Children: Confidentiality of Medical Information (Hansard, 15 June 2004)

§ Baroness Andrews
My Lords, the legal advice is that children who are competent to make decisions about their own treatment are entitled to have their personal health details kept confidential. Information they supply in the expectation that it will not be disclosed to anyone with parental responsibility should not therefore be disclosed unless there is a legal compunction to do so—for example, a court order—or an overriding "public interest" justification for doing so.

§ Lord Northbourne
My Lords, I am grateful to the noble Baroness for that Answer. I accept that there is a problem in that context. However, does she not agree 626 that, even where there has been serious stress between a teenage child and its parents, if that child is then in serious trouble, 99 times out of 100 the parents will rally round and support the child? Under those circumstances, is it in the best interests of a child to encourage her to cut herself off from her parents so that she will not have the support she needs when she goes through the trauma of abortion and the depression that so often succeeds it? Is it fair on those with parental responsibility—who can be taken to court and sent to gaol if their child fails to go school or is guilty of anti-social behaviour—to withhold from them extremely relevant medical information about their child?

§ Baroness Andrews
My Lords, I can assure the noble Lord that, as a government, we would always want parents to support their children as fully as possible and to have the information they need to do so. However, a balance of law and practice has to be struck between the rights of parents to know about the medical treatment of their child and the right to confidentiality of a young person under 16. Confidentiality is important because it can make a difference to the young person seeking medical advice in the first place.
The common law is set out in what has become well known as the Gillick judgment. That has established that if a young person is judged to be competent—that is, if he or she has sufficient understanding and intelligence to comprehend fully what is proposed—he or she can take a decision about treatment. That is well established in law. However, I should point out that both in that judgment and in the subsequent guidance that was issued, great stress was put on the need for health professionals to try always to get the child to involve the parents. That is something that we would all want to see.

§ Baroness Walmsley
My Lords, given that the Fraser guidelines which govern the operation of this kind of confidentiality were set up in 1986, can the Minister tell the House whether there has been any recent review of their operation or whether any such review is planned? I ask because, while I accept that in most cases it is highly desirable that a young girl's parents are in a position to support her in such a situation, there are very often legitimate reasons—for instance, the fear of domestic violence—that may make the girl wish that they do not know. It would be most comforting to know how this is working in operation. Secondly, is there any public interest justification whatever for a newspaper publishing the name of the young girl whose case instigated this Question?

§ Baroness Andrews
My Lords, as to the noble Baroness's first question, the guidance is to be reissued and updated very shortly. We promised to do that in the teenage pregnancy strategy. It is important to have complete clarity, not least in relation to Sexual Offences Act. The revised guidance will support a clear framework for health professionals to work to. It will include the issue of confidentiality, their duty of care 627 and ensuring—this is important—that they have the time and support to give to the young person to enable the right decision to be made.
As to the noble Baroness's second question, I obviously cannot comment on the case. However, I understand that in every instance proper protocols and procedures were followed by the health professionals and the school involved.

§ Earl Howe
My Lords, the situations that have been referred to are often, as the noble Baroness appreciates, extremely sensitive and difficult. Can she say what support is currently available to health professionals and others, such as teachers, to make these difficult decisions about disclosures of confidential information?

§ Baroness Andrews
My Lords, since the passing of the Data Protection Act 1998, the health service has made a specific attempt to ensure that identifiable patient information is properly dealt with. Caldicott guardians—often senior professionals—were set up at that point to handle the whole question of safeguarding confidentiality. We have updated the guidance. Last November the department launched an information governance toolkit which provides a framework for bringing together all the requirements, standards and best practice that apply to the handling of personal information; it covers consent issues, the duties of common law confidentiality and the training that has to be provided. That contains a code of practice, and is a robust support.
The best advice to give teachers is contained in the guidance that goes out from the Department of Health to all people working in this field, including parents and young people.

§ Lord Hylton
My Lords, it seems that we are faced with a conflict of rights. In this context, is the noble Baroness aware of the very considerable public concern that has arisen over the dispensing of the morning-after pill and the vast increase in sexually transmitted diseases? Will the Government trust parents rather more than they do now and not put at risk the relationship between parents and their children?

§ Baroness Andrews
My Lords, I agree with that. We have found, and the evidence is quite clear, that when parents are involved in openly discussing sexual relationships with their children, those children are much less likely to be pressured into having sex too early or irresponsibly. We very much want to support parents in that respect. Through an organisation called Parentline Plus, we are creating opportunities for parents who are embarrassed by this subject—parents often find it easier to talk about homework than sex—to come forward and get some advice about how best to do this. That is a very positive step forward and a positive response to the problems which the noble Lord identified.