Terminally Ill Adults (End of Life) Bill

Lord Wilson of Sedgefield Excerpts

Committee stage
Friday 24th April 2026 Lords Chamber

[Baroness O'Loan (CB)]

This Bill seeks to provide for individuals to be provided by doctors with fatal drugs to kill themselves. Where those patients cannot self-administer, Clause 25(8) says that

“the coordinating doctor may … assist that person to ingest or otherwise self-administer”

the drug. We have not yet debated this clause at length, but it does raise the spectre of Dr Shipman. What protection is there against a Dr Shipman in these circumstances? What protection exists for those who may be subject to coercion, which will not be identified because of virtual assessments—for example, where the assessing doctor is not in the room with the patient or has no way of knowing who else is there or what is going on? These things had to be identified and discussed and amendments tabled to address them.

In the course of our debates and through the submission of evidence to the Committee, we have identified multiple other serious problems. On many of them there was no engagement by the sponsor, as the noble Baroness, Lady Hollins, said. Following clearly argued criticisms, the noble and learned Lord has accepted a long number of problems with the Bill. However, there are virtually no amendments to address those issues. The legal definition of persons exerting pressure must expressly include bodies corporate, to uncover institutional or organisational abuse. Think of the pressures of bed-blocking and budgets in the NHS.

Regrettably, many of the amendments that the noble and learned Lord tabled weaken safeguards for which the MPs voted—such as explicit domestic abuse training or the mandatory independent advocate presence—under the guise of tidying up the Bill. Often these would save the Government money. The Government’s impact assessment reveals that it almost halves the cost of the assisted dying process if independent advocates or translators do not have to be present. There was provision for independent advocates to assist those who have substantial difficulty in understanding the process. Under the noble and learned Lord’s amendments, the advocate does not have to be physically present during medical assessments—and a person is allowed to entirely waive their right to an advocate.

It is perhaps paradoxical and dangerous to expect someone who qualifies for an advocate, precisely because they struggle to understand information, to independently decide to waive that very protection at the outset. The advocate is introduced only after key clinical and eligibility assessments have been completed, rendering them a box-ticking process. Think of the more than 100 languages spoken in England and Wales and of the problems of people with hearing difficulties, articulated by the noble Baroness, Lady Nicholson, and other communication difficulties.

Doctor-shopping possibilities have expanded as a consequence of the noble and learned Lord’s amendments. Let us be very clear. As is appropriate, our debates have ranged over a large number of issues. We have considered the effect on the NHS, the necessity to revise the NHS constitution, and the effect on practitioners who did not join their professions to kill people and who need protection against involvement. We have yet to debate the existing conscience protection provisions, but we know that they are inadequate. The BMA and the royal colleges asked for an explicit opt-in model, which was rebuffed multiple times in the Commons. The noble and learned Lord finally acknowledged the concern, but his Amendment 669A introduces an opt-in requirement only for training, not for assisted dying as a whole.

The Bill provides some protection for professionals but not for all the other people who enable our NHS to work—the administrators, the porters, the cleaners. The current option of going to an employment tribunal if facing disciplinary action in the context of an unwillingness to engage in any way in assisted dying is just not satisfactory. People need their jobs to pay their rent or mortgage, to feed their children. A system-wide opt-in model is the only way to protect staff from institutional pressure, yet the noble and learned Lord drew the line at protecting administrative staff, to ensure that the NHS runs properly.

Too many issues that should be debated fully in this House are to be left to secondary legislation, which Parliament can only accept or reject but not amend—for example, the approval of lethal drugs and the provision of assisted suicide services in England and Wales, which the DPRRC has said should be removed.

We talk of democracy, yet there is nothing democratic about handing sweeping powers to Ministers rather than to Parliament. There are those who, like me, believe that all life is sacred and to be protected, from conception to natural death. That has not been the subject of our debates over these months. As legislators, some with a religious faith and some with humanist beliefs or maybe no beliefs, we have been through this Bill word by word and clause by clause to see whether it can be improved. We have identified the massive inadequacy in the provision of specialist palliative care and the consequences of that inadequacy; the disparity of access to hospice care; the unique identity of hospices in providing a safe place to live and die without pain and at peace; the huge trust that is fundamental to the doctor-patient relationship in places in which people live and die; and the potential consequences if the Bill is passed for private and public funding arrangements for hospitals and the NHS.

[Lord in Waiting/Government Whip (Lord Wilson of Sedgefield) (Lab)]

The noble Baroness has spoken for over 11 minutes and it is supposed to be 10 minutes. Can she bring her comments to an end?

[Baroness O'Loan (CB)]

I am bringing my comments to an end.

We have tabled amendments to provide some protection for the vulnerable, the weak, the poor, the disabled, the sick, those with suicidal ideation, those with mental health problems and all those whom we have identified. Many of us have concluded that this Bill is not safe and have worked to try to make it safer. As I conclude, I pay tribute to those living with serious illness and disabilities; people such as Pete and George, who have attended every day of our debates and who sit behind me; and all those—

[Lord Wilson of Sedgefield (Lab)]

Can the noble Baroness please bring her remarks to an end now? It is nearly 12 minutes and other noble Lords want to speak.

[Baroness O'Loan (CB)]

The 12 minutes include the interruptions I have suffered.

I pay tribute to all those who have written to encourage us as we fulfil our duties as legislators in your Lordships’ House in scrutinising this flawed and very dangerous Bill.

Terminally Ill Adults (End of Life) Bill

Lord Wilson of Sedgefield Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[Lord Young of Norwood Green (Lab)]

My Lords, I have not spoken in this debate before, but the contribution of the noble Lord, Lord Pannick, last week made me want to do so. He reminded us that:

“Nobody could say that a doctor can tell you that you will die within six months. But the Bill does not so provide. Its conditions require only that the doctor, and the panel in due course, are satisfied that … the person has an inevitably progressive illness or disease which cannot be reversed”—

[Lord in Waiting/Government Whip (Lord Wilson of Sedgefield) (Lab)]

The noble Lord is not down as having been present at the beginning of the debate last week.

[Lord Young of Norwood Green (Lab)]

My name was on the list. I checked last week and my name was on there.

[Noble Lords]

Let him speak.

[Lord Wilson of Sedgefield (Lab)]

If it is the will of the Committee to hear the noble Lord speak, then fine.

[Lord Young of Norwood Green (Lab)]

Thank you. I checked before I left, so I am puzzled.

The noble Lord, Lord Pannick, referred to situations where, as set out in the Bill,

“‘the person has an inevitably progressive illness or disease which cannot be reversed … and … the person’s death in consequence … can reasonably be expected within six months’”.—[Official Report, 30/1/26; col. 1261.]

We know from all the evidence we have heard that trying to predict when someone will die is not a precise science, but that is not really the point of this Bill. It is about ensuring that people have a right to choose and are doing so in circumstances where we can feel reasonably confident that safeguards are there.

I look at the safeguards in the Bill, and this is a very cautious step forward:

“Initial request for assistance: first declaration … Witnessing first declaration … First doctor’s assessment … Second doctor’s assessment … Doctors’ assessments: further provision”.


Some noble Lords are speaking as though we have just one doctor, who may not be very mature or experienced. That is not the case in this Bill. It is much more careful and cautious. The noble Baroness, Lady Jay of Paddington, reminded us last time that

“one of the international facts that supports entirely the position he is taking is that, in the … 33 jurisdictions where assisted dying is allowed, it is usually the case—I cite one or two—that, following that suggestion by a doctor, or prognosis or however you want to describe it, over a third of those who make the choice he has described then do not use the provision … There is no question that they want to die; they are simply using it almost as an insurance policy”.—[Official Report, 30/1/26; col. 1262.]

I understand that there is a real difference of opinion in this House. Some feel that, if we make this step forward—I listened carefully to the noble Baroness, Lady O’Loan—without putting more things in the Bill, it will be unsafe. I do not take that point of view. We are giving people, as the noble Lord, Lord Pannick, said, the right to choose. That may not accord with the views of all noble Lords. Others want us to take into account degree of suffering and all sorts of circumstances, but I do not accord with that. I take the view that we in this House are trying, with some difficulty, to ensure that we have a Bill that gives people the right to choose and has significant safeguards. Can it guarantee that we can tell people exactly when they will die? Of course not. Minister Wes Streeting announced recently that we will make significant improvements in cancer treatment, which will change people’s lives fundamentally. On those grounds, I hope the House will continue to support this Bill.

[Lord Shamash (Lab)]

My Lords, can I address the Committee on a personal note? My late brother-in-law suffered from muscular dystrophy, a horrendous progressive disease that many noble Lords may have come across. In the last years of his life, he was pushed around in a wheelchair. It was very difficult for the family, particularly for my wife, his sister.

[Lord Wilson of Sedgefield (Lab)]

Order. The noble Lord is not on the list. He was not there last week and should therefore not be taking part.

[Lord Shamash (Lab)]

Is the Committee prepared to hear me?

Public Health: County Durham

Lord Wilson of Sedgefield Excerpts

Wednesday 12th June 2019 Westminster Hall

[Phil Wilson (Sedgefield) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Owen. I congratulate my hon. Friend—

[Mr Kevan Jones]

Right honourable.

[Phil Wilson]

He is my right hon. Friend, as he reminds me. I congratulate my right hon. Friend the Member for North Durham (Mr Jones) on securing this timely debate. He has been a real campaigner on this issue in County Durham for many years, and I know he takes a real interest in the public health issues we face in Durham.

The backdrop to the debate is this: we face cuts to public health provision in the north-east of England, primarily in County Durham, at the same time as we see a parade of candidates to be leader of the Conservative party, virtually all of whom want to cut taxes by billions of pounds. I am beginning to wonder where exactly the money will come from for any kind of public sector provision. Those claims of future tax cuts will probably end up being unfunded after Brexit, considering that the pot of tax money for the public sector will be reduced anyway.

As my right hon. Friend said, we may face cuts to public health services of around £18 million in Durham. I reiterate what he said about Surrey and Hertfordshire: under the new formula, there will be a £14.4 million increase for Surrey and a £12.6 million increase for Hertfordshire. That cannot be right when we consider the problems we have with health and healthcare provision in Durham. Sedgefield grew up, as a community, on coal. The number of men who worked down the collieries and are still alive today but have ailments related to that industry, such as lung disease and arthritis, just goes to prove that there is a requirement not to cut funding but to increase it.

If we look at random at some areas of health, we see that the figures for Sedgefield are worse than the national average in all of them. It has higher than the national average cases of dementia, patients on antidepressant drugs, patients on painkillers, asthma sufferers, people with high blood pressure, people with depression—the list goes on and on. We are talking about a formula devised by algorithm rather than by listening to what healthcare professionals say the county needs. People in Durham can expect to live a decent life in good health for seven years less than people in Surrey and nine years less than people in Hertfordshire.

Great strides have been made over the years in the use of the public health grant in County Durham. For example, the smoking rate has reduced from 22% to 14%. However, smoking during pregnancy is still an issue and still above the national average. About 20% of the people who live in Durham—I think that is about 114,000 people—are under 19. They should all be due some kind of safeguarding provision. If the cuts go ahead, will we have the health visitors to provide that? The cuts will affect the safeguarding of young people. If drug and alcohol services are reduced, the police will have to deal with an even greater problem of rising crime.

The chief executive of the Tees, Esk and Wear Valleys NHS mental health trust came to see me about the cuts a couple of weeks ago. Because of cuts to public health, fewer and fewer health visitors and school nurses are going to schools and people’s homes. Because that provision is not there, the trust has to see people it would not otherwise have seen because they would have been seen at home or school. Its provision for people with mental health problems is being put under more and more stress. The cuts are impacting on services other than those provided through public health funding.

One thing for which public health services have mandatory responsibility is health visiting services for those under the age of five. The breastfeeding initiation rate in County Durham is 59%, compared with 74% in England as a whole. Health visitors play a pivotal role in helping and encouraging women to continue to breastfeed their babies until they are at least six months old. Public Health England guidance acknowledges:

“Mothers who are young, white, from routine and manual professionals and who left education early are least likely to breastfeed.”

Cutting the public health grant to an area in which many women fit that profile and which is already way behind on breastfeeding rates would once again penalise an area with real need.

Then we have obesity. In the fight to keep the population healthy and active, healthy weight is of core importance to the public health agenda. An estimated 14% of adults on GP registers across the Sedgefield constituency are obese, with the figure in some areas as high as 19%. Five of the 15 neighbourhoods with the highest rates of obesity are in County Durham. In the south-east, which may end up with increased public health provision, those rates are in single digits—around 8%, if not less. In Richmond Park, the figure is 3.6%.

The common theme in all this is that if we cut public health provision in our communities, other providers will be affected. Those providers, which otherwise would not have had to provide those services, will end up doing more and more. The mental health trust told me that case loads are skyrocketing for some of its workers. How, for example, will they be able to look after young people with mental health issues that are not picked up at school or in the home? Those young people will be passed along the road to mental health trusts, which will not be able to cope because they, too, face cuts. That needs to be addressed.

[Mr Kevan Jones]

Does my hon. Friend agree that, especially in mental health, the outcomes for an individual are better if we intervene early, at a young age, rather than leaving problems untreated for many years?

[Phil Wilson]

That is absolutely right, and that is an issue that the mental health trust raised. If those issues are picked up in the early years or when someone is still at school, they can be resolved. Leaving them just puts extra strain on the mental health trusts in the area.

I want to end on a positive note. I had some schoolchildren in Parliament yesterday from the primary schools in Ferryhill and Chilton. Cleves Cross Primary School in Ferryhill has a whole host of initiatives around mental health, eating properly and so on. Around the village, it is setting up edible walkways: instead of flower beds, it is planting vegetables, which people can pick when they mature. It is great that schools are coming up with those great initiatives, but if the same thing is to happen in schools across Country Durham, there needs to be central provision from public health services.

For wellbeing, there are initiatives to make sure that children have meals together with their families, and to ensure that if there are problems, other children and friends from school are invited along to share those meals. Such initiatives for those aged seven to 10 bode well for the future, and the public health service in Durham needs to look at them, but they must be funded.

We also need to think about how we develop best practice, so that we see such initiatives not just in Ferryhill and Chilton but in Consett, Barnard Castle, Durham city, Esh Winning and Easington—all over County Durham. There needs to be some strategy. As my right hon. Friend said, we need some kind of audit or impact assessment of what cuts to public health mean to areas like ours. What is the reasoning behind making cuts in Durham, where services are needed, and increasing funding in places such as Surrey and Hertfordshire, where they will not be?

[Albert Owen (in the Chair)]

Order. Before I call Dr Roberta Blackman-Woods, I remind Members that this an hour-long debate. I will call the Front-Bench speakers at 5.25 pm, with five minutes for the Opposition and 10 minutes for the Minister, allowing Mr Jones a couple of minutes to finish the debate.

--- Later in debate ---

[Seema Kennedy]

Of course we want evidence. The shadow Minister says from a sedentary position that it is not working. We did an impact assessment in 2015-16 and we are reviewing all the evidence in preparation for the next spending review.

[Phil Wilson]

Just for clarification, did the Minister actually say that the formula is not working?

[Mrs Hodgson]

No; I said that.

NHS Blood Cancer Care

Lord Wilson of Sedgefield Excerpts

Wednesday 17th January 2018 Westminster Hall

[Julia Lopez (Hornchurch and Upminster) (Con)]

I thank my hon. Friend for securing an extremely important debate. He talks about the trouble of diagnosing hidden cancers such as leukaemia in adults, but it is sometimes particularly difficult to diagnose cancers in children. Before Christmas I had a sad meeting with a constituent of mine whose daughter Isla Caton has neuroblastoma, a particularly vicious form of childhood cancer. He discussed how it took three months to diagnose her, because she was only showing lethargy and people had come up with various different diagnostic ideas. In Japan, they test children from birth—

[Phil Wilson (in the Chair)]

Order. This is just an intervention, not a speech.

[Julia Lopez]

I am sorry, excuse me. Does my hon. Friend encourage tests from birth to diagnose these sorts of cancers?

--- Later in debate ---

[Several hon. Members rose—]

[Phil Wilson (in the Chair)]

Order. I want to bring in the Front-Bench spokespeople at 3.30 pm. That gives us about 30 minutes for Back-Bench speeches. I call Colleen Fletcher.

--- Later in debate ---

[Phil Wilson (in the Chair)]

Order. Before the Minister responds, can I say that I would like to see if we can get the Member who moved the motion in at the end for a winding-up speech?

[Steve Brine]

I thank the hon. Member for Central Ayrshire for that point. I might have to come back to her on it, so that—as is only fair, and bearing in mind the Chair’s point—I am able to cover some of the other points that Members raised in their speeches.

My hon. Friend the Member for Crawley said that he would be sending a copy of his report to his local CCG, and I would echo his call for MPs from England who are in the debate today to do the same. MP and CCG relationships are very important to implementing the cancer strategy and reports such as this one. I have the mobile numbers of my local CCG lead and CCG chair in my phone, and I did long before I was a Minister. How many other Members, not only in this Chamber, but in the House, have that? It is a key relationship and Members have a role to play.

The hon. Member for Coventry North East (Colleen Fletcher) spoke very well, as always, with her personal testimony. She calls for five-year plans for patients who have had a stem cell transplant. As I said, the recovery package is a personalised care plan for all cancer patients, and if the care team feel that a five-year plan is appropriate, I expect it to be considered and, if appropriate, commissioned.

The hon. Member for Strangford (Jim Shannon), who has left his place, spoke, as always, in an informed contribution full of personal testimony. I will say that cancer survival rates in England have never been higher. If we can help his colleagues in the Northern Ireland Assembly, when that is back on its feet, I would be delighted. If he wants to set up a meeting, I would be delighted to attend.

I need to close because I know, Mr Wilson, that you want to move on to the proposer of the debate. I hope that my hon. Friend will agree that implementation of the strategy is already beginning to transform services and to implement a number of the recommendations in his report, which is an excellent piece of work. Next week I will be meeting Bloodwise, which I know has representatives here today and does excellent work with his all-party group, to discuss further the important issues that Members have raised today. Next month I will be having the second of my big cancer roundtables, which this time will be joined by Cally Palmer, who is NHS England’s national cancer director. That is a great chance for me to bring all the cancer charities together.

I thank my hon. Friend for bringing the report to Westminster Hall today and wish him well with its launch in a few minutes’ time.

Safeguarding Adults with Learning Disabilities

Lord Wilson of Sedgefield Excerpts

Tuesday 17th October 2017 Westminster Hall

[Neil Gray (Airdrie and Shotts) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Wilson, and to sum up the debate on behalf of the Scottish National party. It is customary at this stage to congratulate the hon. Member who has brought the debate, but those words do not do justice to what the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) has brought before us.

This is an incredibly tragic, harrowing and cruel case, and she has done her constituent and his family a great service in bringing it to the House. She should be congratulated on her perseverance in ensuring that the story was heard today; the manner in which she covered such tragic and horrendous issues was commendable and incredibly honourable. I pay considerable tribute to her for her contribution and I thank her for it, and I am sure the House does also. I am also sorry that there were not more hon. Members in the Chamber to hear what happened. I am sure we all, as constituency MPs and representatives as well as parliamentarians, will have taken note of what happened in Lee Irving’s case, and will hopefully have learned lessons for ourselves and our local services as well.

The case that the hon. Lady raised covered unspeakable cruelty and was harrowing and devastating to hear; it was probably one of the hardest things I have had to hear in my time as a parliamentarian, particularly in the Chamber. Most concerning are Mencap saying that this is possibly not an isolated case and the history of missed opportunities in the handling of Lee’s case, with clear warning signs and failures from a variety of services that should have supported him to get on, but sadly let him down.

I am also very sorry for Lee’s mother, Bev; if she is watching and listening, this will be incredibly difficult. As a father, my worst nightmare must be losing a child, but to do so in such cruel and painful circumstances must be an incredible torment. My heart goes out to her. It is unspeakable, and I am so glad that, in the end, it appears that justice has been done and that those murderers are behind bars and serving the time they deserve for their horrible crime.

Most aspects of the issues discussed are devolved, so forgive me for raising some of what is happening in Scotland. It would not be right for me to comment too heavily on aspects of the case, as much of it is a matter for England and Wales. The SNP Government acknowledge that transformational change is needed for disabled people of all ages to realise their full potential. That is why the Scottish Government are working with partners towards the long-term ambition of halving the disability employment gap in Scotland. In 2015, the employment rate in Scotland for those who were Equality Act-disabled was 42%, compared with 80.3% for those who were not. It was 73.1% for the total population aged 16 to 64. We will work to reduce the barriers to employment for disabled people and will redress the imbalance of disabled people making up only 12% of the private and public sector workforce in Scotland.

The SNP Government are also working with the national skills agency, Skills Development Scotland, to make modern apprenticeships more open, attractive and available to people with disabilities. The SNP is also committed to promoting and protecting equality and human rights for disabled people. We want to make sure that disabled people can take part fully in all areas of daily and public life. We are working to break down the barriers to independent living that people may face. Living an independent life is important to people with learning disabilities. That means having the same choice and control in their lives that others have.

The Scottish Government have taken practical steps such as supporting disabled and young people and their families from birth, through school and into the world of work. We are also investing £5.4 million over the next two years to improve learning disability services in Scotland. We are continuing our work to create a fairer and more equal society through our draft delivery plan, which sets out the steps we will take over the next four years to implement the United Nations convention on the rights of persons with disabilities. We are also consulting disabled people and the organisations that represent them, including the likes of Mencap, to bring the voice of disabled people into the heart of Government in Scotland.

We are committed to the independent living fund and will protect the funding for it. The Deputy First Minister announced in April 2014 that the new Scottish independent living fund would be set up following the decision here in Westminster to close the fund. On 1 July 2015, the Independent Living Fund Scotland came into force and now administers the Scottish and Northern Irish independent living fund service users’ awards. The scheme will safeguard more than 3,000 disabled people across Scotland and will build on existing care through a £5.5 million investment, which will reopen to new users, ensuring its long-term future.

Clearly, there is more work to be done with ILF Scotland, but I am confident that Scottish Ministers can and will continue to support that service. We also passed the Social Care (Self-directed Support) (Scotland) Act 2013, which embodies the ideas of equality, human rights and independent living. The Act is designed to give those who require community care more choice and control over the social care they receive and will integrate the language of self-direction into support in legislation. The Scottish Government also legislated to better integrate the provision of adult health and social care with more joined-up working between local authorities, health boards and third sector organisations.

Again, I congratulate and pay tribute to the hon. Member for Newcastle upon Tyne North. I wish to put on the record my deep condolences again to Bev, Lee’s mother, at a time when the cruel and unspeakable death of her son is being raised in such a public way again. If nothing else comes from this debate, I desperately hope that the fact that this case has been heard today in such a public setting will trigger the people responsible for the care of vulnerable adults with learning disabilities to always press a little bit harder to save a life.

[Phil Wilson (in the Chair)]

Order. I got the procedure the wrong way round and called the SNP spokesman before the hon. Member for North Swindon (Justin Tomlinson), so I apologise for that.

Community Pharmacies

Lord Wilson of Sedgefield Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Phil Wilson (Sedgefield) (Lab)]

In my constituency, there are 22 pharmacies. Some 60% are not eligible for the pharmacy access scheme, which, I understand, is based on distance between pharmacies and does not take into consideration deprivation and other health issues. It is predicted that of the 22, six will close. In the Durham, Darlington and Tees area, there are 271 pharmacies, issuing 2.5 million prescriptions a month and covering a population of 1.2 million. The Government want to take £170 million out of community pharmacies, which is equivalent to £14,500 a pharmacy. That is a total of a third of a million pounds out of community pharmacies in my constituency or £4 million across the Durham, Darlington and Tees area.

A new pharmacy integration fund has also been announced. This was originally allocated £300 million over five years. I now believe that the figure will be £42 million over two years. The Government have admitted that these proposals in total will lead to the closure of 3,000 community pharmacies. Pharmacy closures will only place further strain on those pharmacies that remain open. More people will use GP surgeries and A&E departments when they need not do so. Pharmacies could be forced to scale back services, while being under increased pressure.

The proposal to encourage people to contact the 111 service for emergency referrals on repeat prescriptions, which will then be referred to a chemist, was described by one pharmacy in Trimdon in my constituency as “ludicrous” because

“It will place an extra burden on the 111 service, and ignores the fact most people who require an emergency supply of their regular medication will go to their local pharmacy who have their records, and who will bend over backwards to help. In the case of people from out of the area needing an emergency supply of regular medication in Trimdon this only happens around three or four times a year. Ultimately, the 111 service is designed to help people who do not know what is wrong with them, not to assist those who know exactly what is wrong with them and are already being treated for it.”

The Government’s impact assessment states:

“there is no reliable way of estimating the number of pharmacies that may close as a result of this policy”.

However, the figure of 3,000 has been mentioned and the question then arises: is that figure a minimum? Pharmacies offer important services to their local communities, the elderly, the disabled and those with long-term illness, and offer vital support to overstretched GPs and hospitals. I looked at the statistics: there are 11,700 community pharmacies and 1.6 million people visit a pharmacy every day. Some 79% of people have visited a pharmacy at least once in the last 12 months, with 75% of adults visiting the same pharmacy, and 2.7 million items are dispensed every day.

Pharmacies are increasingly seen as a referral mechanism to GPs for patients with possible early symptoms of cancer. Two in five of the pharmacies in my constituency may be protected—I say “may be”—but three out of the five will not be. They face an unsettled and uncertain future in an area with some of the worst health, deprivation and disability statistics in the country. More importantly, the tens of thousands of my constituents who use pharmacies will be affected the most. They will feel that uncertainty the most and will feel unsettled the most. With all that in mind, only this Government would introduce a strategy to close the pharmacies on which so many of my constituents rely.

Digital Records in the NHS

Lord Wilson of Sedgefield Excerpts

Thursday 28th April 2016 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Wilson. I congratulate the hon. Member for The Cotswolds (Geoffrey Clifton-Brown) on securing this important debate and I thank the Backbench Business Committee for granting it. It has been interesting. I am a new Member of this House and it is true, and a great pleasure, that every day brings new insight into the working of the House and its rules and procedures. I am grateful to have seen some of that today.

We have heard some valuable contributions. The hon. Member for Twickenham (Dr Mathias) used her practical experience as a clinician to talk about patient control data and her dream, which I share, of co-ordination on behalf of her constituents. The hon. Member for Bury St Edmunds (Jo Churchill) emphasised the value of research and the role of charities and other non-NHS bodies in driving this agenda forward and having the time to understand diseases. I was particularly glad to hear her mention health economics in this sort of work.

The hon. Member for South Basildon and East Thurrock (Stephen Metcalfe) heroically used his experience of large data in another Department and I look forward to his accelerated political career through the Government ranks. The perspectives of all hon. Members have enriched this debate not just today, but previously. Let us hope that we can move the discussion on digital health records forward for the benefit of patients across the country.

This subject is dear to the heart of the hon. Member for The Cotswolds. He talked about his constituent’s experience and referred to four ways in which the digitisation of data can be transformational for the health service by speeding up new developments, improving co-ordination of care, giving patients control over information about their health and driving whole processes forward. He has been a powerful advocate for his constituents. I often say that patients are assets to be utilised for their knowledge and experience, not nuisances to be ignored. The potential for people to look for hope, not just for themselves but using their experience for others, is an inspiration and at the heart of much of this debate.

I want to talk about the benefits of the data. This debate is important because the NHS, which provides a large population with universal coverage that is free at the point of use, is uniquely placed to be a world leader in innovation.

I started my career as an NHS manager in 1988 without access to a computer and finished as a manager of a patient referral service, so I know how far we have come but also how far we need to go. The NHS must be one of the last remaining organisations that still communicate with people via letter. Extending the use of technology to patient records is not just about using taxpayers’ money more effectively, important though that is. The effective use of the right data has huge benefits as yet unseen and unknown, such as how such data can be used to help tackle inequalities, particularly health inequalities?

With a growing and ageing population, more and more people are living with different combinations of illnesses and conditions. None of us here knows the huge potential healthcare benefits that the wise use of data could bring to the population we serve in years to come. The principles of the Government’s proposals are worthy of our support. As members of the party that founded and nurtured the NHS, we want to find ways of delivering high-quality, personalised and cost-effective care. I assure the Minister that we will support in principle the Government’s plans to roll the agenda forward, as long as there is scrutiny and challenge in a number of areas.

As with everything, there is a vital balance to be struck, particularly on privacy, protection and penalties for the misuse of data, which the hon. Member for The Cotswolds highlighted. I hope the Minister will agree that public confidence in the integrity of the programme is pivotal to its success. I also hope he will assure us today that the Government will take on board important lessons from the shambles surrounding the roll-out of care.data. At the heart of that was lack of public trust about possible misuse of data and a perception that the Government were trying to make changes on the quiet. This must not happen again. I agree with the hon. Member for The Cotswolds that we need a public information campaign that brings patients with us on this journey.

The efficient and effective use of data and technology plays an increasing role in many areas of our lives. The public, perhaps rightly, expect the NHS to catch up and to make for an easier and better-quality patient experience. It can be hard to convince a sceptical public and worried patients that sharing data about their health conditions and treatment will benefit them and their families.

Examples from years past can help and we have heard some powerful examples today. Data played a vital role in tracking and establishing a link between smoking and lung cancer. As a result, earlier diagnosis and swifter treatments were made possible. I am sure that people who have felt the frustration of putting themselves under the care of healthcare professionals who, for whatever reason, have not had access to their health records and so are not always best placed to move treatment forward can be readily convinced of the programme’s benefits.

In my city of Bristol, GPs collaborate on a web-based platform with well-established sharing agreements for data that includes community providers. There is good practice across the country. Bristol is a high-tech, savvy digital city, but I have learned during my time in this place that many hon. Members have constituencies that do not even have good broadband coverage. If this project helps to bring the benefits of shared platforms to people nationwide, it will be a good thing, but it will require a lot of work. If patients can be helped to understand the interoperability of patient data, that promises to improve the quality of experience for the patient, and the programme will receive widespread public support.

I hope the Minister will be able to explain what plans the Government have to educate the public at large about the benefits of this important project, to ensure that concerns that are bound to be expressed by some about privacy and security are tackled before they can multiply. There will be concern that such a major programme of digitisation with an ambitious timeline could run into glitches of the type that many governmental IT projects across different types of government have suffered in the past. What degree of confidence does the Minister have in the deliverability of the timeline and the budget overview? What guarantee can he give that it will be met and who can the taxpayer hold to account if it is not? What confidence does the Minister have in the safeguards that will be put in place to ensure the credibility of confidential data? Is he confident that the requirements of the National Data Guardian will be met?

I now want to turn to a few other concerns that I hope the Minster will address this afternoon, first about money. I have mentioned taxpayer value, as have other hon. Members, so let me turn to some elements of the financial side of this project. Like other hon. Members, I have seen the headlines proclaiming the additional money that is supposedly being allocated to these projects as part of the “General Practice Forward View”, but with the Department of Health struggling to remain within its expenditure limit, 80% of trusts in deficit and the well-documented pressures on primary care, will the Minister be crystal clear, not just about the money allocation he will want to tell us about but, crucially, what pot or pots it will come from and how it will be allocated to support this work?

The Secretary of State has referred to the so-called extra investment of £45 million being dependent on uptake. Will he outline how he sees this dependency shaping up over the coming years? If digitisation of medical records is about improving patient health and genuinely bringing healthcare into the 21st century and speeding up patient care, it will be worthy of support, but we do need to know how it will be implemented.

There are serious questions about capacity and ability to deliver, not just the capacity of the Department of Health and NHS England but, crucially, the capacity of GP surgeries and other providers to deliver a credible digitised service. How will GP practices, which are already hard-pressed by soaring patient demand, be supported to implement this project? What level of engagement in the process to shape the roll-out can GP practices expect? If the Government are keen to limit piling additional pressure on busy GPs, how will they ensure that digitisation processes do not simply add to the burdens? I look forward to reassurance from the Minister to take back to GPs in my constituency, and for colleagues to take back to theirs, because I know that the latest announcements will, with other pressures, bear heavily on their current and projected workload.

Finally, I turn to accountability, which was of concern in my professional experience during the structural changes of 2010-2015. The source of responsibility for change and delivery remains a concern to me and others and is a problem that permeates many aspects of our healthcare system. Throughout the digitisation programme, who will be accountable for its delivery? In the realigned structures of the NHS, we are well used to having difficulty navigating a complex web of accountability for various elements of various programmes. When it comes to patient data, Governments of all persuasions do not have a glowing track record. I suspect that if this project goes to plan, the Minister will claim credit, but if it goes wrong, who will carry the can?

I again thank the Backbench Business Committee for granting this important debate. I hope this will be the start of many more discussions with hon. Members on both sides of the House about this very important issue.

[Phil Wilson (in the Chair)]

Before I call the Minister, let me say that I am really disappointed that he could not be here from the start of the debate. I know that the agenda for this afternoon was changed, but that was on the Order Paper; it was known. I am sure that the change would also have been communicated to the Department, in ample time for this afternoon’s debate. Bearing that in mind, I call the Minister to respond to the debate.

--- Later in debate ---

[Dr Mathias]

In defence of the clinicians out there, I am sure the majority believe that the patients they serve are sovereign.

[Phil Wilson (in the Chair)]

Minister, before you respond, may I say that you have been on your feet now for 30 minutes and the Minister’s response is usually about 10 minutes? I just want you to bear that in mind.

[George Freeman]

Thank you, Mr Wilson. Having arrived a little late, I was taking the opportunity to deal with the points that my hon. Friends and the hon. Member for Bristol South have made. I will do my best to expedite matters for you.

I want to make the point that the covenanting of public trust and confidence is completely central for the Secretary of State and me. We want to make sure that the public have faith and confidence that we are not in any way playing fast and loose, and I hope that the measures I have announced will go some way to underpinning that.

We have also gone further. People have been concerned about the selling of their data for purposes beyond healthcare—commercial purposes—particularly those that may prejudice their eligibility for healthcare. We have not only made it clear that that is unacceptable; we have made it illegal and imposed a substantial fine and penalty on it. We need to use data but we need to use them appropriately, and we need patients and the public to know that that is our commitment.

On the commitments that we have made, we have secured funding from the Treasury for the completion of the paperless NHS 2020 project, which the Secretary of State has set out in other speeches in some detail. It is a £4.2 billion funding commitment, and in the past few months, since the completion of the comprehensive spending review, officials in the Department of Health, in NHS England and in the Health and Social Care Information Centre—which I recently announced is to be renamed NHS Digital—have been working on a complex work plan for seeing this through. It comprises 26 workstreams in six domains, and we are very committed to making sure that this is properly managed with clear milestones and clear accountability procedures. The project is complex and some things will not go according to plan. We need to make sure that we are on top of that and bringing the very best levels of management to that project.

I want to cite one or two examples of where we are profoundly leading in this space. One is a project for which I have ministerial responsibility—the 100,000 Genomes Project, in which we are sequencing the entire genomes of 100,000 volunteer NHS patients, and combining those with hospital data to form the world’s first reference library for genomic medicine. All the information is consented, and the project represents a pioneering showcase of the use of data in 21st-century health research. We have also launched a genomic medicine service in the NHS through the 13 genomic medicine centres. We want the NHS to pioneer genomic diagnosis and treatment, particularly in cancer and rare diseases. It is a shining informatic and digital data programme as well as a genetic science programme.

I also want to highlight a project that I recently saw, which goes to the other end of the spectrum: the day-to-day management of disease. It is a diabetes service pioneered, to my great joy, by Litcham surgery in my constituency. It involves patients self-monitoring their blood sugar levels, and barcode and digital transmission of that information back to the GP practice. I went to see it in use. Patients go to the consultation and the nurse comes with their data, which is used to monitor their precise condition. That leads to the use of the very latest drugs in ever-more accurate precision dosing and comparative data across all participating GP clinics, which drives up standards. It is a brilliant example of data being used to improve care and the use of novel and precision medicines in the NHS.

--- Later in debate ---

[George Freeman]

The hon. Lady makes an important point. It is being driven by the National Information Board, which is NHS-led and involves all the key stakeholders within the service. It is a shining example. I recently spoke at its annual conference, and NHS clinicians will tell you that they are setting the protocols and programmes through the NIB. I genuinely do not believe that the establishment of Dame Fiona Caldicott and the CQC and Wachter reviews are distractions. They are intended to try to support clinical pioneers in the service.

I understand the point that the hon. Lady makes about the service being under pressure, which it is. The demand for healthcare is exploding, and NHS England has set out in the “Five Year Forward View” that digitisation and the greater use of technology is essential to reducing unnecessary pressure on the system. It has forecast that in 2020 we will be looking at £22 billion of avoidable costs from hospital admissions, from bureaucracy, and from paperwork. How many of us have had a diagnosis and received three or four, sometimes five, letters all saying slightly different things? That is incredibly wasteful and expensive.

NHS England itself has identified the fact that if that technology is properly implemented it can play a part in driving efficiency. However, I do not underestimate the extent to which that requires investment—which is why we have front-loaded it—as well as capacity and the ability to integrate. That is a challenge. When those systems are put in place in the private sector, huge numbers of people and huge amounts of resources are devoted to driving the integration properly. I would expect Dame Fiona’s review to touch on that, particularly in relation to training, and organisations’ culture and capacity.

However, things are happening. I want to share the data. More than 55 million people in England now have a summary care record. That is 96% of the population. As to how many are aware of that, it is an excellent question. How many of us have obtained access to our summary care record? That is important. Eighty-five per cent. of NHS 111 services, 73% of ambulance trusts and 63% of A&E departments now use the summary care record, and by April next year more than 95% of pharmacies will have access to it. By 2018 clinicians in primary care, urgent and emergency care, and other key transitions of care context will operate without paper, using the summary care record.

Several colleagues have touched on the question of apps today. We have clearly set out, through the National Information Board, a commitment to ensure that there are high-quality appointment-booking apps, with access to full medical records, from this year. NHS England and NHS Digital are working with GP system suppliers and third-party app developers.

[Phil Wilson (in the Chair)]

Order. May I just respectfully say to the Minister, you have now spoken longer than the Member who moved the motion for the debate. You turned up an hour late and have now spoken for 40 minutes. I just want you to bear that in mind. The debate does go on to 4.30, but I respectfully point out that Ministers who have been present for the full debate usually speak for just 10 minutes. Hopefully you will bear that in mind, and are reaching the end of the speech.

[George Freeman]

I was trying to signal my respect for the questions that have been raised by giving comprehensive answers, but I will try to wrap up.

There is a major programme of work on apps, led by the NIB. That is to create a framework in which approved apps can be launched on the NHS Digital system. They need to be approved, so that patients have trust and confidence that they are verifiable and appropriate and can fulfil the claims they make. Ultimately we see NHS Digital as a major platform for sponsoring and developing those apps. We are not alone in that. There are stunning international examples. Estonia launched its electronic health record in 2009 and it is worth having a look at what it is doing. The US Veterans Association provides an integrated in-patient and out-patient electronic health record for VA patients. I will be in Washington in 10 days to look at that system again. Denmark is doing some extraordinary work, with more than 45% of patients now contacting their GPs digitally and using digital technology.

In accordance with your strictures, Mr Wilson, I will cease to set out the Government’s programme. I shall happily write to all those who attended the debate—particularly in response to the questions raised just now by the hon. Member for Bristol South about GP funding and what streams funding is coming through, as well as any other questions that I have not had the chance to answer. Once again I apologise for being late; I had no idea that the timing of the debate had changed. I hope that I have addressed the points that were made.

Mental Health Taskforce Report

Lord Wilson of Sedgefield Excerpts

Wednesday 13th April 2016 Westminster Hall

[Several hon. Members rose—]

[Phil Wilson (in the Chair)]

Order. Before I call the first speaker, I will impose an informal time limit on speeches of five minutes, because so many people want to get in. Please will the next speaker and others keep within the timeframe, so that I do not have to reduce the time limit any more?

Oral Answers to Questions

Lord Wilson of Sedgefield Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Norman Lamb]

May I first pay tribute to my hon. Friend’s work in this area? He has been really impressive and dedicated in his work. I absolutely agree with him about the importance of ensuring access to mental health services for children and adolescents. In fact, the Government are investing over £50 million over a four-year period through the children and young people’s improving access to psychological therapies programme and, critically, involving schools and colleges in that work. I would be very happy to work with my hon. Friend to improve access for children and young people.

[Phil Wilson (Sedgefield) (Lab)]

Will the Minister confirm that funding for children’s mental health services has actually been cut?

NHS Risk Register

Lord Wilson of Sedgefield Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

No, I am not giving way again.

I asked about expenditure by the Department of Health on contracts with McKinsey, because I read about it in the paper and I thought, “Well what’s this all about?” I was told, “Ah, well, £5.2 million was paid to McKinsey in May 2010,” because it related to work done before the election—work done for Labour.

[Phil Wilson (Sedgefield) (Lab)]

Will the Secretary of State give way?