other health care establishments from intrusion by the media. I refer immediately to the use in the Question of the term "mentally disordered". I am not happy with it, but I am advised that it is technically correct. I see that in an adjournment debate in another place on Wednesday 24th June, the Minister of State at the Home Office, Mr. Peter Lloyd, referred a number of times to "the mentally disordered".

I ask the Minister whether the Department of Health and the Home Office could find a different term. I believe that she agrees with me that it is not a happy one, although so far as I am aware there is no generally acceptable term in use to cover the mentally ill, mentally handicapped, drugs-dependent and all those who are covered by the term which I have used, "mentally disordered". We all agree that it is unfortunate, although it is semantically correct.

The Question on the Order Paper refers to the media, which covers printed and broadcast material. I have no wish to overlap with the debate on Wednesday on the first report of the Press Complaints Commission. It is clear that the PCC has an important role in the area and I am assured by its chairman, the noble Lord, Lord McGregor of Durris, that the PCC is fully aware of its responsibilities in the matter.

We know that every day editors and others have to make difficult judgments on such matters as accuracy, the opportunity for and right of reply, the distinction between comment, conjecture and fact—during the general election, some of us thought that this distinction was not clearly made in certain newspapers — and such matters as the invasion of privacy, harassment and intrusion. Not even the most fervent defender of the freedom of the press would argue that the media always get it right. This debate may help to highlight the problems in a particular area of possible intrusion by the media—that of health service patients and particularly patients who are mentally disordered. I hope that we may help to ensure that there are sufficient safeguards in practice so that all patients are properly protected. As we know, there are people who are particularly vulnerable and whose recovery could be seriously delayed if media intrusion resulted in increased stress and tension.

Noble Lords may be interested to know that I was the recipient not of intrusion by the media but misreporting when I was a patient in hospital. Your Lordships will remember that in this House four years ago there was an outbreak of salmonella. I was a victim and went to hospital. It was reported in a tabloid newspaper that I was in hospital suffering from legionnaires' disease. I telephoned the deputy editor of the newspaper and explained that if his reporters were unable to tell the difference between viral pneumonia and acute vomiting and diarrhoea they were not particularly expert. He apologised and said that he would print a correction the next day. However, it did not appear as a correction, it appeared in a news story to the effect that Lord Carter was able to confirm that he was not suffering from legionnaires' disease. In other words, they subtly put the blame on me for misreporting.

How serious is the problem that we are discussing? I say immediately that it would be most inappropriate in a debate concerning matters such as confidentiality and privacy to refer to details of individual cases which would enable identification. I do not propose to do so. MIND—the National Association for Mental Health—has given examples of things which it says have gone on: intrusion into the lives of patients who are mentally disordered who wish to marry; the libellous description of a patient who had been given leave of absence from hospital; the publication of highly intimate and personal details of a patient's life, not known by the patient's family but which they first read about in a Sunday newspaper.

There is apparently real worry that sensitive information about individual patients has been revealed to the media. The Matthew Trust which concerns itself with issues relating to the mentally disordered in security hospitals and in prisons (besides other related issues) also claims to have received complaints from patients that details of medical records and treatment have been given to the media, often at the request of the media and for payment.

I ask the Minister: what are the safeguards against this happening? Is it a matter of the common law relating to breach of confidence, or is there a form of statutory protection for patients? I understand that before the formation of the Special Hospitals Service Authority (SHSA) release of such information by NHS staff was a breach of the Official Secrets Act. But now it would be a breach of an employee's contract of employment. Is this correct?

Can the Minister tell the House what is the exact legal position of the patient, the NHS employee and the Department of Health? Again I quote from MIND: the elements of an action for breach of confidence in a non-commercial and non-governmental context are not clear, if only because the decided cases have been concerned with the protection of valuable commercial information or valuable government secrets".

We immediately understand that patients who are mentally disordered would find it extremely difficult to initiate complaints. That would have to be done on their behalf.

What guidance is given to NHS staff to help them deal with inquiries from the media? I understand that the guidance given in 1956 is in the process of being updated. If that is so, will the new guidance include advice on how to deal with the media?

A wider issue relating to privacy will, I am sure, be dealt with at length during the debate on Wednesday on the Press Complaints Commission's first report. But it is not at all clear where the ultimate responsibility lies in the area that we are discussing. Is it with the Department of Health or the new Department for National Heritage with responsibility for the Press Complaints Commission and the broadcasting media? We also have to ask what is the role of the Home Office in all this. It would be helpful if the Minister would explain exactly how the various departmental responsibilities are allocated and where responsibility would lie if there have been intrusions into a health service hospital or other health care establishments.

I am sure that the Minister is aware of the report, The Media and the Mentally Disordered, prepared by the Matthew Trust. The report includes a number of recommendations for changes in the practice of the Press Complaints Commission, the national press ombudsman system and the BBC.

I appreciate that the governmental responsibility does not extend to the operations of those bodies, nor should it. However, I think that we are entitled to ask whether the Government broadly support the general thrust of the recommendations which were contained in the Matthew Trust Report.

Support is forthcoming from some organisations concerned with the problem such as the Royal College of Psychiatrists. It is concerned about the publication of reports in the press about hospital patients without their consent.

It states: This can, at times, amount to an unacceptable invasion of privacy which can cause extreme distress to patients and their families. People with mental illness are a particularly vulnerable group. They may, in common with other patients, have real difficulty in pursuing complaints against the press through the complex system currently in operation".

Also, the Special Hospitals Service Authority, to which I referred (SHSA), says that it welcomes any move that would help enhance and protect the privacy of patients within its care. The authority believes that an intrusion into patient privacy can be highly counter-productive to an individual patient's care plans. The authority's view is that the media should exercise extreme caution before the publication of personal information about the patients in special hospitals which, while it may have interest for a section of the readership, could have a devastating effect on the well-being of the individual patient.

Another area of anxiety is the way in which journalists and photographers try to gain entry into health service establishments and to gain access to medical records. There have been a number of well publicised cases of this in the recent past. Is the Minister satisfied that existing NHS rules are sufficient to prevent this kind of thing happening, or should they be strengthened?

I shall now turn to the broadcasting media. Broadcasters are certainly not without fault. They must have a woeful lack of basic knowledge in this area. The BBC, for example, refers to Broadmoor as a prison and repeats that statement after the error has been pointed out. Broadmoor, Rampton and Ashworth are of course special hospitals. They are not prisons and the inmates are not prisoners. They should be regarded as patients.

Broadmoor was an asylum for the criminally insane until 1959 when it became a special hospital as a result of the Mental Health Act. In April 1981, 22 years later, the BBC still referred to "the criminally insane" in the hospital. It retracted that blunder but in July 1991 it referred to Broadmoor as a prison. When that was pointed out the BBC admitted it had made an error but the statement was allowed to persist in news bulletins.

I referred earlier to the Adjournment Debate in another place on 24th June. The Minister of State at the Home Office, Mr. Peter Lloyd, gave some interesting and encouraging figures in column 363 of Hansard of another place. Those figures show the numbers of prisoners transferred to hospitals in certain years. In 1986, 137 prisoners were transferred to hospitals. In 1990, 325 were transferred, and in 1991, 470 were transferred. The Government expect that this year at least 600 will be transferred. Obviously that is an encouraging trend. I am sure we would all agree it would be ironic if mentally disordered patients were transferred from prison to hospital—that is a welcome policy—only to find that they were more liable to intrusion by the media there than if they had remained in prison.

I have tried to avoid polemics or overstatement on this sensitive topic but there is anxiety among the people involved with this problem that intrusion by the media continues. There is nothing new in complaints concerning sensationalism and trivialisation on the part of the media. That is bad enough when it involves people who may be able to complain or seek some form of redress. However, such action is almost impossible for a mentally disordered patient. Such patients must rely on other people to take action on their behalf. I hope when she replies the Minister will be able to assure the House that the Government are aware of this problem and they are taking steps to deal with it.

5.12 p.m.

Lord Butterfield

My Lords, I thank the noble Lord, Lord Carter, for introducing this important topic. I greatly support the sentiments that lie behind all the remarks he has made. Like the noble Lord, I, too, hope the Minister will be able to tell us what steps are afoot to take care of this situation.

Also like the noble Lord, I, too, have had occasional difficulties with the media. I shall refer briefly to two such occasions. I simply wish to make it clear that all of us in this House, and those involved in the profession I try to serve, must realise that the ideal situation is one where we work with the men and women of the media.

I must relate what happened to me in a hospital ward when a ward sister brought a man to me who introduced himself as a member of the press. I shook his hand. This incident occurred exactly 30 years ago. The man said, "I believe Professor you have been carrying out a diabetic survey in Bedford and that you now know how many diabetics there are in the country". I said his first statement was true but the second was not. I told him we were doing a survey and we had an idea how many diabetics there were in Bedford. The man then said, "Surely you can tell me the results of the survey so I can put them in my newspaper and bring glory to your hospital for announcing there are I million diabetics in Britain today. Your results are out".

I told the man I had the results of the survey but that I did not know for certain there were 1 million diabetics. I said I was disinclined to give him a free headline as we had to confirm the results and were not sure that Bedford was typical of the country as a whole. The man then said, "Come on, professor. Just say there are probably 1 million diabetics". I said I could not do that and that was the end of the story as far as I was concerned. The man was not very pleased with me but we parted reasonably good friends.

I shall now relate the other side of the story. In the hospital where I worked there was the editor of a great newspaper who suffered from an undiagnosable disease. Consequently he was seen by many people in many different places. We did not send him quickly enough to be seen by specialists in tropical medicine, who unravelled his disease. However, he was seen by a great psychiatrist who was anxious to press the possibility that the man was malingering. That seemed a rather unwise line to take.

The psychiatrist took the man to his Friday afternoon main clinic which was held in a lecture theatre and was attended by about 150 students. He tried to unsettle the editor by revealing a little of his previous history to the students. He said to the patient, "Tell me, why don't you make an honest woman of your mistress and marry her?" In my view that was a pretty serious assault on the editor. However, I shall always remember the editor's reply as one to produce if one ever needs such a reply oneself. He was sitting in a wheelchair. He drew himself up slightly and waited until he knew he had the attention of every student in the lecture theatre. He looked the professor in the eye and said, "Professor, in my view that is not the sort of question one gentleman puts to another in circumstances like these". The students roared and the professor never again got on top of the situation with that patient.

I have told those two stories as they represent two sides of the combative situation that exists between fact finders such as those involved in medical research and government affairs and the newspaper men. The remarks of the noble Lord, Lord Carter, drew attention to the dilemma between those sets of people. Doctors desperately need the help of the press these days as regards getting the facts straight and reporting information clearly. We may need the help of the press as we begin to shift from what I shall call the cholesterol story to a new story about the possible causes of coronary heart disease. We call those who expound the latter story free radicals and they are in fruit at the moment expounding theories about orange juice and other such theories.

If we can, we must move away from the combative relationship that exists between those in the professions and those in the press. I remember a word which was current in the playground of my school when I was aged about nine. It was pax. I believe we have now reached a stage where it should be perfectly acceptable for people who have been assaulted by the press to look pressmen dead in the eye and say "pax" meaning they want a little peace. We must protect people in hospitals from intrusion by means of some new kind of approach to media personnel. I do not wish to lose the support of media personnel for the sake of all the good things they do. That is why I mention the possibility of introducing the "pax" concept when things get out of control.

5.18 p.m.

The Earl of Longford

My Lords, I do not possess the qualifications for speaking on this matter that the previous speaker possesses. My qualifications may also be inferior to those of the Minister. However, I have one or two reasons for speaking apart from my general desire to support blindly the noble Lord, Lord Carter, whatever he suggests.

It is many years since I first visited a special hospital. It was in 1940 to be accurate. Later I visited Broadmoor many times. I visited the hospital that is now called Ashworth and I also visited Rampton. I visited Peter Thompson, who was the founding spirit of the Matthew Trust, several times when he suffered a breakdown. He spent four years in Broadmoor. When he left Broadmoor he wrote two books about his experience for which I wrote the introductions. That all happened a long time ago and since then Peter Thompson has carried out some great work in founding, guiding and inspiring the Matthew Trust. That is the background.

Today I want in particular to call attention to a difficult aspect of the problem, although I do not believe that anyone considers this to be an easy matter. I wish to call attention to the all too ubiquitous presence of moles. Moles are not confined to special hospitals or mental hospitals; they are to be found everywhere in prisons. I cannot go to a prison without finding representatives of the tabloid press outside if I am visiting an "interesting" prisoner. Indeed, there are three prisoners with whom I remain on friendly correspondence terms who would rather not be visited by me because of what they call the hassle. The situation in the prisons is not unlike that in the special hospitals. There is a problem because of moles. No one ever seems to be able to put a finger on them and to unearth them. They are very active.

Some years ago I visited a well-known prisoner at Ashworth. Later the News of the World published a story saying that I had assaulted a security guard. Some people would say that to suggest that an octogenarian had assaulted a security guard was a compliment rather than a detraction. I would never dare to assault a security guard. In fact it was impossible because there was a pane of glass between me and the gentleman concerned. The hospital apologised and eventually the paper published my rebuttal, although it did not publish an apology.

I considered what I could do. I talked to my solicitor and after we had chatted for a few minutes I asked him how much it would cost. He said, "£100 plus VAT—so far". It would have cost £1,000 before the matter got anywhere near court. It is not easy to sue the media in those circumstances. We have to face the fact that there are such moles. My inclination is to suggest that somehow the institution concerned should be made responsible.

Perhaps I may give as another example the horrible scene when the media gathered round the Maxwells as they were arrested the other day. Clearly the press had been briefed by the police, but the top people in the police said that they do not authorise such behaviour. Hospitals do not authorise it. It originates with people lower down the scale. How do the authorities cope with them? It is very difficult.

A first step would be the one for which my noble friend Lord Carter is pressing—clarification of the law. That might make it easier to sue the institution or to bring criminal proceedings.

I wish to support my noble friend Lord Carter, the Matthew Trust and everyone who has spoken in the debate and to ask the Minister whether she believes that the law can be clarified and, if it is unsatisfactory, strengthened.

5.23 p.m.

Lord Jenkins of Putney

My Lords, if my noble friend is not qualified to speak on this subject I certainly am not. My interest in the subject stems from 1965 when I was Member of Parliament for Putney. One of my constituents was Mr. Peter Thompson, who has just been mentioned by my noble friend. I was therefore in touch with his case from the beginning when Mr. Thompson, quite uncharacteristically, committed a violent assault, as a result of which, as my noble friend said, he had to go to Broadmoor for five years. Since then he has had a distinguished career and is now a prominent and leading member of the Matthew Trust.

The trust has received many complaints that medical records of patients in special hospitals are given to the press by staff of those hospitals. It is suggested that that must sometimes be in return for payment.

Far from resisting press intrusion some hospital authorities, with the best possible motives, appear to co-operate and to accept the press plea of public interest. That presents us with a difficult problem. However, if it is in the public interest to conceal the secret service from press intrusion and the Government can plead the public interest in refusing to answer questions on such a subject, then surely the privacy of the afflicted should also be preserved in the public interest. We need to draw a line here. However, if we are to draw a line there is consequently a difficulty in determining where the public interest lies. I believe that in some instances that would have to be determined in the courts. However, I believe that the drawing of that line is an absolute necessity and we should not shrink from it.

I suggest that the public interest is not served when it is interpreted as giving a right to infringe the freedom of the sick. That cannot be regarded as being in the public interest, or at least one would want a very convincing case to justify such an intrusion.

It seems to me that two things need to be done. I suggest that the terms of reference of the review which I believe has already been embarked upon or is about to be embarked upon under the aegis of the Secretary of State for National Heritage should be extended to include an examination of the efficacy of the self-regulation of the press currently carried out by the Press Complaints Commission. I believe that we are to debate the commission's report more widely in a couple of days' time so I shall not pursue that item. However, it is relevant to the point that we are discussing this evening.

One of the problems is that the endeavours of the Press Complaints Commission to keep the lower end of the press under reasonable control do not seem to be effective. That matter needs to be looked at. Is that an area in which self-regulation can operate? It seems to me that the answer may well be at least in doubt. I suggest the replacement of the Press Complaints Commission by a genuinely independent body rather than one that merely claims to be independent but is not.

Since 1956 guidance has been give to the NHS. Equally, that guidance does not seem to be effective in this area. Perhaps that guidance should be reviewed, brought up to date and enforced. At present it seems to be observed more in the breach than in practice. When the Minister replies perhaps she can help us on that point. It appears that that guidance is either out of date or ineffective. The problem of its enforcement needs to be tackled.

I have nothing further to add to those two suggestions. Although I have spoken for only five minutes I shall now sit down.

5.28 p.m.

Lord Thomson of Monifieth

My Lords, I join with other noble Lords who have spoken in thanking the noble Lord, Lord Carter, for raising this debate on an important subject. It is a subject which has wide ramifications. As the noble Lord, Lord Jenkins of Putney, said, those wider ramifications relating to the role of the Press Complaints Commission will be discussed more fully on Wednesday.

On the narrower focus of the debate dealing with media treatment of hospital patients generally and of the mentally disordered in particular, the whole House will feel that the mentally disordered are a particularly vulnerable group in society and require special protection in this matter. The problem was put very clearly, as reported in the Calcutt Committee, by Lord Justice Bingham, who referred to the case involving Gordon Kaye a few years ago, which no doubt noble Lords will remember. I think that the words he used in his judgment have a general application to anybody who is a patient in a mental hospital. He said: If ever a person has a right to be let alone by strangers with no public interest to pursue, it must surely be when he lies in hospital recovering from brain surgery and in no more than partial command of his faculties". He went on to say that the invasion of this person's privacy: however gross, does not entitle him to relief in English law". That still remains the position and we wait with interest to hear what the Minister has to say about the Government's approach to the matter of legal provision in this field.

Noble Lords will remember that the Calcutt Committee made two broad recommendations. One was that a new press commission should be set up and given a period of time to show that self-regulation can work effectively in the general field of relations between the media and the individual citizen. We shall come to that issue on Wednesday. The other recommendation, separate from the first and alongside it, was that a new criminal offence of physical intrusion into private property should be created. It sought to define private property and specifically included hospitals in that definition. I should be interested to hear the Government's views on that proposal, which might help in this situation.

But it is by no means the whole answer. Leaving aside the role of the Press Complaints Commission, about which I shall say a few words before I sit down, in terms of today's debate the main thrust must be toward looking at the arrangements made inside the medical profession and the hospitals to try to ensure that proper confidentiality relating to a patient is adequately protected. We all have stories to tell. I remember landing in intensive care on one occasion and was astonished to read about myself in the newspaper the next morning. It was not an inaccurate report, but as it happened, it was a great breach of confidentiality at that particular moment. I am sure that the reported allegation that in Broadmoor and Ashworth Hospitals the personal details of patients are given out by employees for money can be substantiated. That is a very serious allegation and demands effective action to deal with it.

Beyond that, I do not wish to go into detail about the role of the Press Complaints Commission. It is undoubtedly true that a major aspect of relations between the media and the citizen concerns the relations between medicine and the media. It is an important and legitimate area of coverage by the media. One of the healthier developments of the past 20 years has been the greatly increased interest of the citizen in health matters and in maintaining health. The educational role that the media can play in these matters is important. Equally, the investigative role of the media can be important at times when the question of the best policies for our hospitals and the health service is at issue.

But speaking as a former chairman of one of the regulatory bodies of the media, the present fashion of the media, particularly the television media, of feeling that the intimate details of clinical cases, however harrowing, are a proper matter of public interest, can be carried a great deal too far. The noble Lord, Lord Jenkins of Putney, was absolutely right to raise the difficult question of how one defines the public interest in these matters. I rather like the definition given by the noble and learned Lord, Lord Donaldson, on one occasion, when he said: The media … are an essential foundation of any democracy … However they are peculiarly vulnerable to the error of confusing the public interest with their own interest". That is part of the problem. We are all to some extent voyeurs, but an interest in other people's problems and troubles is not a general public interest. That requires a different and more responsible definition. How that is to be achieved is the subject of Wednesday's debate about the future of the Press Complaints Commission and the Government's attitude toward alternatives to self-regulation. I do not wish to trespass on those issues at this stage.

On the narrower and important issue of the media in relation to people suffering from mental disorders, I note that there is not a good relationship between the Matthew Trust, which has worked hard on this issue, and the Press Complaints Commission. The chairman of the Press Complaints Commission, with whom I have spoken about this matter, assures me that it is willing to investigate carefully, as is its duty, any specific complaints made to it. I hope that perhaps a fresh effort might be made to deal with some of the problems in that way.

5.36 p.m.

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

My Lords, I too welcome this opportunity to debate the very important issue of the media and its relationship with the NHS and hospital patients. I should like to thank all noble Lords who have taken part in the debate and in particular the noble Lord, Lord Carter, for raising the issue and introducing it in such a measured way. I shall answer for the Government. But before I do so perhaps I may make some personal observations.

This Question particularly interests me as I have a long association with the NHS, chairing a national association health authority and trust working party which produced a report entitled Protecting Patients. I was also a member of the Press Council from 1977 to 1983. Although the Press Council is now much denigrated, I believe that it served a useful purpose. Perhaps it was a creature of its time but it was led by distinguished lawyers as chairmen, not least by the noble and learned Lord, Lord Shawcross, who was the first chairman under whom I served. It is perhaps right that the council was succeeded by the Press Complaints Commission, but the principles established by the council still hold good.

The press council guidelines have been adopted by the Press Complaints Commission. The latter's 15th point of their code of conduct reads as follows: Journalists making inquiries at hospitals or similar institutions should identify themselves to a responsible official before entering, except in very rare cases where information which ought to be disclosed could not otherwise be obtained". I think the Press Council originally put the caveat rather better: There can be occasions when newspapers may rightly disregard this obligation and courtesy. They are when information which should be disclosed in the public interest cannot be obtained in any other way". The general principle in dealing with the press in the NHS is that hospitals and everything about their organisation and services should be open and available to public scrutiny. Management must be accountable to the people it serves.

When I became a district chairman there was a rather secretive and defensive attitude towards the press. Some services were covered by Crown immunity, doctors when interviewed were not named and the Patient's Charter was unheard of. There was an incident in one hospital when a camera crew broke into the kitchen and food store to film. The authority was full of righteous anger in the knowledge that, if asked, permission would have been granted. But the incident nevertheless highlighted the inadequacy of the kitchen and that, like other hospital premises, it was subject to Crown immunity. Subsequently Crown immunity was lifted and the pressure on the NHS as a whole to conform to modern standards triggered a huge and justified investment in hospital facilities. With regard to this issue the media played a useful role, as it does in boosting local charity campaigns, informing the public about the spread of infectious diseases, promoting healthy lifestyles and educating the public about common clinical conditions and new and what can often appear frightening surgical procedures and drug regimes. In local situations, where relationships are good, it is because there is openness at the top and recognition that the freedom of the press is an essential part of democracy and in order to facilitate the media a professional public relations officer is appointed, who is known by all and who is trusted, accessible and honest.

There should be no need for the press to enter a hospital furtively. Journalists should be given access after having had the courtesy to ask. If they are refused they should seek permission from the highest authority. If permission is always refused without very good reason, there might well be something to hide which the press may feel it has a duty to expose.

There is of course another absolutely inviolate principle, and that is the individual person's right to privacy in particular in medical matters. It is embodied in medical ethics and the Patient's Charter and is the subject of the debate today. Patients in hospital are least able to defend themselves, and those who are mentally disordered and perhaps formally detained under the Mental Health Act are the most vulnerable of all. There have been occasions in the past when reporters and photographers have employed subterfuge to enter hospitals and have interviewed and photographed patients. This kind of behaviour, motivated solely by a prurient interest, is to be deplored, but the response needs careful judgment. There is clearly a legitimate public interest in knowing about certain aspects of the hospitals' work, in particular that patients are being properly and securely cared for and that the hospitals are making effective use of the resources entrusted to them.

However, as I have said, one of the most effective ways of countering negative publicity is to promote positive understanding of the hospitals and their work. The Special Hospitals Service Authority, which since 1989 has been responsible for the management of the hospitals, has rightly seen that as an important part of its work. Recently it has made some new press officer appointments showing its determination to improve relationships with the media. The Government support that approach, but also the firm line which the Special Hospitals Service Authority is taking in doing everything in its power to protect the confidentiality of information about the patients in its care.

I have referred to the Press Complaints Commission's code which is the general framework within which the NHS should work. But the department also has guidelines issued in a circular of 1956 and referred to by noble Lords in the debate. It states: Information should not be divulged to the Press without the consent of the patient beyond the statement that the person enquired about is a patient. Where even this could be against the patient's interests"— examples have been given today, especially with regard to a patient who is in a specialised hospital because from that factor his or her condition can be deduced— no information should be given without the consent of the patient and doctor. In the case of well-known people, a brief indication of progress can be given, but only with the patient's consent".

On another occasion, I am sure that the hospital will seek the consent of the noble Lord, Lord Carter. In accident cases, the hospital should inform patients' relatives before any statement is given to the Press. Again, the patient's consent must be given before any information, beyond a general indication of [his or her] condition, is made public". The guidelines clearly annunciate principles about confidentiality for the individual. However, the hospital may say on being asked that the person inquired about is a patient and that information may be withheld if the person is in a special hospital since, as I have said, it will allow the press to deduce the nature of the person's condition.

I do not wish to publicise individual cases and therefore I do not wish to quote from individual findings. However, I gain the impression that the Press Complaints Commission is perhaps taking a more pro-press attitude than its predecessor, the Press Council. Sir Louis Blom-Cooper, in an erudite speech to the annual meeting of the Royal College of Psychiatrists last year, cites the case of a well-known person being named as a patient in a special hospital which in itself identified his medical condition. Though the NHS guidelines prohibit that type of disclosure, it strengthens the case for new guidelines which should be accepted by all, including the NHS, the media, the Department of Health and other organisations which take a keen interest in the matter.

It is widely recognised that the guidelines are 36 years old and I am pleased to announce that new guidelines are being prepared and will be issued shortly for consultation. They will be more comprehensive and will cover a larger remit than just information to the press. They will cover the importance of preserving confidentiality, the responsibilities of all staff in the NHS for the management of health information and for controlling its use and disclosure and operational guidelines for preserving confidentiality and handling disclosures of health information.

The guidelines will thus build upon the existing common law requirements and take account of the ethical responsibilities of doctors and other health professionals. They will cover many of the detailed issues raised by the noble Lord, Lord Carter, and others today.

We shall be consulting widely on the guidelines to ensure that interested parties have an opportunity to help shape the finished product. It is vital to have a policy of openness in the service, but of course the confidentiality of individual patients is of paramount importance.

I wish now to pick up on one or two points raised by noble Lords. The noble Lord, Lord Carter, gave me the courtesy of informing me of some of the issues that he would raise. I have spent the weekend trying to think of a different term than "mentally disordered". I believe that words are important. One sees how attitudes have altered by the change from the word "bastard" to the words "one parent family". The search for such a term will be a great challenge to wordsmiths. I regret that over the weekend I have failed to find such a term. I hope that others will succeed.

The noble Lord, Lord Carter, and the noble Lord, Lord Thomson of Monifieth, raised the question of access to confidential records by those who work in hospitals, some of whom might be tempted to sell or give information to the press. The noble Lord, Lord Carter, asked whether those acts are governed by contracts of employment. They are, but perhaps I may suggest that such serious behaviour should be combated in three different ways. First, management in hospitals needs to maximise the information about the institution and to give adequate opportunities for press and public visits. Indeed, the special hospitals are beginning to do that. Secondly, it must be ensured that the establishment has efficient and open management. Thirdly, it is necessary to ensure that both employees and journalists who buy or divulge confidential information are brought to account by their prospective employing authorities and appropriate disciplinary action is taken.

The noble Lord, Lord Butterfield, enunciated some interesting experiences. He portrayed so well the balance of the dilemma that we all face. In a perhaps more bureaucratic way our guidelines will encourage the "pax" philosophy. But I hope that they will go further: I hope that they will prevent the conflicts from arising in the first place.

The noble Earl, Lord Longford, has a more prodigious knowledge of such hospitals and some of the unhappy people in them than perhaps any of us. He covered the point also by referring to the guidelines that we have drawn up. I hope that he will make a powerful contribution in the consultation period. I am most anxious that everyone interested in the subject should contribute and that we achieve the best guidelines possible.

The noble Lord, Lord Jenkins of Putney, penetrated the issue surrounding self-regulation of the press. I am reluctant, as other noble Lords have been this afternoon, to pre-empt Wednesday's debate. Ours is a narrow issue which must be seen in a wider context and all the aspects of the subject need to be treated together.

I am grateful to the noble Lord, Lord Thomson of Monifieth. I hope that I have addressed many of the issues and anxieties that he raised. I invite him as former chairman of the Independent Broadcasting Authority—an important regulating body—to take part in the consultation process.

I have also sought the views of Sir Louis Blom-Cooper on the issue because he is chairman of the Mental Health Act Commission. He is aware of the particular and morbid interest taken by sections of the press in people detained in secure hospitals. Those people should have the same privacy as everyone else. Sir Louis has assured me that the commission is taking a more active part as a channel for patients' complaints and in ensuring that information on the management and operation of the institutions is available and there is proper accountability in the running of the hospitals. He acknowledges that there is a problem with some special hospitals and there is certainly a requirement to update the 1956 guidelines governing patients' confidentiality.

The noble Lord, Lord Carter, also asked about the change in the situation of staff who were previously covered by the Official Secrets Act. I believe he considered that a breach of that Act prevented many of them from divulging confidential information. I have thought a good deal about that, but I return to my first principle. We are trying to move from a secretive to an open society. I am sure that there can be no going back; we must be more open. Reverting to the Official Secrets Act as a measure to prevent staff from divulging confidential information would be a retrogressive step.

I am always nervous about what goes on behind the closed doors of any secure unit. The doors must be closed, but the higher the security the greater the necessity to monitor the conditions. I believe that giving the press access on our behalf is a good independent check. There should be nothing to hide except the privacy of individual people.

I am grateful for the opportunity to discuss what I believe to be a crucial issue, which the debate has provided. It is one in which I take a close interest. We shall ensure that consultation on the revised guidelines is wide ranging and capable of influencing the outcome. I hope that we shall again debate this important subject so that understanding is deepened and consensus is achieved in the interests of the patients, the media and the NHS.