Police, Crime, Sentencing and Courts Bill

Lord Carlile of Berriew Excerpts

Lords Hansard - part one & Committee stage
Monday 25th October 2021 Lords Chamber

[Lord Patel (CB)]

My Lords, I support the amendments in this group in the name of the noble Baroness, Lady Brinton, to which I have added my name. The provisions in the Bill relating to serious violence introduce a new legal duty of disclosure that seriously threatens the doctor-patient relationship, especially in relation to patient confidentiality.

The Bill explicitly sets aside the common-law duty of confidentiality that I as a doctor owe to my patients. Doctors regard patient confidentiality as a fundamental ethical duty, upholding the trust that lies at the heart of the doctor-patient relationship. The Bill’s proposals that relate to disclosure of patient information threaten the common-law provision of confidentiality, the requirements of data protection laws and doctors’ ethical standards.

The General Medical Council, in guidance on professional standards, makes it clear to all doctors when and in what circumstances a doctor can release confidential patient information without a patient’s consent. This, in my view, covers the requirement for disclosure in situations of serious violence. The police having the ability to gain identifiable—I stress “identifiable”—patient information from health bodies without setting out clear reasons, which should be limited by statute, is fundamentally wrong. The Bill does not provide clear statutory arrangements that have the confidence of the medical profession, as highlighted by its regulator—the GMC—the BMA and some other health professionals, and, importantly, the data protection guardians. These bodies have raised serious concerns.

The noble Baroness, Lady Brinton, spoke eloquently and in detail on all the issues in moving her amendment, so I do not need to enlarge on that, but I support her comments. The Minister needs to set out more clearly the Government’s intention, scope and implementation of the powers in the Bill relating to access to patient data. The noble Baroness, Lady Brinton, asked some key questions that also cover some of my concerns. The issues are important. Might the Minister agree to meet the GMC, the BMA and representatives of other health professionals? I look forward to her response.

[Lord Carlile of Berriew (CB)]

My Lords, I apologise for not having taken part in the Second Reading debate, when I was unavoidably abroad for professional reasons, or in the first Committee day, when unfortunately I was recovering from coronavirus—an experience I would not recommend to any of your Lordships given my experience of it. I rise to speak having very much enjoyed the speech by my noble friend Lord Patel, because I thought he introduced an element of balance that had not quite reached the debate in the earlier moments, eloquent as the introduction from the noble Baroness, Lady Brinton, was.

I will cite two pieces of my own experience as evidence. I spent 10 years as a lay member of the General Medical Council and, during those 10 years, sat successively on the health committee and the conduct committee. The health committee is a form of conduct committee, but with an obvious emphasis, as its name indicates. We spent a great deal of our time discussing whether doctors can be fully relied upon at all times, and in particular at critical moments, to understand the limits of the duty of confidentiality. Because it is not an absolute duty; there is a balance between the private rights of the patient and the general duty of the doctor not to disclose information, and the public duty of the doctor to disclose information if there is, for example, serious danger of violence to the public. I fear that more work will be needed on the amendments being proposed at the moment if that balance is to be sustained.

My second piece of evidence relates to an inquiry I conducted in 2012 for the then Secretary of State for Education, which related to something called the Edlington case. The brief story was that two small and neglected boys, who were fractionally over the age of criminal responsibility, nearly killed another child in a wood. Fortunately, that child and their companion survived—one of them only just. In my inquiry, I looked at the sharing of information by a host of organisations—schools, general practitioners, social workers and so on. It was a clear conclusion of my report that, if key information had been shared, the child who nearly died would not have been assaulted, the two very unfortunate little brothers who committed the assault would not have spent the succeeding years of their lives in a custodial institution and the schools would have been able to create a situation in which the dreadful problems for everybody concerned did not arise. One of the key issues in that case was that the general practitioners did not fully understand the balance between their duty to the public and the rights of their patient—and near-disaster ensued.

To noble Lords moving these amendments and to the Minister, who I know listens to these debates extremely carefully, I say that this is not the time for people to take up closed positions on these matters. There is a lot of work to be done. I think my noble friend Lord Patel probably agrees with this, but I speak with great trepidation, because right in front of me are two of the most distinguished doctors in the whole country. We must ensure that, where it is necessary as a public duty, they and others need to be consulted to ensure that the balance is right and is therefore not the subject of the controversy we have been hearing about already this afternoon.

[Baroness Chakrabarti (Lab)]

My Lords, I do not disagree with the noble Lord, Lord Carlile, but I none the less think that the noble Baroness, Lady Brinton, and her colleagues are on to something. There is no question but that the noble Lord, Lord Carlile, is right that, under common law, doctor-patient confidentiality is not and has never been absolute. The question is when it is trumped by other considerations, and who decides.

It is always dangerous to suspect what the Minister will say in her eventual reply, but I suspect that she will say reassuring things, and her colleagues will have given her reassuring things to say, about the intention. I am sure that the intention is not for the wholesale trumping of doctor-patient confidentiality. There is no public interest in that and the Government would not want people to take that as the case, because it would be completely counterproductive not just to the effective functioning of public health but to law and order. To give an obvious example, if everyone involved in knife crime feels that there will be no confidentiality whatever in the emergency room or elsewhere, one runs the danger of people not going to get the vital help and emergency care that they need. I know that the Minister will understand that.

Going back to the detail—as this is Committee—when should there be a trumping and who decides? That is a worthwhile, detailed conversation to be explored between organisations such as the General Medical Council and the Minister and her team. Because, while it may not be the Government’s intention to trump common-law principles of ethics and confidentiality en masse, we have to remember of course that statute displaces the common law. If the statute is unclear and people think or perceive that the common law has been trumped and that the decision has been taken completely out of the hands of an individual practitioner on the advice of ethical bodies or ultimately taken out of the hands of a judge and that the principles of confidentially have been totally trumped, we have a problem—and that means the Government have a problem as well.

So I hope that, when the Minister eventually replies to this debate, she will not reject these concerns out of hand and will take on board the possibility of a bit more detailed discussion about when the duties to collaborate and so on should trump confidentiality, when not and, crucially, who is to decide. For my part, I would favour practitioners, properly advised, perhaps by more and further guidance from their professional bodies, and, if necessary in individual cases, by the order of a judge, possibly sought on an ex parte basis, as opposed to anything too wholesale or administrative. That is just my suggestion. I am sure that the Minister and her team will be able to come back with something that meets the concerns of the noble Baroness, Lady Brinton, and her colleagues before the next scrutiny stage of the Bill.

--- Later in debate ---

[Lord Patel (CB)]

My Lords, I am sorry to intervene again, but it may help the debate if I address some of the issues raised. I should have mentioned in my speech—but I deliberately did not—my personal experiences when I was approached on four occasions by the police to give some information about patients. I refused, because I followed the guidance of the General Medical Council, and at no time did that threaten or harm the health of the patient nor anyone else—relatives or any members of the public. On one occasion, I voluntarily informed the police about a patient who had approached me for completely different reasons, but I had noticed that harm was being done to her and, on subsequent occasions, it became quite clear that it was becoming a serious issue. Therefore, I disclosed information to the police; again, following the GMC guidelines.

The common law may have soft edges, but if a doctor follows the common law and the guidance the GMC issues, it works. On what happens when a doctor refuses to give information, despite the fact that the patient is being harmed or that the patient may cause harm to other people, then the doctor will be wrong in his or her duty, and therefore can be overridden. That is the only point I would make.

[Lord Carlile of Berriew (CB)]

My Lords, I hesitate to be disorderly, but I was asked a direct question by the noble Baroness opposite. I think in fact it has been pretty fully answered by my noble friend Lord Patel, but the noble Baroness phrased her question in the language of judicial review, and I would just point out to her that in the real world the possibility of the judicial review of a single medical practitioner in these circumstances is not realistic in the slightest, so it would not happen. If I may say so, it is a good question but the wrong good question.

--- Later in debate ---

The Government have dedicated a chapter of the Bill to tackling serious violence. This amendment would specifically recognise violence as a reason to relocate a person or household at risk. I do not believe there is any disagreement on the desired outcome—that we want a young person to be moved out of harm’s way before violence escalates or lives are lost—so I wonder why the Government would not prioritise that as part of their action on serious violence. I look forward to the Minister’s response.

[Lord Carlile of Berriew (CB)]

My Lords, I support the amendments introduced so ably by the noble Lord, Lord Young, and the noble Baroness, Lady Blake. This has been an example of how good this House is at certain things, with two noble Lords with huge experience in the policy area under consideration—and I understand, in the noble Baroness’s case, a deep understanding of the housing situation in one of our major metropolitan cities, Leeds. We should listen to them with great care; I am sure the Minister will.

Other examples can be given of evidence showing that housing really needs to be included right at the core of all these considerations. A recent initiative by a very experienced retired criminal Queen’s Counsel, Bruce Houlder QC, focused on knife crime. The work that Mr Houlder—a very good friend of mine—is now doing, to some acclaim, demonstrates, among other things, that knife crime becomes a cultural issue in certain housing areas. It requires attention in a Bill such as this.

I want to add something about the Edlington case, which I mentioned earlier. One of the issues that arose in that case, which I included in my report to the Secretary of State, was that housing was not included in the consultative group trying to resolve the florid problems of the two children who became serious offenders. Had it been included, they would have been moved and would not have been allowed to stay in the housing where they were. It was absolutely fundamental as a mistake, and we are now nearly 10 years on.

I hope that the Minister responding to this debate will take on board what has been said and ensure that further consideration is given to these amendments.

[Baroness Bakewell of Hardington Mandeville (LD)]

My Lords, I rise to speak briefly to this group of important amendments, and declare my interest as a vice-president of the LGA.

The noble Lord, Lord Young of Cookham, and the noble Baroness, Lady Blake of Leeds, set out the reasons for these amendments, and I fully support them. Those responsible for providing housing have changed over the years, from the time when it was solely the purview of local authorities to now, when it is a mix of elected councils that hold housing stock themselves through to housing associations and registered social landlords providing a mix of accommodation for couples, families and, less frequently, single people living alone.

Whatever their circumstances, tenants all deserve to feel safe in their home and free from violent attack. Women and young people are often the target of violence, sometimes with catastrophic consequences. Some of this will be domestic violence; in other cases it will be gang related. Whatever the cause or outcome, it is essential that the housing providers have a robust strategy in place—first, to prevent violence in the first place and, secondly, to deal with the aftermath once it has occurred.

Housing provider co-operation with the police is essential in dealing with violent abuse. Relying on GDPR protection to avoid releasing information is unhelpful at best and, at the other end of the spectrum, borders on ignoring the violent act itself. Of course, this release of information on behalf of the housing providers does not extend to medical professionals, the subject of the previous group of amendments.

Violence is abhorrent and prevents people enjoying the safety they should feel in their home, whether that is a bedsit or a three-bedroom family home. Local authorities will receive complaints about the behaviour of their tenants from neighbours. This might be about noise or anti-social behaviour. In more serious cases, the complaints will be about violence suffered by children and women, and sometimes men, living in a nearby home. It is difficult for local authority housing departments and RSLs to take action on what might be a malicious complaint, but I believe that where a robust serious violence reduction strategy is in place, officers will have the confidence to act before the violence ends in a tragedy, as in the case study the noble Baroness, Lady Blake of Leeds, mentioned.

I have only one caveat: the Government should ensure that local authorities, whose budgets have been slashed over recent years, have sufficient funding to be able to produce and implement a violence reduction strategy and not be expected to fund additional work on their already overstretched budgets.

Society is becoming immune to the level of violence experienced by some communities. This has to be reversed. A serious violence reduction strategy for each community living in social housing, whoever the provider may be, is a step in the right direction towards raising the profile of the damage that such violence causes and beginning to tackle its reduction. I fully support this group of amendments.