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Access To Medical Reports Bill

Volume 127: debated on Friday 12 February 1988

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Order for Second Reading read.

1.29 pm

I beg to move, That the Bill be now read a Second time.

The long title of the Bill says that its purpose is to
"Establish a right of access by individuals to reports relating to themselves provided by medical practitioners for employment or insurance purposes and to make provision for related matters."
Hon. Members will recall that last year I introduced the Access to Personal Files Bill, which has since reached the statute book, albeit in a greatly reduced form. Originally, that set out to allow people to have access to their full medical files. There is enormous public support for that measure, and a recent survey by the Data Protection Registrar found that 86 per cent. of people asked wanted a right of access to their medical records. They now have a limited right in relation to computerised medical records only, under the Data Protection Act 1984 and I know that the Government are seeking a voluntary agreement to facilitate greater access to other medical records. However, I do not believe that either of those moves deals with the area with which this Bill seeks to deal. I believe that the Bill, although it is a finely focused and modest measure, is necessary to fill the gap that exists.

When someone applies for a life assurance policy or a job, he is almost invariably asked to allow the insurance company or the employer to take up a medical reference. On the whole, people have no option but to agree, because to do otherwise could severely jeopardise their job or insurance application. They sign a form which permits the company to contact their current doctor, or any doctor who has treated them previously, for information about their medical and social history.

In doing that, although they may not realise it, they waive their right to have kept secret the information that they have given to a doctor in confidence. The doctor can reveal whatever he or she knows about the patient, whether it relates to a current medical condition or one that has long since passed, whether it is relevant to the applicant's current fitness or not, and even if it relates to personal matters that do not involve a medical problem of any nature. My Bill would allow people to see the report that the doctor proposed to send or had sent to an insurance company or employer in those circumstances.

Many doctors are concerned that their patients do not appreciate the real significance of the consent form that they sign. A patient may assume that the doctor will be asked merely to confirm that he, the patient, is not suffering from a major illness. That is a perfectly reasonable supposition for him to make. In fact, the doctor may be asked detailed and intrusive questions. I have seen some such questions that have caused me concern and I shall share one example with the House.

A medical practitioner was asked to
"State details of any facts concerning health, habits, sobriety or family history or other circumstances which might affect our assessment."
I doubt whether there are many hon. Members on either side of the House who would willingly submit themselves to the full rigour of an investigation on those terms.

The current concern of the insurance industry is AIDS. As an illness it is causing us all concern, but the insurance industry's concern with AIDS has led to questions about patients' sexual behaviour, designed to discover whether the patient is a homosexual or is promiscuous. It may be that employers will soon be doing the same, if they are not already doing so.

Most people assume that their medical records contain nothing but medical information. They do not realise that information about their family, their personal life or sexual relationships may well have been recorded at an earlier stage, let alone that the doctor may be passing such information to other bodies without their knowledge. Moreover, they have no guarantee that the information will not be passed further.

Most insurance companies have a medical officer to whom the GP's report usually goes. He receives the information and deals with it properly within the usual terms of medical confidentiality. Medium and small-sized employers do not always have such a person. Sometimes, the GP's report can be sent to the personnel department and it may be handled by people who have no tradition of protecting the confidentiality of medical information.

There are specific reasons for concern if doctors are allowed to write reports to other bodies which their patients cannot see. First, when people realise that information that they have given to a doctor in strict confidence is in danger of being passed on in this manner, they will become extremely cautious about disclosing sensitive matters to their doctor. That can only be harmful to the long-term doctor-patient relationship, and it may cause problems in securing accurate diagnoses.

Secondly, there is the danger of errors being passed on, particularly by a doctor who does not have direct personal knowledge of the patient and must rely on what is written on the medical record. Clerical errors occur, and some that I have seen have caused me great concern. One doctor who examined the accuracy with which he summarised his patients' notes found that he had made errors in 27 per cent. of his diagnoses, and he regarded 58 per cent. of those errors as fairly serious.

Thirdly, it is by no means unknown for a patient's medical notes to contain information about someone else whose notes have been filed by mistake. The Campaign for Freedom of Information has described several such cases. There was the example of a perfectly healthy woman who was wrongly described as a heroin addict. A young student was falsely described as suffering from convulsions and of having had an operation to remove a brain tumour. Another perfectly healthy woman who visited her doctor before applying for a life assurance policy learnt that the notes forwarded by her former GP included the incorrect statement that she was terminally ill from cancer. A page from somebody else's notes had been placed in her file. Luckily, she discovered that mistake and had it corrected. Had she not had a chance to visit her doctor, the policy would have been refused. As the House knows, the insurance industry keeps a central register of people refused policies on medical grounds, so an initial refusal can permanently prejudice a person's chance of obtaining cover.

Fourthly, the report may involve an unjustified invasion of privacy. The best example that I have of that is of a woman who applied for a post as a part-time teacher in a religious school. She was asked to supply a complete medical history and she had to answer more than 30 questions about her health. She was asked to allow the school to take up a medical reference. If the doctor had provided her full history, he would have had to disclose that she had had an abortion. Given the ethos of the school, that would probably have ruled out her chances of getting the job. More important, she feared that the abortion would have become known locally, and since the school was run by people who knew her it would have had a devastating effect on her standing in the community. Under the Bill she would have been able to discover what the doctor proposed to disclose and she would have been able to make representations to him. Ultimately, she could have withdrawn her consent for the report to be made, even if that meant forgoing the job, which was something that she would have preferred to do in the circumstances.

I shall deal briefly with the content of the Bill. It requires insurance companies and employers to have the written consent of the applicant before they approach a doctor for a medical report. That consent would be valid for 90 days only. Thus, if, at a later stage—perhaps long after the employee has been employed — the company wants to make further inquiries of the GP, it must ask again for consent. It cannot simply recycle the original consent.

At the time that consent is obtained, the employer or insurance company will have to notify the applicant in writing of the right of access under the Bill — the person's right to see the proposed report before the doctor sends it and, indeed, afterwards.

That could be done by adding a statement about the right of access to the original consent form. It would be up to the applicant to contact his or her GP and explain that he or she wanted to come and see the report before it was sent. If the applicant did that, the doctor would be obliged to refrain from sending in the report until the person had had the opportunity to see it. If the applicant did not get in touch with the doctor, he would be free to supply the medical report in the normal way, without delay.

Reports can also be inspected after they have been sent. The Bill would require a doctor to keep a copy on file for no less than five years, so that there would be a record. The patient would be entitled to make a photocopy of the report, for which the doctor could make a reasonable charge.

The Bill also contains exceptions. I am sure that the House will appreciate the reasons for them. The exceptions are based as carefully and accurately as possible on those that already apply when people seek access to their computerised health records under the Data Protection Act 1984. A doctor may withhold information where it is judged that disclosure would cause serious harm to the patient's health, or where the report contains personal information about someone else, such as another member of the applicant's family.

The Bill applies only to reports produced by a doctor who is or has been responsible for treating a patient, and therefore will have access to information provided in confidence during ordinary doctor-patient consultation. It does not apply to a report resulting from an independent medical examination carried out for employment or insurance purposes by a doctor who had no access to medical records and no previous contact with the patient.

The two cases are somewhat different. In the first, a doctor who has been acting exclusively to further a patient's health suddenly assumes a different role in using information obtained on that basis to advise an insurance company or an employer. Indeed, the doctor is paid by such companies to provide reports. This serious conflict of interest does not arise when an independent medical examination is carried out.

A person who made use of the opportunity under the Bill to see a proposed report before it was sent would be able to discuss its contents with the doctor and make representations about anything that he or she considered inaccurate or irrelevant. The Bill does not allow a patient to demand that anything must be omitted from what ultimately must be a doctor's professional opinion. If the Bill goes into Committee, I would wish to discuss the possibility of a right to correct factually inaccurate material, or alternatively to allow the patient to add a comment to a report that is under dispute.

Patients would have a final sanction against a report which they considered wholly unacceptable. They could simply withdraw their consent for the report to be sent. A doctor who passed on a report against a patient's wishes would be committing an actionable breach of confidence and could also be guilty of professional misconduct.

The Bill has all-party support and is supported by the Consumer's Association, the Patients Association and the Campaign for Freedom of Information. I am pleased to say that the British Medical Association's general medical services committee,—the BMA committee representing general practitioners—strongly supports the principle of the Bill. It has suggested that it should be strengthened in several ways and that its scope should be expanded to include reports made by doctors to third parties other than employers or insurance companies. The Bill is deliberately modest in its scope, but I should be happy to discuss suggestions for improving it should it reach Committee, and I commend it to the House.

1.43 pm

I welcome the Bill. Although, as the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) said, it is a modest measure, it is long overdue.

The Bill covers many injustices. Most hon. Members through their constituency surgeries have met people who have been subject to dismissal, or have not been offered a job by employers who have given no good reason for that other than the fact that the medical report that they had received from the applicant's medical practitioner was unsatisfactory in some respect. I have had cases, as I am sure have many hon. Members, in which people have been alarmed about the reasons for an employer's attitude. The employee may feel that he or she should have known and been informed about something in the report. The Bill will go a long way towards remedying these problems.

In some respects, the Bill does not go far enough—as the hon. Member for Roxburgh and Berwickshire said, it is a deliberately modest measure — to tackle a major problem. We must ensure that, if a medical practitioner is exempted from giving such a report under clause 6, the reasons why the report is not shown to the patient or is held back are made clear to the patient. The fact that the patient cannot obtain access to which he would normally be legally entitled may make the problems considerably worse for him. That point must be closely considered to ensure that we do not create other problems while solving a major one.

There is a tragic aspect of most of the difficulties in relation to the medical profession. The people who come forward with these problems, who are not told why they were dismissed or not offered a job and who do not have a relationship of confidence with their general practitioner or other medical adviser, such that he says, "This is what I shall tell your employer and this is what you will need to know about what will be in the report", are those least able to exercise the rights which they will have under the Bill.

These people may be desperate for a job and agree to almost any conditions that an employer imposes. They perhaps would not understand the significance of what was said in a medical report, if only because it was couched in such language that a man or woman of perhaps less than good education could not understand it easily without it being explained. There are considerable problems for the most vulnerable members of society, even in the protections implied in the Bill. This point needs to be closely considered in Committee.

We need to ensure that those who will suffer most will be assisted by the type of information provided. Perhaps we should put more onus on the doctor to ensure that if he puts in his report anything to the patient's disadvantage or anything about which he feels, as a reasonable man, the patient should be concerned, he has an obligation to bring it to the patient's attention.

A doctor is always in a position of considerable power in respect of the patient. Many people have a certain fear of going to see their medical adviser. It is not just the fear from which we have all suffered when sitting in the dentist's waiting room—the fear of pain. It is not just the fear that the doctor might diagnose a problem. It is the fear in seeing a person who is highly educated, as the master of a somewhat mysterious science who is in a position of authority over the patient. It is the fear that will lead people perhaps not to ask the right question or even to think of the right question until they have left the doctor's presence. We need to ensure that doctors have an obligation to ensure that the spirit, as well as the words, of the Bill works.

The hon. Member for Roxburgh and Berwickshire said that the Bill does not cover the case, which is particularly true with both employers and insurance companies, of an outside medical adviser, frequently attached to the employer or insurance company, and retained as a medical adviser, who is asked to make an examination of a prospective or existing employee to decide whether he meets the medical criteria. That, as I am sure many hon. Members have found, has also led to abuse. I do not wish to go into the rights and wrongs of this case, but a constituent of mine was sent as part of a regular check to a doctor who was not his regular general practitioner. The doctor diagnosed — incorrectly, according to my constituent and his regular general practitioner — that my constituent was an alcoholic.

My constituent was working in a job for which alcoholism would disqualify him from being employed. That medical practitioner, who was on a retainer to the employer, recommended that he could not carry on with his employment, even though my constituent's GP flatly denied that my constituent had any history of alcoholism. That was some seven or eight years ago, and to this day my constituent has failed to get that one adverse medical report changed. It took him five years, assisted by my predecessors in the constituency, to get access to that report. He knows what is in the report, but cannot get anybody to gainsay the medical practitioner who made the original diagnosis, which appeared to have been at fault.

If my constituent had been able to get access to the report before it went in, he would have been in a position to make representations to his employer and to the doctor being retained to make the examination. He could have got a second opinion and had his case reviewed in consultation with his general practitioner. The Bill does not deal with that particular situation, but many similar injustices deny people insurance and employment, and sometimes, as in this case, get people dismissed. They can lead to apparent gross injustices purely because of the secrecy which surrounds the ethos of the medical profession when making such reports. I should like the Bill to be expanded in Committee to cover such situations.

There should not be a fundamental difference in a report from a patient's general practitioner or close medical adviser and that from a doctor brought in from outside to make a consultation. The effect of an adverse report, if it is incorrect or mistaken, on an employee can be devastating. The Bill is an attempt to remedy that.

I should also like the Committee to look at another aspect of the Bill. If, under the provisions of clause 4, the employee objects, looks at the report and decides that he does not like it, he can withdraw his consent and the report will not be sent at that stage. That is fine as far as it goes, but an employer who knows that consent has been withdrawn after the employee has seen the medical report can draw only one conclusion— that the report was so damning that the employee has effectively dismissed himself. That may not be the right conclusion. There is a problem for somebody in employment who may be dismissed if an adverse report is submitted.

An employee could have to decide which is the lesser of two evils—being dismissed, effectively, for withholding consent or being dismissed because the report is adverse. He must ask himself whether he can talk himself out of a problem more effectively when the employer lacks information or when the employer has an adverse medical report with which the employee disagrees.

In the case of the teacher who had had an abortion, the information did not stop her being a good teacher, but if she failed to send the report she could guarantee that she would not be recruited. In her case, going to another doctor might make no difference. We must try to find an acceptable middle route so that more emphasis is put on ensuring that, when a report is strongly objected to, the reporting doctor discusses those objections and possibly takes outside advice or a second opinion.

I am sure that most of us agree that doctors are, by definition, reasonable people who take decisions that are in the best interests of their patients, but I am also sure that one or two of us have come across doctors who, probably through overwork, have been less than willing, apparently, to discuss with patients the finer points of what they are doing.

I strongly welcome the Bill. It is long overdue as it brings greater openness to medical records. The House may like at some future date to consider the secrecy of medical records in general, but that is not an appropriate subject for consideration here. I have the great fortune to have the Charing Cross hospital, which is a major teaching hospital, in my constituency. I am therefore approached by many people who have had excellent treatment and others who feel that the hospital has been less than successful.

Often, the person who complains about the treatment that he or she or a relative has received does not understand the full facts because the hospital has been reluctant to release any medical records. The hospital is sometimes unwilling for the complainant to discuss what has happened with the consultant in charge. If patients were able to have better access to medical records, such a problem would rarely occur. I am the first to recognise that there are problems associated with such a step.

Doctors need to be able to include in their medical reports the full details of a case—their suspicions as well as confirmed facts. Completely open access might cause more fears than it would allay. There must be a middle course to enable the quite justified fears, concerns and doubts felt by patients to be allayed by allowing them to examine their records, even in an edited version, so that they can understand why certain decisions were made and certain treatments given and see whether they have received the right treatment. We need to achieve that balance. The Bill is perhaps a step in the right direction.

For now, the Bill goes far enough, but I would welcome a measure that went further and tackled the whole problem of medical records.

2 pm

I shall continue my self-imposed training scheme in readiness for the cameras and see how succinctly I can make my remarks.

I congratulate the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) on choosing this subject for his Bill. Along with many other hon. Members, the hon. Gentleman and I welcome any chance to take a pick-axe to the walls of secrecy so needlessly erected around so much of our daily lives.

I am glad that the Bill has all-party support. It will right a wrong, which is that at present we are not allowed to see what doctors propose to say or have said to would-be employers or insurance companies. I agree that it might be useful to see whether we can widen the Bill to cover medical reports to all third parties.

There can be no defence of the present position, and I hope that the Bill will start a process that gives patients a right to see their own medical records and not only reports required by employers and insurance companies. Some doctors already make such records available, and more should do so, the better to aid patients' recovery from illness. Such a partnership can only be for the good, because general practitioners benefit when patients know the details of their condition and understand the reasons for the treatments that they are given. Similarly, when a job or insurance application may well turn on a medical report, it cannot be right for the applicant to be denied knowledge of what the doctor says.

In case the House should think that I do not practice what I preach, let me make it clear that when I get a request for a job reference I unfailingly send a copy of what I have written to the person whom it concerns. That may well account for the fact that so few applicants whom I support are successful in their job applications. Indeed, when my wife and I were asked to give references for two separate applicants for the same job, the applicant whom my wife supported got the job.

I look forward to the Committee stage of the Bill and, beyond that, to more steps to make our society more open, with more freedom of information.

2.3 pm

I congratulate the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) on his success in getting a favourable place in the ballot, on his choice of subject and on his speech. Let me make it clear at the outset that the Government have no intention of seeking to prevent the Bill from reaching its Committee stage, and I hope that the Committee will take a constructive look at the Bill when it gets there.

I congratulate my hon. Friend the Member for Fulham (Mr. Carrington) on his speech. He made a number of interesting points, particularly about the way in which vulnerable groups are the most affected by the present arrangements. He gave a graphic description of at least one injustice that has flowed from the present system, although, as he said, it does not fall within the scope of the Bill.

My hon. Friend said that he agreed very much with the spirit of the Bill and hoped that that spirit would be carried forward as much as the letter. I emphasise to him and to all other hon. Members how important it is in Committee to get the letter of the Bill right. It is all very well saying what one's intention is, but when the courts start looking at the Act, if the letter is not right, all too often the whole matter can go astray.

My hon. Friend raised the wider issue of the secrecy of medical records, but it is this Bill that we are talking about, and I shall not be diverted into job applications and giving references. It is normally friends who ask one to provide a job reference. I do not know whether one loses faith more quickly in one's friends or in the employers to whom one sends the job reference if one pursues the pattern of activity of the hon. Member for Birmingham, Erdington (Mr. Corbett).

As was made clear, the Bill seeks to give individuals the right of access to reports by doctors responsible for their care, prepared for their employers, past, present and potential, or insurers, past present or potential. It requires the written consent of individuals before any report is prepared on them, limits the life of such consents to 90 days and requires that individuals are informed of their right of access to those reports. It provides that if any individual wants to see a report before it is sent to an employer or insurer, the doctor must arrange for that to be done before he lets the employer and insurer see it. No time limit is set for exercising that right. There are several other provisions, all designed to give increased rights to individuals in that sensitive area.

By our reading of the Bill, it does not appear to give the individual any right to have inaccurate reports corrected or withdrawn; nor does it create a specific right to withdraw consent if the individual dislikes a report, or provide for patient's comments to be added. It does not apply to doctors employed by insurers or employers merely to conduct a specific one-off examination of individuals. That point was touched on by my hon. Friend the Member for Fulham. Nor does the Bill apply to examinations conducted by statutory authorities, for example, for heavy goods vehicles licences and so on. The Committee may wish to turn its mind to this matter. The Bill does not seem to provide any penalty for contravention or any means of enforcing the law.

I congratulate the hon. Member for Roxburgh and Berwickshire on his success in introducing the Bill. The House will recall that during the passage of what is now the Access to Personal Files Act in the previous Parliament the Government gave an undertaking to enter into talks with the medical profession, with a view to achieving substantive and timely progress in opening up medical records further, on a non-statutory basis. I am sure the House will be pleased to hear that those talks are taking place at the moment and that significant progress is being made.

On the whole, the Government would have preferred to reach a successful conclusion to those talks, since by making health records more generally available there would be no need for legislation on specific related areas such as the reports covered by the Bill. A non-statutory basis might have been preferable, because we are feeling our way, and we may need to adapt our approach to that sensitive, but important, area quite rapidly if it is seen to be causing unforeseen problems in the care of patients. Nevertheless, as I made clear at the outset, we do not wish to oppose the Bill as it is consistent with the Government's objectives and may give us some valuable experience in extending access to medical information, albeit in that limited but important area.

As a Government, we consider that, as a matter of principle, patients should have the right to know what has been recorded about them. However, it is widely recognised that there will be some circumstances in which the uncontrolled disclosure to an individual of personal health information about himself or herself would run the risk of causing serious harm to that individual. The Bill picks up the necessary safeguards, which are in line with the Data Protection (Subject Access Modification) (Health) Order under the Data Protection Act 1984.

The safeguards were designed specifically to protect the individuals from such serious harm to his or her physical or mental health that such full disclosure of information might cause, and to maintain the confidentiality of other individuals. They are important matters and I am pleased that the Bill is consistent with the Data Protection Act 1984 in that respect.

Should the Bill be given a Second Reading today, I hope that the hon. Gentleman will consider the points that have been put to him by the insurance industry and the medical profession. As I understand it, the insurance industry is concerned about the quality of information that will be provided. It is concerned that if medical practitioners prepare a report in the knowledge that individuals have the right to see it they may dilute the information, and therefore it may be more difficult to establish the true risks. It is also feared that administrative costs will increase and that paper work may add to delays and therefore increase costs. On balance, the insurance industry would prefer the non-statutory rather than the legislative route.

It is not for me to do the hon. Gentleman's job for him, but I believe that, despite all the objections, the principle of letting people know what is recorded about them should be encouraged as widely as possible, with the necessary safeguards. In practice I do not believe that the take-up of that right is likely to be very wide, and I do not believe that the administrative burden will loom particularly large.

I am sure that the hon. Gentleman will also take into account the concerns voiced by the medical profession. Indeed, the Health and Safety Executive has expressed some concern, and I know that the hon. Gentleman has been in touch with my hon. Friend the Parliamentary Under-Secretary for Health and Social Security on that matter.

When the Bill goes into Committee, I hope that it will be considered seriously and that the arguments that have been raised on Second Reading will be taken into account. This will ensure that the Bill meets its desired effect without hindering the free flow of information upon which employers and insurers rightly depend, and also ensure approach that is within the provisions of the Data Protection Act 1984 and the Access to Personal Files Act 1987.

2.11 pm

I believe that the Bill shares a number of things in common with other recent Bills.

It is important that a balance is struck. First, one must consider what is genuinely a matter of information that should be available to a person—in a sense his right of privacy—to enable him to have enough information to know what is going on in matters that affect his personal life. On the other side of the coin, one must consider whether freedom of information, which underpins that notion, could be an invasion of his privacy. I believe that that philosophical question will have been carefully considered by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood). I am sure that other hon. Members who have sponsored similar Bills have also addressed that problem.

It is a curious state of affairs that in the past few weeks the Unfair Reporting and Right of Reply Bill has been introduced by the hon. Member for Cynon Valley (Mrs. Clwyd), I have introduced the Right of Privacy Bill and today we have debated at length the Malicious Communications Bill. Now we are considering the Access to Medical Reports Bill. At the centre of all those measures is the balance between what information sho:uld be reasonably available to people—what is legitimately in the public interest — and what is essentially a private question that should overlay considerations of public interest. It is the balance between those principles that has caught the imagination not only of the House, but of the press. Indeed, only yesterday I was involved in a television debate with David Montgomery of Today regarding the balance between those two propositions. For that reason I believe that the Bill is important.

I was glad to hear what the Minister said about the Bill, and to note that the Government have taken a view about a person's right to have information about himself that is different from what we might have expected of previous Governments. This Bill should be brought to the attention of the media, which have gained an impression that the Government are more interested in suppressing than in releasing information. In matters concerning the freedom of the individual we are anxious that people should have access to information, and the dividing line that we seek to draw comes where that impinges on a matter of genuine public interest, such as national security. It is a difficult issue. These matters are reverberating around the courts almost daily, which is reason to consider the issue at its root, and the Bill provides us with an opportunity in Committee and during its later stages further to consider the principles that underpin it.

I approve of what the hon. Member for Roxburgh and Berwickshire has in mind, but I want to discuss whether the Bill should be confined to employment or insurance purposes. The hon. Gentleman is restrained, because of the scope of the long title, from tabling amendments that would enable this access of infomation to go beyond employment or insurance purposes. There is a way around that problem—by subsequently altering the long title—but that is a messy procedure. I can only hope that he finds some way round it.

If it is right in principle that a person should have access to his medical records because they relate to his privacy, confining such access to matters of employment or insurance seems unduly restrictive. I do not want to criticise the hon. Gentleman's Bill, but he may want to tackle the issue of widening its scope.

Another aspect of the Bill that caught my attention was the use of the expression, "medical practitioner", which must be defined by reference to the Medical Act 1983. The Bill also refers to "health professionals." The hon. Member for Roxburgh and Berwickshire and others will know that I am chairman of the all-party committee on complementary and alternative medicine and I provide advice to people on those subjects. It would be a strange state of affairs if people these days were to make the assumption that medical practitioners are exclusively those who are medical practitioners within the terms of the Medical Act 1983. I had to raise that point during discussion of the Data Protection (Subject Access Modification) (Health) Order 1987, which is mentioned in clause 2 as defining a health professional. When that order was going through — I am a member of the Select Committee on Statutory Instruments—I drew attention to this anomalous state of affairs. Not only in this Bill, which is confined to medical practitioners, but in the context of health professionals, to which the Bill does not apply in toto, the people who are excluded from the article to the Data Protection (Subject Access Modification) (Health) Order 1987 are those from the practice of complementary and alternative medicine. Obviously, I include people such as osteopaths, acupuncturists and chiropractors and people in similar areas. It seems quite extraordinary that the schedule should exclude them and include people such as art or music therapists employed by a health authority.

If we are to pass legislation that applies across the board, it is at least worth considering putting health professionals who provide independent advice on the same footing as medical practitioners. In many respects, for reasons of common law that I will not go into, they provide that independent advice not exclusively on referral but in an independent capacity. That is the way it should be and I hope that the legislation will be framed to take account of that. I welcome the Bill and hope that it will be fully considered in Committee and will make its way through the House.

Question put and agreed to.

Bill accordingly read a Second time and committed to a Standing Committee pursuant to Standing Order No. 61 (Committal of Bills).