LETTERS

The Health and Social Care Bill's clause 59 relates to 'information for medical purposes', including both 'medical research' and 'the management of health and social care services'.

At first I missed its importance, as it uses the verb 'prescribe' 21 times in its first seven sentences and the following clause 60 is called 'Prescribing rights' (relating to the Medicines Act). But clause 59's final sentence explains that 'prescribed' means anything the secretary of state chooses, at any time, in any regulations he arbitrarily imposes on the use of health information (whether or not that information identifies individuals).

These wide-ranging powers cover any aspect of the population's 'information (however recorded) which is to any extent derived, directly or indirectly' from any person's 'health' or 'condition' or 'his care or treatment' (section 10).

Note it covers not only confidential or highly sensitive and attributable observations on individual patients, but collated and derived information essential for identifying public health concerns or informed quality management of services.

The 'processing' of information is covered: for example, publishing evaluations of'health service bodies' in HSJ.

Crucially, a future secretary of state might invent regulations 'creating offences punishable on summary conviction' with fines or other unspecified punishments. I am sure Alan Milburn would never inflict torture on a public health researcher like me who infringed some restriction. But how might a future secretary of state behave, given such unrestrained powers to restrict and prohibit the processing of information?

This issue was raised briefly at a recent King's Fund meeting on equity in health. A Department of Health spokesman swept the issue aside with words about the rationale being to protect existing cancer registers. After five readings of the bill, I finally identified one sentence about 'processing' which is 'lawfully done' that might conceivably relate to disease registers.

In comparison, it is unambiguously clear that this bill's main implication for health and social services, as it stands, is 'restricting' professionals' ability to find out about the public and restricting the public's ability to find out about us.

Woody Caan International Centre for Health and Society University College London