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Data Protection Act: Statutory Instruments

Lord Graham of Edmonton asked Her Majesty's Government:

Lord Bassam of Brighton: Drafts of a further six statutory instruments will be published on the Internet at on 9 October. Copies will be placed in the Library.

Residential Care Staff: Training

The Earl of Listowel asked Her Majesty's Government:

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): Professional social workers train for the Diploma in Social Work. National Vocational Qualifications at various levels are available for other social care staff. The Training Organisation for the Personal Social Services has now delivered to Government a national training strategy for social care and proposes to issue it for consultation. This training strategy includes proposals for foundation level training for all social care staff and contains supplementary reports on residential care and child care. The Government are considering their response to the strategy.

Medical Professions: Public Appreciation

The Earl of Munster asked Her Majesty's Government:

Lord Hunt of Kings Heath: We believe that the public are generally satisfied with the excellent job done by the vast majority of doctors in the National Health Service. This is reflected, for example, by the recent national patient survey, which showed very high

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satisfaction levels of patients with their general practitioner.

There is, however, no room for complacency in ensuring that high standards are maintained. Part of the thrust for clinical governance is the Government's desire for clinical services to become more responsive to people's needs by encouraging active and effective patient and user involvement in service development.

The medical profession has recognised the need for all doctors to respect the right of patients to be fully involved in decisions about their care, and this has been enshrined in the General Medical Council's guidance Good Medical Practice. The Government are determined to work with the medical profession to modernise the system of professional self-regulation to ensure that the public's confidence in the profession's ability to maintain high standards is sustained.

Consultants and Junior Doctors: Retention

The Earl of Munster asked Her Majesty's Government:

    What are their policies to reduce the present tendency for early retirement among consultants and the emigration of junior doctors.[HL4471]

Lord Hunt of Kings Heath: There is no evidence to suggest that doctors are retiring earlier than in other professions. The most recent research about doctors working abroad indicates that less than 8.5 per cent. of doctors qualifying in United Kingdom medical schools leave to work abroad at the end of their pre-registration training. Almost the same proportion (7.5 per cent.) of students in UK medical schools are overseas students, many of whom are obliged to return to their own country on completion of their training.

For England and Wales, we collect information from professional bodies, including the Medical Royal Colleges and the Medical Practices Committee, about wastage and retirements. The Specialty Workforce Advisory Group takes account of these factors in advising the Department of Health and the National Assembly for Wales about the numbers of higher specialist trainees needed to meet future assumed demand for consultants and general practitioners.

In Scotland and Northern Ireland, the appropriate advisory bodies take these factors into account in a similar way.

Organophosphate Working Party: Confidentiality

The Countess of Mar asked Her Majesty's Government:

    Whether papers sent to the Committee on Toxicity working party on organophosphates by individual members of the public under strict confidentiality are expected to be kept confidential to the members of the working party; and, if so, what recourse there is for any individual who finds

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    that the information has been released without their consent.[HL4407]

Lord Hunt of Kings Heath: All confidential papers sent to the working group are expected to be kept confidential by officials and members alike. All documents sent to the working party, unless they are already in the public domain, are marked "for members' use only" by the secretariat and then only sent to members.

We are not aware of any evidence that there has been a breach of confidentiality by any member of the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment working party or an official. However, any formal complaint of such a breach would be investigated.

Advance Statements

Lord Alton of Liverpool asked Her Majesty's Government:

    Whether they have considered the British Medical Association Guidelines and Code of Practice on Advance Statements about Medical Treatment; and whether they have made any response to those guidelines.[HL4465]

Lord Hunt of Kings Heath: The Government have considered these guidelines and code of practice carefully. In the policy statement Making Decisions the Government recognised that, together with guidance contained in case law, they provide clarity and flexibility to enable the validity and applicability of advance statements to be decided on a case by case basis.

Lord Alton of Liverpool asked Her Majesty's Government:

    Whether and on what grounds they differentiate between advance directives and advance refusals; what definition they use of the meaning of the phrase "a patient's best interests"; and in what precise circumstances they consider that definition to include intentionally bringing about the death of a patient by action or omission.[HL4469]

Lord Hunt of Kings Heath : Advance statements are anticipatory decisions made while a person is capable which are intended to give effect to that person's wishes as to how he or she shall be treated or cared for after the loss of capacity. An advance statement can be concerned with the refusal of medical treatment and are then sometimes known as advance directives.

A patient's best interests includes their physical and psychological health, well-being, quality of life, relationship with family and other carers, spiritual and religious welfare.

Medical treatment given to the patient with the primary purpose of inducing death is illegal. Anyone alleged to have undertaken such action would be open to a charge of murder or manslaughter.

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Assisted Food and Fluid Treatment

Lord Alton of Liverpool asked Her Majesty's Government:

    Whether there are any differences between their policies in relation to the removal of assisted nutrition and hydration from (a) patients in persistent vegetative state; and (b) other mentally incapacitated patients; and whether they have any plans to propose changes to the law or practice in relation to such matters.[HL4466]

Lord Hunt of Kings Heath: The removal of artificial nutrition and hydration is in all cases a matter of clinical judgment which is undertaken in accordance with professional advice provided by a responsible and recognised body of medical opinion and the general law. There are no plans to change the law in this respect.

Lord Alton of Liverpool asked Her Majesty's Government:

    Whether (a) they have any plans to change their policy not to enshrine in statute law the judgment in Airedale NHS Trust v Bland (1993) in relation to the definition of assisted food and fluid as treatment and the removal of tubal feeding from Mr Tony Bland, or (b) they intend to introduce legislation defining assisted food and fluid as treatment which may be withdrawn from patients with mental incapacities other than persistent vegetative state.[HL4467]

Lord Hunt of Kings Heath: There are no plans to enshrine this judgment in statute law. The Government have indicated that they intend to introduce a provision on continuing powers of attorney (CPA) when parliamentary time allows such legislative changes.

It is a general principle of law and medical practice that all adults have the right to consent to or refuse medical treatment. The CPA is a method by which adults can continue to ensure that their views are respected in decisions concerning their welfare when they can no longer take, or communicate, those decisions themselves. A CPA therefore would allow an attorney to make decisions on behalf of the person without capacity about the withdrawal of artificial nutrition and hydration but only if the person has specifically given authority to do this in the CPA. Where decisions need to be taken in such cases, the healthcare team and attorney should do so in the best interests of the individual concerned.

Lord Alton of Liverpool asked Her Majesty's Government:

    What estimate they have made of the annual numbers of mentally incapable adults in (a) Scotland and (b) the rest of the United Kingdom whose death could be brought about by the removal of artificial nutrition and hydration if such removal were legally sanctioned (a) without recourse to the courts for such patients not in persistent vegetative state and (b) through recourse to the courts for such

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    patients in persistent vegetative state; and how many and what percentage of those patients they estimate each year would (a) have issued an advance directive requesting such a course of action or (b) have such nutrition and hydration removed without their own express request.[HL4468]

Lord Hunt of Kings Heath: The information requested is not available centrally.

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