Health Bill [HL]

I thank the noble Baroness, Lady Barker, for her kind words; I will ensure that my noble friend receives them and those of the noble Baroness, Lady Cumberlege. I assure her that she definitely matched the noble Earl in her eloquence. I will address the amendments together. Amendment 123 seeks to limit Clause 32 so that it relates only to the income or expenses of dentists or GPs in respect of their professional activities. The GP earnings and expenses inquiry and the dental earnings and expenses inquiry draw on the anonymised and aggregated analyses that the HMRC transfers to the NHS information centre for health and social care. The resulting reports are intended to provide single, trusted sources of information on GP earnings and expenses and dental practitioner earnings and expenses that can be relied upon by the four UK health departments, the British Medical Association and British Dental Association. It is worth noting that my officials have been in discussion with the British Medical Association and the British Dental Association about these matters. Both organisations are closely involved in the production of the inquiries and agree that it is vital that they continue. I completely agree with the noble Baroness’s sentiments that it is in no one’s interest to use HMRC data for GPs and dental practitioners that are unconnected with their professional activities. Having said that, this is a rather complex area and I hope that noble Lords will bear with me while I explain further. As noble Lords know, GPs can be contractors or salaried employees. Where GPs operate solely as contractors, the relevant data would be unaffected by the proposed amendment. However, where a GP draws a salary of any kind it is not possible, from analysis of the tax data, to unambiguously confirm that the recorded employment earnings of GPs relate to professional medical activities. This is because the tax data that the HMRC analyses record the business of the employer but not the occupation of individual employees, as this information is not needed to calculate tax liability. Given that it is impossible, in practice, to have certainty in this regard, the income of all salaried GPs could be ruled out of the analysis by the proposed amendment. This would be highly undesirable given the large increase in the number of salaried GPs over recent years from 3,117 in 2003 to 7,246 in 2007. The amendment seeks to insert a safeguard into the process, and I would like to reassure noble Lords that the most important safeguard is that the data in question must be anonymised and aggregated. Also, the whole process is overseen by a group known as the Technical Steering Committee. The membership of the committee includes representatives from the four UK health departments and the British Medical Association. They are of the view that the data in question are a necessary part of the inquiry. I hope that that reassures the noble Baroness and that she will feel able to withdraw this amendment. I turn to the second amendment in this group. Amendment 124 would prevent the HMRC from sharing analyses from which information relating to a group of persons can be ascertained. I appreciate the intention of the amendment—that we should seek to preserve taxpayer confidentiality to the greatest possible extent. In the reports, the earnings and expenses are analysed through a range of groupings that are useful both to the Government and the professions. For example, the GP inquiry breaks down overall GPs by contract type, by country within the United Kingdom and by employment status. This highlights the difficulties that are faced when one tries to find an appropriate level of safeguard, and why the Government have decided that the most appropriate safeguard operates at an individual level. Let us be clear on precisely what the clause as currently drafted permits. It is not enough for the information simply to be anonymised. The HMRC must also bring the anonymised data together at an aggregated level, and only then may it disclose the summarised information to the NHS Information Centre for health and social care. The current practice is for HMRC not to release aggregated, anonymised statistics based on less than 30 cases. This figure would be increased if statistics were thought to be potentially disclosive at, for example, practice level; that is, when there are large practices. The safeguards mean that there is no possibility whatever of any individual being identified from the data disclosed. Nor is there any possibility of a particular GP’s practice being identified because aggregation is done in a way which cuts across individual practices and protects against that disclosure risk. For these reasons, I hope that the noble Baroness will not press her amendments.