Health Bill (Tenth sitting)

Danny Chambers Excerpts

Committee stage
Thursday 2nd July 2026 Public Bill Committees

[Dr Danny Chambers (Winchester) (LD)]

I beg to move amendment 60, in clause 43, page 30, line 35, at end insert—

“(2A) The Secretary of State must give integrated care boards directions to increase spending on Primary Care services.

(2B) The increase in spending set out in subsection 2B must be in line with the change in level of their total programme funding.”

This amendment would introduce the primary care investment standard, requiring integrated care boards to increase spending on primary care services at least in line with the growth in their total programme (healthcare) funding.

[The Chair]

With this it will be convenient to discuss amendment 61, in clause 43, page 30, line 39, after “subsection (1)” insert “and (2A) and (2B)”.

This amendment is consequential on Amendment 60 and would enable the Secretary of State to implement financial penalties if an integrated care board fails to comply with a direction to increase spending on primary care services in line with the growth in their total programme (healthcare) funding.

[Dr Chambers]

Amendments 60 and 61 would introduce a primary care investment standard that required integrated care boards to increase spending on primary care services at least in line with the growth of their total programme healthcare funding. We have discussed the importance of primary care in previous sittings, so I will be brief now, because we have a lot to get through.

The primary care investment standard would be similar to the mental health investment standard. It would set a clear benchmark to which to hold the Secretary of State. Primary care is the very frontline of a health service, and it is vital to stop the rest of the health system becoming overburdened, with issues such as corridor care and long ambulance handovers often a direct result of the system’s failure properly to shift resources and focus into primary care and community care, so that we can catch diseases early and prevent people from going into hospital.

If people cannot get GP or dentist appointments, they turn up to A&E. That transfers the load to what is not only not the most efficient part of the NHS for dealing with routine issues, but the most expensive part of the NHS. That is hugely expensive, as well as not ideal for the individual. Although more than 90% of patients’ direct experience with the NHS is through primary care and GP practices, less than 10% of the NHS budget in England is spent on primary care.

Despite years of all Governments promising to shift patient care out of hospitals into the community, the proportion of the NHS budget spent on general practice has fallen to its lowest point in the past 10 years. The Royal College of General Practitioners’ 2025 practice manager survey revealed that although 61% of practice managers said that they need to expand the GP workforce to meet their patients’ needs, 62% said that the lack of funding in general practice is a major barrier preventing them from hiring the number of GPs they need.

It has been revealed that 22 out of 27 of the first round of neighbourhood health centres are already doing some of those functions; they are simply being rebadged and slightly expanded. We know that in the NHS, money is key, and there are constant important and competing demands for the limited amount of funding. Protecting funding streams for primary care would ensure that the Government actually provided the funds to back up their ambition of shifting care into the community. The benchmark that amendments 60 and 61 would set for the Government is modest, but it would have a huge impact if we could successfully transform the NHS by shifting care into the community. We hope that the Government will view this as a spend-to-save initiative as well. One question is always where the money comes from, but having fewer demands on A&E, the most expensive part of the NHS, would save money in the long run.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

The amendments would introduce a primary care investment standard, requiring the ICBs to increase spending on primary care services at least in line with the growth of the total funding that they receive. The Secretary of State would be able to implement financial penalties if ICBs failed to comply.

As the hon. Member for Winchester said, we do not need to talk about the importance of primary care, because we all know it is very important and quite efficient. The Darzi report said that primary care is one of the most financially efficient parts of the NHS. The challenge is that demand is increasing across the whole system, and unless overall funding is increased, then giving primary care a bigger share must mean giving somebody else a smaller one.

My other concern is about how the hon. Gentleman thinks this will be measured. Is measuring inputs rather than outputs really the right way to run the health service? We have tested almost to destruction the idea of just giving more and more money, which I suppose is why the Government have introduced this Bill: to try to reform things and make them more efficient. We can argue about whether they are doing that well or not, but that is the thrust of what they are trying to do.

I think the idea behind the amendments is interesting, but I would be interested to hear more about how the hon. Member thinks the standard would work, and in particular whether he thinks it could be justified if there was huge unmet demand in the secondary care or mental health sector. The balance of need may change over time, and if it does, then legislating for a set proportion to go on this or that type of care, rather than on delivering this or that type of outcome, might not be the right approach.

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To deliver the 10-year plan’s shift towards care closer to home, local leaders must have the flexibility to invest according to the needs of their populations and the evolution of local services. A statutory investment standard would risk being overly prescriptive, constraining that flexibility and diverting resources from other areas of greatest need. For those reasons, I ask that the hon. Member for Winchester withdraws the amendment.

[Dr Chambers]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Dr Chambers]

I beg to move amendment 9, in clause 43, page 30, line 36, at end insert—

“(2A) The Secretary of State must give integrated care boards directions to increase spending on mental health services at least in line with the change in level of their total programme funding.”

This amendment would place the original mental health investment standard on a statutory footing, requiring integrated care boards to increase spending on mental health services at least in line with the growth in their total programme (healthcare) funding.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 10, in clause 43, page 30, line 39, after “subsection (1)” insert “and (2A)”.

This amendment is consequential on Amendment 9 and would enable the Secretary of State to implement financial penalties if an integrated care board fails to comply with a direction to increase spending on mental health services in line with the growth in their total programme (healthcare) funding.

New clause 27—Duty of integrated care boards to meet Mental Health Investment Standard—

“In the National Health Service Act 2006, after section 223GC insert—

‘223GC A Duty of integrated care boards to meet Mental Health Investment Standard

(1) An integrated care board must exercise its functions with a view to ensuring that expenditure incurred by the board in a financial year in relation to mental health complies with the Mental Health Investment Standard.

(2) For the purposes of this section, expenditure by an integrated care board complies with the Mental Health Investment Standard where the expenditure is greater than or equal to the amount specified for that board by the Secretary of State in accordance with subsection (3).

(3) The Secretary of State must specify an amount of expenditure for an integrated care board which secures that the proportion of the board’s expenditure in a financial year in relation to mental health is larger than the proportion of the board’s expenditure in relation to mental health for the previous financial year.’”

This new clause puts the Mental Health Investment Standard on a statutory footing by requiring the Secretary of State to specify an increasing amount of expenditure by integrated care boards on mental health and then requiring integrated care boards to incur that expenditure.

New clause 33—Review on mental health treatment delays across rural and urban areas—

“(1) Within six months of the passage of this Act, and every 12 months thereafter, the Secretary of State must conduct and publish a review into the number and length of delays for patients’ receipt of mental health treatment.

(2) A review under subsection (1) must consider any disparities in the number of length of delays between rural and urban areas.”

This new clause would require the Secretary of State to conduct and publish an annual review into the number and length of delays for patients’ receipt of mental health treatment across rural and urban areas.

New clause 34—Duty to promote mental health wellbeing—

“(1) It is a duty of the Secretary of State and any relevant body or authority carrying out functions under this Act or the Mental Health Act 2025 to promote mental health wellbeing among the people of England.

(2) In carrying out the duty under subsection (1), the Secretary of State and/or any relevant body must have regard for—

(a) the prevention of mental illness,

(b) the promotion of positive mental health,

(c) the reduction of stigma and discrimination associated with mental health conditions, and

(d) the provision of accessible and appropriate support services to individuals experiencing mental health challenges.

(3) The Secretary of State must publish an annual report outlining the steps taken to discharge their duty under subsection (1), including an assessment of—

(a) progress in improving mental health wellbeing amongst the people of England, and

(b) any barriers to promoting mental health wellbeing for such persons and proposed actions to address them.

(4) The Secretary of State may issue guidance on the discharge of the duty under subsection (1) for which any relevant body or authority to which subsection (1) applies must have regard.”

This new clause creates a duty for the Secretary of State and any relevant body or authority carrying out functions under this Act or the Mental Health Act 2025 to promote mental health wellbeing among the people of England.

[Dr Chambers]

Amendment 9 would place the mental health investment standard on a statutory footing, requiring ICBs to increase mental health spending at least in line with the growth in their total programme funding. Amendment 10 would enable the Secretary of State to implement financial penalties if ICBs failed to comply. New clause 27, tabled by the Chair of the Health and Social Care Committee, my hon. Friend the Member for Oxford West and Abingdon (Layla Moran), is similar. It is quite reassuring to see that the policies of the Liberal Democrats and of the Health and Social Care Committee are fairly well aligned.

The Darzi report highlighted that 20% of the NHS caseload is mental health, yet at the time it was receiving just under 10% of the NHS budget in funding, and now it is receiving 8.4%. To put that in the context of real lives, when I was first elected in 2024, there were just over half a million children and young people on mental health waiting lists; as of last week, there were 1 million. While the Government have done commendable work in reducing waiting lists for physical conditions, mental health cases are increasing—and fast.

[Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

I am very interested in the increase in the number of people waiting for mental health care, particularly mental health assessments. Does the hon. Member think that that is because the funding is inadequate, or is there some other reason why the waiting list numbers have been shooting up?

[Dr Chambers]

I would happily speak for several hours on the multifaceted reasons why young people in particular are struggling with mental health. One of my passions is ensuring that people get intervention and support before they require clinical care, but at the moment that is not happening. For a whole variety of societal reasons, including young people applying for 300 or 400 jobs and not even getting a response, more and more people are ending up on mental health waiting lists.

The mental health investment standard has been widely hailed for bringing about positive change in the health service. It protects funds and provides certainty for services that are seeing dramatically rising demand and, importantly, it provides certainty about future finances. Placing it on a statutory footing in primary legislation would make it more transparent and prevent it from becoming a political football. It would also help to stop the watering down of targets that seems to have happened over the last few years. Claire Murdoch, NHS England’s national mental health director, essentially resigned over those changes.

To pick up on the point made by the hon. Member for Bury St Edmunds and Stowmarket, the Milburn report and the report by the Children’s Commissioner this week showed that the number of children referred to mental health services in England has risen by over 10% in just one year—it is now at more than a million. The pressures on NHS services and funding are clear. If funding is not protected, there is a real risk that it will be cut due to competing demands.

One thing I found when speaking to staff at Winchester’s A&E department is that when mental health patients turn up, having been unable to get support and often having already been on a waiting list, sometimes for more than 18 months, the average time they spend in A&E is more than 18 hours, during which some of them require constant supervision. So, we are badly supporting people with mental health issues in the most expensive part of the NHS. We cannot afford to let the mental health crisis in this country continue slipping out of control, and funding for NHS mental health services is an essential part of stopping that.

New clause 33 would require the Secretary of State to

“conduct and publish an annual review into the number and length of delays for patients’ receipt of mental health treatment across rural and urban areas.”

Something I found interesting growing up on a farm and working as a vet is the almost unrecognised mental health issues in rural areas. That is partly because many people who work in rural vocations have minimal contact with people outside their workplace. Sometimes the vet and the postman might be the only people that a farmer sees in one, two or three weeks. There are a lot of questions about why disparities in accessing treatment in rural versus urban areas exist. Alternative approaches are needed, and some of the ideas floated have included mental health support officers for rural GP surgeries, or training vets up as mental health first aiders, because they might be a point of contact for a farmer and recognise when they are struggling.

Different communities require help in different ways, and farming communities often feel overlooked. They are vital for keeping the nation fed and fit and healthy, but they have a job that involves working from before 5 or 6 in the morning until late at night. If services are provided that do not fit with that person’s lifestyle and job restrictions, they can often struggle to access them, which, when coupled with having virtually no mobile signal and poor broadband, means that people in rural areas are sometimes cut off in more ways than one.

The Mental Health Act 2025 had a fairly limited focus on providing care to those with the most acute mental health problems. We need to look at preventive measures to ensure that people are supported through difficult times in their lives. These new clauses will require a report from local authorities so that we can ensure that they are providing tailored support to those in need. The Liberal Democrats strongly believe that early intervention and preventive services are key to tackling to mental health issues. These new clauses would urge mental health service providers to look beyond putting out the fire. This is about moving from crisis management to ensuring that people are supported in their local communities so that they do not reach the point of crisis. We need to treat mental health as seriously as we treat physical health. I know the Minister agrees with that; we think these new clauses will enable the Government to deliver on that ambition.

[Dr Johnson]

Amendments 9 and 10 have some similar issues to the last two Liberal Democrat amendments. They referred to the primary care investment, while these amendments refer to the mental health investment standard, which seeks to define the proportion of NHS money spent on mental health and maintaining it at a static position. Essentially, similar arguments apply.

In 2016, the mental health investment standard was brought in, albeit not on a statutory footing, to ensure that mental health got the attention it deserved and that the resources provided to it were higher, because the number of people with mental health problems was increasing. There was good sense to that.

However, the challenges to the NHS evolve over time. If the standard were to be fixed in statute, what effect would that have? Would that create an upper limit on spending on mental health at a time when mental health was increasing in prevalence as a problem? Would it increase the lower threshold when the reverse was the case? The Government need flexibility. I would hope that the Government make the right decisions, but that is the democratic process, and they need the flexibility to make the decisions that are appropriate for the time, rather than having this fixed in place.

If we look at current waiting list figures on the Government’s referral to treatment dashboard, in general, the number of people waiting has risen in the last month for which figures are available. If we look in particular at people who require an admission to hospital for a procedure or operation, the numbers are higher over the last month, and also over the last year, for all types of admissions. Not all mental health figures are covered in the dashboard, but those that are have improved slightly in the last month. The point I am making is that things fluctuate over time, and the Government need flexibility to deal with that.

Let me turn to new clauses 33 and 34. As a rural MP, I have some sympathy with the point that the hon. Member for Winchester made about rural healthcare. It is more difficult to get to the major, tertiary centres that provide the most up-to-date treatments. People might have to travel quite long distances to get to the doctors they need to see or to visit in-patients. Of course, those individuals also face transport costs, as we discussed in a previous sitting.

I note for the record that I am a member of the Royal College of Paediatrics and Child Health and the British Medical Association, and an NHS consultant paediatrician. Last week, the Children’s Commissioner published a report that found that 60,000 children were waiting for more than two years for support; the Royal College of Paediatrics and Child Health has also sounded the alarm about the number of children attending A&E because of mental health service issues. In that sort of the situation, the Government might want to move money from A&E services to mental health support to prevent A&E admissions. They may also need to do the reverse, in order to treat those A&E admissions in the first place. Flexibility is required.

New clause 34 would create a duty for the Secretary of State and any relevant body or authority carrying out functions under this Act or the Mental Health Act 2025 to

“promote mental health wellbeing among the people of England.”

That is a statement of his job, and a statement of the obvious; if the Minister is responsible for the mental health services of the country, of course he has a duty to make sure that they do their jobs properly.

It is a nice amendment—it is one of those things that it is politically difficult to vote against—but I would ask the hon. Member for Winchester what practical effect he thinks it would have on mental health. Does he think the Secretary of State is not thinking about mental health? I do not sit on the same side of the House as the Secretary of State, but I think he is interested in mental health and wants to do his best job. Does the hon. Member for Winchester think that is not the case? What does he think the new clause would achieve in practice?

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[Karin Smyth]

My hon. Friend touches on what I will come to as I conclude my remarks on the next new clause. He is absolutely right. The wider determinants of mental health need to be part of developing these services, as with physical health.

On new clause 34, I reassure the Committee that the Government are taking significant steps to improve mental health services in this area. We have recruited over 8,500 extra mental health workers since July 2024, we are accelerating the roll-out of mental health support in schools and colleges, and we are investing a record £16 billion in NHS mental health services this year. Furthermore, there will remain a requirement, as introduced in the Health and Care Act 2022, for mental health expertise on local integrated care boards.

However, as my hon. Friend just said, we know that good mental health and wellbeing requires more than improving NHS services. It requires concerted action to promote positive mental health and tackle the causes of mental ill health. That is why we are developing a new cross-Government mental health strategy for England, to be published later this year. It will take a whole-system approach, recognising the role of schools, employers, the voluntary sector and local government, and representing all parts of the country in promoting positive mental health and preventing mental health ill. The strategy will also go further on reducing the stigma and discrimination associated with mental health conditions, with a focus on improving mental health literacy across the population.

Finally, the new clause risks imposing unnecessary burdens on local systems. For those reasons, I ask the hon. Member for Winchester not to press it. I hope he feels assured that the Government will take forward many of the Committee’s concerns in the mental health strategy.

[Dr Chambers]

I thank hon. Members for their insightful input to the discussion on mental health in general and for their thoughts on our amendments. It is reassuring to see the cross-party concern for mental health and the recognition that it seems to be an increasing problem.

The hon. Member for Bury St Edmunds and Stowmarket made a good point about the causes of mental health problems. We know that people in debt are three times more likely to have mental health issues than people on an average income, and that people who have served in the armed forces are at a higher risk. A whole combination of non-clinical things, such as insecure housing, zero-hours contracts and even social media for adults and children, are potentially adding to the mental health challenges that we are facing.

I appreciate the Minister talking about the new cross-Department mental health strategy. It sounds valuable and it seems to address a huge number of the multifactorial issues that have led us to this point. I will happily not press any of the amendments apart from amendment 9. The mental health investment standard is one of our absolute core priorities, and I would like to press that to a vote. I thank everybody for their contributions and insight into this.

Question put, That the amendment be made.

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[Dr Chambers]

The hon. Member for Sleaford and North Hykeham covered most of the points I was going to make, so I will be very brief. The changes that are proposed to the better care fund seem like another example of decision making being taken away from local authorities and other organisations, which are often the ones that are best placed to understand the health and care needs of their local populations. This measure centralises power rather than devolving it.

Ultimately, the Bill leaves the impression that social care is being pushed more and more on to local authorities. That seems like an ill-judged move, given the ongoing stand-offs we have on the funding of social care and continuing healthcare up and down the country, and it is hardly encouraging the integrated working that everyone accepts is needed to address the joint issues in social care and the NHS. We are worried that there are multiple measures in the Bill that are separating social care and the NHS at a time when greater integration and closer working are so clearly needed. If we want to grasp the nettle on corridor care, overcrowded hospitals, ambulance delays and delayed discharge, we need to get the NHS and social care working together. All those issues seem to have their roots in social care—or the lack of it.

Taking these changes alongside others, such as the removal of local authorities and GPs from ICBs, it looks as though ICBs will not be capable of living up to the ambition of acting as joint committees that co-ordinate care with local trusts, GPs and social care. In summary, this all boils down to the fact that we cannot keep treating NHS services and social care as separate entities.

[Gregory Stafford]

While I agree with the points made by the hon. Member for Winchester, I note the irony that he is talking about how he wants more independence in this clause, whereas the amendments he tabled previously would have taken independence away from the ICBs—but hey, ‘twas ever thus with the Liberal Democrats.

On the new powers in clause 43, we have previously discussed the power of the Secretary of State to direct how ICBs use and manage both financial and other resources, impose expenditure limits, require approval of local decisions and compel repayment of funds where directions are not followed. These provisions substantially weaken the operational independence of ICBs, transforming them from organisations that are intended to exercise local strategic leadership, as my hon. Friend the Member for Sleaford and North Hykeham said, into bodies primarily responsible for implementing centrally determined priorities. Such centralisation risks diminishing the flexibility required to respond to local, demographic, clinical and population health challenges.

The timing of these legislative changes also raises significant concerns, because they coincide with the abolition of NHS England, the redistribution of its functions and the requirement for ICBs to reduce their operating costs by at least 50%--and, in some cases, even more than that. Collectively, those reforms represent one of the most significant reorganisations of NHS governance. However, there remains little clarity regarding which responsibilities will remain with the ICBs.

The clause makes it even less certain which responsibilities will transfer to regional teams or providers, and how accountability will operate across the system. Introducing substantially enhanced ministerial powers before the future operating model is fully defined, as we have discussed with regional mayors and other bodies, will essentially risk creating uncertainty, duplication and potentially gaps in oversight.

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[Dr Chambers]

I beg to move amendment 8, in clause 47, page 34, line 19, after “behalf” insert “, including nominated carers”.

This amendment makes it explicit that nominated carers can access the single patient record on behalf of those they care for.

[The Chair]

With this, it will be convenient to discuss amendment 65, in clause 47, page 35, line 6, after “treatment” insert

“, or to any specific support needs or reasonable accommodations required for the effective provision of such care or treatment”.

This amendment aims to clarify that “patient information” held on the Single Patient Record would also include any specific support needs or reasonable accommodations, such as those arising from health conditions or disabilities, that a patient requires for the effective provision of their care or treatment.

[Dr Chambers]

All the stakeholders have said that the single patient record is part of the Bill that could be genuinely transformative. I would also like to note the Bill’s many references to carers, including the Secretary of State’s duty to promote the involvement of carers alongside patients in decision making around care and commissioning. However, the Bill is currently quite vague as to whether carers will be able to access the single patient record, and we want that to be made explicit. We want to reiterate the lack of focus on social care, which is the biggest issue facing the NHS, and emphasise our call for carers in general.

The benefits that the single patient record could bring to patients have been well-established, and it is well-supported, but we believe that the single patient record could also be of huge benefit to carers. It could allow them to care more effectively for their loved ones, and it could allow it to be flagged on their own records that they are carers, so they receive the support that they need.

[Gregory Stafford]

I have a lot of sympathy with this amendment and what the hon. Gentleman is trying to achieve through it. Does he have any idea of how a patient would nominate a carer in such a circumstance? Indeed, would it be done by the patient themselves? If not—for example, the patient might have mental health issues or capacity issues—could the carer be nominated by a health professional or a statutory body?

Although I absolutely agree with the intentions of the amendment, could he give some examples? For instance, would a carer be able to access all of the patient’s record, or just the part for the period in which they have been providing care? It is entirely right that a carer should see the patient record relating to whatever it is they are providing care for, but—I am not trying to be flip—should carers know that at 17, the person who they are caring for was treated for a sexually transmitted disease or something similar, which the patient might not want them to know?

[Dr Chambers]

The hon. Gentleman makes some very good points. Obviously, the whole point of this amendment is to equip people who are providing what is often the daily care for someone else with the information they need to provide that care. My family cared for my father at home for many years when he had dementia; he was on medication for other physical health issues as well, and he was not capable of administering his own medicine, or even of understanding what he was on half the time.

[Sojan Joseph (Ashford) (Lab)]

I am very sympathetic to this amendment, and to the argument that patients and carers should have enough information about what they are providing care for. In the current system, carers get a copy of the care plan, which states what the patient’s care needs are, as assessed by health professionals. Does the hon. Member agree that carers need to see only the care plan for the patient, rather than the patient’s whole record?

[Dr Chambers]

I agree that there is no need for carers to see irrelevant or extremely historical information in the single patient record. Currently, however, there are a lot of carers who, for various reasons, such as not having legal power of attorney, cannot access the information that they need.

We also sometimes find that the people who are carers, who are potentially the spouse of the patient and are themselves elderly—because a lot of people receiving care are elderly—do not understand the information that they are being given. There can be a situation where the person providing care does not fully understand why the patient is getting some medication, or the best way to treat them. We hear that quite a lot.

We understand that the Bill is not designed to set out all the specifics of what the single patient record will look like—that key point was made in the interventions by the hon. Members for Farnham and Bordon and for Ashford. However, although we do not know exactly what it will look like, as it is being created, drafted and thought through, we would love the Minister to confirm to us that carers will be able to see the appropriate parts of the single patient records of those they care for, so that they can oversee their medical care and flag any issues.

There are some specific advantages to having a single patient record when travelling between hospital trusts. For example, being able to quickly see what historical medication the patient has had, especially when it comes to antimicrobials, and the results of tests that were performed in other hospitals and healthcare settings, is absolutely vital to ensure that we do not allow antimicrobial resistance to increase at an unnecessary pace. Often, patients do not understand the type of antibiotic they are on, or remember the name of it, and that is a specific but big issue, because it can generate antimicrobial resistance. There are a few more issues that I could speak to, but I will sit down.

[Dr Johnson]

I rise to talk about amendment 8. I essentially understand what the hon. Member for Winchester is trying to do—to make sure that carers are provided with the information that they need to provide the best possible care—and I think we would all agree with that ambition. However, I have a couple of questions for him. The Bill, as drafted, discusses “making” information

“available to people other than a patient on the patient’s behalf”.

I am not quite clear why would that not encompass a nominated carer.

My hon. Friend the Member for Farnham and Bordon made an important point about privacy. The single patient record will encompass a patient’s entire medical history, medical notes and medical information, but every person who provides that patient with medical or social care does not need to see all of that, and in some cases, the patient may not want them to. My hon. Friend gave a good example of that; another example would be an elderly lady who does not want her carer to see that she had a termination at 23. There are lots of things that are private to people that they do not want others to see. I am interested in the Minister’s comments on this issue. Access to the record is seen as a binary choice, but in some respects, it needs to be a much more nuanced affair than that, while still allowing someone access to the areas of the record that are required for them to complete their duties.

[Dr Chambers]

The hon. Lady is making very good points. The whole thrust of the argument is that there is little detail around how the single patient record will be created and implemented. This is a perfect opportunity to work out how we can empower carers while preserving patient confidentiality where necessary. If we do not focus on that in the early stages of the SPR’s implementation, before it has even been designed, we will miss the opportunity to ensure that carers have an easy way to get the right information. We should not miss that opportunity.

[Dr Johnson]

I understand the hon. Member’s point, but we need to start with the patient at the centre and ask what is best for patient care. It is about what the patient wants to share with their carers. The patient may make an informed decision not to share information that is potentially useful, but if they have capacity, they are free to do that. It is about starting with the patient.

I have huge sympathy with the principle of what the hon. Gentleman is trying to achieve, but I am not sure that that is not already included in proposed new section 250E(2)(c)(i) of the NHS Act 2006, which mentions “making” information

“available to people other than a patient on the patient’s behalf”.

The important thing is that patients make the decision if they have the capacity to do so, or that someone acting with power of attorney has done so on their behalf.

Amendment 65, which is also in this group, talks about support needs. I have some sympathy with that as well. When I see a patient in clinic—I am a paediatrician, so they are all children—I look at the notes, which say they have a particular issue, and I go out into the waiting room and call the child’s name. There is nothing on the record, necessarily, to tell me that the patient and the mum are deaf, or that the other parent is deaf and may not be able to hear me calling them in the waiting room. So I have sympathy with the idea that the record would flag up reasonable adjustment needs; I think there is a place for that.

There is something called the reasonable adjustment flag on the NHS Spine, and perhaps the answer is to use that rather better than is happening at the moment. With carers, as the hon. Member for Winchester said, or with parents or legal guardians looking after children, we should consider whether reasonable adjustments also need to be made for the parent, guardian or carer who is likely to bring the patient to be seen.

[Gregory Stafford]

As I expressed in my intervention on the hon. Member for Winchester, I have a lot of sympathy for what he is trying to achieve with amendment 8. Whether by accident or design, he has allowed us to have a real think about—

[Dr Chambers]

It is by design.

[Gregory Stafford]

I will be charitable and take him at his word. We have opened a vital conversation about who will have access to this record, how it will be shared, which bits of it will be shared, and how we ensure that the laudable aim of a single patient record—to ensure that a clinician treating a patient has all the vital facts in front of them—is balanced with that patient’s privacy. As the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham said, we must make sure that the patient is put at the centre of this.

We need to look at the amendment under that microscope of scrutiny. We must use our role as legislators to ensure that gaps in legislation are closed so that loopholes cannot be exploited. I am fully in favour of the Government’s intention on that. However, I have some concerns about privacy and access, and amendment 8 potentially highlights those.

The amendment provides for a nominated carer to access a patient’s record, but who nominates the carer? Is it always the patient, and how will that consent be verified and continually checked so that if the patient wishes to remove consent for the carer to see their record for whatever reason, there is a way of doing so? What protections exist for vulnerable patients who may feel pressured or even coerced into granting access? If circumstances change, how easily can that access be withdrawn, by whom and through what process?

Although I am not being critical specifically of the amendment, the Government will need to think about those questions when they introduce the single patient record. It is not as simple as saying, “Here is a wonderful record and everyone can access it,” because it will contain some of the most sensitive information an individual holds, including details of their physical and mental health.

I entirely accept that carers often play a vital role in supporting patients, but unrestricted or poorly governed access could undermine patient confidentiality and therefore trust in the system. I am sympathetic to the concerns of the hon. Member for Winchester and think that, not just in relation to this amendment but as the record is pulled together, we really need to consider these vital issues.

On amendment 65, like the shadow Minister, I have a lot of sympathy with the point about reasonable adjustments. We need to be careful when deciding as legislators the purpose of the single patient record. Is it simply a repository of treatments, illnesses, conditions and so on, or does it give a wider commentary on those conditions and treatments? In the example given by the shadow Minister, knowing that someone has hearing difficulties would be useful, but is the single patient record the appropriate place for that? I do not know the answer, but we need to discuss and decide that, because there is a danger of scope creep. If we try to make it all things to all men and women, it could lose the stated purpose, which is to ensure that a clinician has the full facts when dealing with a patient.

--- Later in debate ---

[Karin Smyth]

The hon. Lady knows that we are talking about an enabling power in the Bill. All the details will be brought forward in regulations, through discussions and consultation. We will discuss that more broadly as we talk about the wider clause.

One of the key issues I have been asked about is protecting vulnerable people. Patients will access a single patient record through the NHS app, and NHS England has published guidance on clinical safety, safeguarding and the NHS app, which provides advice on minimising the risk to those where there may be challenges or potential risks. We will adopt a similar approach to the single patient record. Clinicians will be able to redact information that is too sensitive to share, and we will agree a protocol with professional bodies on how that will be applied. I am sure that we will discuss that in more detail, because it is an important area to get right.

[Dr Chambers]

I thank everyone for that very useful discussion. I was pleased to see everyone broadly in agreement that we need to work out how we can provide the necessary information to provide better care, and to balance that with privacy. Everyone made really insightful points on that.

I just emphasise that, as we all know, there is a difference between treatment/prescription and compliance, and compliance is where many medical treatments fall down. It is once the medical staff are not involved on a day-to-day basis, when the patient is not under their direct care or in the facility of the medical treatment, that most of the care takes place, and that is when successful or unsuccessful treatment for the medical condition occurs. If the people providing the daily care are not empowered properly, it is—well, not a complete waste of time, but the efforts of the medical staff are in vain if the compliance day to day is not accurate.

I thank everyone for the discussion. I will not press the amendment to a vote, and I beg to ask leave to withdraw it.

Amendment, by leave, withdrawn.

Ordered, That further consideration be now adjourned.—(Emma Foody.)