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Baroness Gardner of Parkes: That confirms what I am saying. Therefore, when the patient comes to the dentist, the dentist must decide whether or not the case is suitable for treatment in the surgery. The noble Baroness, Lady Masham, was talking of dentists in general. I had a number of wheelchair-bound patients. I could not treat them unless I borrowed a surgery which was on the ground floor so that the patient could get into it. My surgery was on the first floor. I had one patient who was almost blind and wore heavy leg calipers. She came to my surgery for years and managed to get to the first floor. We treated her all the time and I have nothing but great admiration for how well she coped with double disabilities when most of us would find it impossible to cope with one. It is a specific problem because National Health Service dentists, particularly in the cities, can only afford first-floor premises, ground-floor premises being much more expensive. An answer may lie in community dental services providing services of that type. I hope therefore that my noble friend will assure me that this is fully covered and that the National Health Service has such obligations already. I certainly would not want to see discrimination against people with disabilities.

7 p.m.

Lord Mackay of Ardbrecknish: We have had an interesting debate. I have a great deal of sympathy with the amendments and the problems which have been brought to our attention. The amendments appear to have the effect of making it illegal to discriminate against disabled people in the provision of health services. This is an extremely difficult and sensitive area and I can understand the Committee's concern, though my concern changed at one stage during the contribution of the noble Lord, Lord Robertson of Oakridge, when he suggested that we may need another Bill. My heart sank at the possibility and perhaps the noble Baroness, Lady Hollis, shared my sinking feeling. We do not need another Bill, nor do we need the amendments. I hope to be able, not just to persuade your Lordships, but also place on record what the position is.

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In relation to the specific examples quoted, it is true that, given the size and complexity of our National Health Service, mistakes will be made. That is a human failing. It happens to the disabled and the non-disabled alike, rather like the rain falling on the just and the unjust. It is not therefore a specific problem for disabled people, though I understand the points being made that may particularly affect them. I shall certainly draw the attention of my noble friend Lady Cumberlege to the examples brought to my attention today. I said that I felt the amendments were not necessary. As we have consistently emphasised, there are no exceptions to the fundamental principle that the National Health Service is there to provide services for everybody on the basis of clinical need—a point made by my noble friend Lady Gardner. We categorically spelt out in the Patient's Charter the right of every citizen to receive healthcare on the basis of clinical need and not on any other factor. Indeed, the National Health Service Executive produced the Patient's Charter in a number of versions—audio cassettes, Braille, large print, video and British sign language, and in signs and symbols for people with learning difficulties. The charter sets out the standards which people can expect of the NHS, including that the NHS will make it easy for everyone to use its services, including children, elderly people or people with mental or physical disabilities. Since the Patient's Charter was first launched in 1991, considerable progress has been made by the NHS in making services more accessible for disabled people. The Government have specified the improvement of the performance of the NHS for disabled people as a priority in the priorities and planning guidance for the NHS for 1995-96. There have been great improvements in healthcare over the past 20 years or so and disabled people can now benefit from a variety of interventions. Procedures such as hip replacements, which vastly improve quality of life, are commonplace. These amendments are inappropriate because questions of medical ethics are matters for the General Medical Council and the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) respectively which are independent statutory bodies. The Medical Act 1983 gives powers to the General Medical Council to provide,

    "in such manner as the Council thinks fit, advice for members of the medical profession on standards of professional conduct or on medical ethics",

while the UKCC's powers under the Nurses, Midwives and Health Visitors Act 1979 include that of

    "providing in such a manner as it thinks fit advice for nurses, midwives and health visitors on standards of professional conduct".

The noble Lord, Lord Carter, quoted the BMA, perhaps underlining the point that there ought not to be discrimination in the health service. I shall go further and quote the General Medical Council, which issued advice on medical ethics in its Blue Book Professional Conduct and Discipline: Fitness to Practise. This states, under the heading, "Principles governing decisions about access to medical care" that,

    "A doctor should always seek to give priority to the investigation and treatment of patients solely on the basis of clinical need".

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That advice was revised on 23rd May 1995 and approved by the GMC council. Its new guidance is called Good Medical Practice which states:

    "You must not allow your views about a patient's lifestyle, culture, beliefs, race, colour, sex, sexuality, age, social status, or perceived economic worth"—

a point alluded to once or twice—

    "to prejudice the treatment you give or arrange".


    "You must not abuse your patient's trust. You must not, for example deliberately withhold appropriate investigation, treatment or referral".

It continues,

    "You should always seek to give priority to the investigation and treatment of patients solely on the basis of clinical need".

For nurses, midwives and health visitors, the UKCC in its code of professional conduct, issued in 1992, recommended:

    "As a registered nurse, midwife or health visitor, you are personally accountable for your practice and, in the exercise of your professional accountability, must ... recognise and respect the uniqueness and dignity of each patient and client, and respond to their need for care, irrespective of their ethnic origin, religious beliefs, personal attributes, the nature of their health problems or any other factor",


    "report to an appropriate person or authority any circumstances in which safe and appropriate care for patients and clients can not be provided."

This code of professional conduct is issued to all registered nurses, midwives and health visitors by the UKCC. The council is the regulatory body responsible for the standards of these professions and it requires members of the professions to practise and conduct themselves within the standards and framework provided by the code. Maintaining and defending the highest professional standards in the public interest is a complex and difficult job which goes to the heart of the self-regulatory role which Parliament has already entrusted to the statutory bodies. I do not believe that duplicating that role in another context would of itself add to the consideration that patients are entitled to expect from the practitioners who serve them. The noble Lord, Lord Robertson of Oakridge, and other noble Lords asked whether GP fund-holders would be able to refuse disabled patients. The noble Lord is correct in thinking that GPs, fund holding or otherwise, will not be able to refuse disabled people because they are disabled. We shall bear in mind the points he raised when we come to issue codes of practice and guidance on the new rights of access. Perhaps I may sum up my speech by saying that the question which has been raised by a number of noble Lords can be encapsulated as: are all medical services covered in the Bill? Noble Lords may say that I should have answered that question at the beginning and then I need not have spoken for so long. But this is an important issue and I wanted to put a number of things on the record so that the position is clear. To answer the simple question, "Are all medical services covered by the Bill?", the answer is yes. But we believe there is no need to have this on the face of the Bill because we cannot list every possible service in that way. My assurance that the Bill covers all health services given to disabled people is now on the record. I am grateful

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to noble Lords for giving me the opportunity to make the position absolutely clear. With that explanation and assurance I hope that the noble Lord will be able to withdraw the amendment.

Baroness Masham of Ilton: The Minister mentioned the Patient's Charter. What legal value do charters have? Are they not just words? That is the reason why we want "health" written on the face of the Bill.

Lord Mackay of Ardbrecknish: Of course they are words. So are all the remarks I make. But the point is that they are words that are backed up, first, by the powerful guidance given to the professionals involved in the health service. That is the first very important point. They are also backed up by various aspects of legislation, including the assurance I have just given that medical services are covered by the Bill. I do not think we need necessarily add one because we could add a number of things which are not specifically on the face of the Bill. We could debate at least until the end of the evening on different issues which people would like to see on the face of the Bill. The Patient's Charter helps to guide patients and tells them what their rights are and those rights are underlined and underwritten so far as concerns this Bill and so far as concerns disabled people by my assurance that all medical services are indeed covered by the Bill.

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