Doctors' letter to justice secretary Jack Straw

Dear Mr Straw

We welcome your recent decision to rewrite the Coroners and Justice Bill and would like to request a meeting with you to discuss this further. We have grave concerns about the widespread powers Clause 152 of the Coroners and Justice Bill gives to ministers as written. In our view, the Bill will undermine the presumption of confidentiality, corrode trust in the doctor-patient relationship and could have a disastrous impact on both the health of individuals and the public. Many key public health goals will be put at risk. We are seeking your assurances that confidential person-identifiable health information will be exempt from this legislation and this will be included as part of the amendments to the Bill.

Both common law and the Data Protection Act (DPA) 1998 enshrine an individual’s right to have the data stored about them protected. The DPA in particular includes the principles that data must be processed for limited purposes, be adequate, relevant and not excessive, and not kept longer than necessary. The principles of the Data Protection Act 1998 are fundamental to the functioning of the National Health Service. We are therefore extremely concerned that the Coroners and Justice Bill, as currently drafted, allows the override of these principles, and rather than protecting confidentiality, permits an unjustifiable level of sharing of confidential person-identifiable health data.

The doctor/patient relationship is based on trust. In the course of consultation and treatment, patients will often disclose highly sensitive information on the basis that it will be kept confidential. The Bill, as drafted, will mean that doctors will no longer be able to reassure patients that their confidential information will only be accessed by those who are directly involved in their care. This could result in patients withholding information or even avoiding the healthcare system altogether. This could have disastrous consequences both for the health of individuals and for the wider public. We can provide real life, anonymised examples of cases where patients have been reluctant to share health information vital to their care due to concerns about confidentiality. In such cases it has been trust in the doctor and assurances that information will remain confidential which has finally resulted in disclosure.

We also have serious concerns about the impact of the Bill on broader health policy issues. As currently drafted, there is nothing in the Bill to prevent the Government overturning the confidentiality clauses of the Human Fertility and Embryology Act or even of the Venereal Disease Regulations. In our view, the proposals will also be in violation of Article 8 of the European Convention of Human Rights (ECHR). The government has invested significant public funds in the NHS Care Records Service and the Bill could damage confidence in the system. A loss of public trust could result in patients opting out of sharing their data, affecting their care, impeding public health initiatives and impacting upon the quality of research.

We fail to understand the problem to which this proposed legislation is the solution in relation to healthcare data. We support the use of certain healthcare data for appropriate research, commissioning and public health purposes. Section 251 of the NHS Act 2006 provides the legislation to enable the disclosure of health information where it is not possible to obtain patient consent. In addition, NHS Connecting for Health and the NHS Information Centre are working hard and consulting with various stakeholders to find solutions, which provide mechanisms to enable controlled access to anonymised and pseudonymised data under a robust governance structure. This Bill therefore comes at a time when progress is being made and its proposals could undermine these developments. With these existing mechanisms in place we can see no case for introducing sweeping powers to enable ministers to order the release of health information.

I would very much hope that you will agree to meet us at your earliest convenience so that we can discuss our concerns.

We look forward to hearing from you.

Dr Hamish Meldrum, Chairman of Council, British Medical Association

Mr John Black, President, Royal College of Surgeons of England

Dr Peter Carter, chief executive and general secretary, Royal College of Nursing

Dr Stephanie Bown, director of policy and communications, Medical Protection Society

Dr Christine Tomkins, deputy chief executive and professional services director, Medical Defence Union

Professor Steve Field, chairman, Royal College of General Practitioners

Professor Alan Maryon-Davis, president of the faculty of public health, King’s College, London

Professor Dame Carol Black, chairman, Academy of Medical Royal Colleges