Health Bill (Eleventh sitting)

Dave Robertson Excerpts

Committee stage
Thursday 2nd July 2026 Public Bill Committees

[Dr Chambers]

I will speak to clause 47 and to new clauses 7 and 8, which were tabled by my hon. Friend the Member for Newton Abbot (Martin Wrigley). The sector has been calling for a single patient record for decades, and it is the single most impactful part of the Bill. It could be transformational for patient experience, care, outcomes, consistency of treatment and reducing errors.

Members have talked about the hassle of people having to tell their story repeatedly or recollect the history, which many people cannot do accurately, so the clause could be hugely impactful. Polling shows that nine out of 10 Britons want better access to medical records. Many assume that a single patient record already exists and are often quite surprised when they go to another hospital and find that it has no record of what has been done in the county next door.

Although the public are rightly concerned about the use of their data, especially outside of direct care and for planning and research purposes, we wholly support the idea of a single patient record. The plan is for people to be able to see their primary, secondary and social care records all in one place, all in the NHS app. It will be transformational, but patients should be in control of their data. They should be able to see who is accessing their records and should be able to opt out of sharing data. It is essential that there is sufficient control and guarantees around the sharing of data, whether for research or other reasons. The Bill does not go far enough to provide reassurances that patients will ultimately be in charge of their own data and how it is used.

Trust among medical staff, patients and the public is essential for this much-needed system to succeed, and we have only to look at the pushback on the federated data platform to see that. Sufficient guardrails are necessary to make sure that secondary uses of health data are allowed only when they deliver a clear public benefit. Rules need to be future-proofed so that they are not vulnerable to change depending on the political or economic situation. There should be meaningful checks, balances and transparency.

We want to make sure this technology is focused on enabling and delivering healthcare. We know that, in the US, Palantir is providing health data to US Immigration and Customs Enforcement, which is then used to support deportations. We would be really concerned if people were too worried to come forward for medical treatment because they thought that their immigration status might be passed on to another Department.

There was a Westminster Hall debate recently on the concerns about Palantir and about the single patient record being abused. From an economic point of view, it seems a lost opportunity to have such a huge infrastructure project farmed out to foreign companies based abroad. First, this is a huge opportunity for companies in the UK to boost our economy, provide employment and drive innovation. Secondly, if we are reliant on foreign companies to deliver this service, we could lose our health sovereignty and their motivations might change depending on the political and economic situation of the country in which they are based.

There have been recent examples of NHS staff inappropriately accessing the private health records of the victims of the Southport and Nottingham terror attacks. The decision by the University Hospitals of Liverpool Group not to inform patients of the breaches understandably raised privacy concerns. The Government must therefore ensure that there are sufficient safeguards and guardrails, and that they are communicated clearly to the public to build trust.

The single patient record needs to happen, but in the right way. The issues with the FDP’s uptake have shown that patient and staff mistrust can significantly undermine a system’s effectiveness. The most important safeguards should not be left entirely to later implementation. They should be laid out in primary legislation at the beginning of the process. The Bill should be more explicit on who is responsible for decisions about access, sharing, liability and redress. That is why we have tabled various amendments, which we will get to later, most notably on our health data charter, setting out the key principles of how health data should be handled and a duty to prioritise domestic suppliers in technology procurement.

We welcome Opposition amendment 49, which we debated earlier—I believe it was echoed by the NHS Alliance—suggesting that a plan should be laid before Parliament for a minimum three-month public information campaign before the system goes live. The discussion on this needs to be constructive, not alarmist, to make sure that the SPR is rolled out in a safe fashion and so that we all get to feel the benefits.

Public involvement should be ongoing, visible and tied to real implementation decisions. Past NHS data reforms show that support depends on people feeling informed, heard and able to challenge decisions. Any red lines should also be clear. For example, there should be consented use for marketing or insurance purposes.

We also need to discuss the role of GP practices in this debate, given that they work within the NHS but are also private businesses. GP records are among the NHS’s richest data assets, and GP practices are to remain independent data controllers. I have spoken to three different practices in Winchester, and the practice managers are quite concerned that GPs will be required to share data much more routinely than they do now, but they will still carry the legal and professional risk and will likely act as the channel to explain to patients how their data will be used. GPs will need to be brought on side for the SPR to work, and that will depend on who decides, what safeguards apply and how burdens on practices are managed. Recent experiences show the sensitivity of the issue. The British Medical Association has stated that it may consider collective action on GP data sharing. The 2022 roll-out of automated prospective GP record access through the NHS app was paused after concerns about safeguarding and the burden on practices.

Will the Minister expand a little on the detail and on how all this will be implemented? What precautions will be taken to ensure that patient data is protected? Will she consider the Lib Dem proposal for a health data charter that sets out principles and responsibilities for handling NHS data?

[Dave Robertson (Lichfield) (Lab)]

As ever, it is a pleasure to see you in the Chair, Ms Lewell. I have listened very carefully to people’s speeches, and it is important to say that we are debating that clause 47 stand part of the Bill. The clause creates the single patient record and, while many Opposition Members have justifiably and understandably asked how we will do this right and what safeguards we will have, it is important that what we are debating is that the clause stand part of the Bill.

The clause creates the single patient record, and it creates the overarching ability for the NHS to use data better than it currently does. I am not a data scientist. I am a physicist by training, and I taught physics and worked in trade unions for a long time. Because of my training and my use of data, every group of people I have ever worked with invariably came up with nicknames for me, which usually boil down to “Data Dave”. There is something so valuable about being able to use aggregated values to tell us something that we do not already know.

One of the most valuable things we may get from this is that, when a clinician talks to a patient and they say or present something that does not match what is on the single patient record, it will raise a red flag that leads the clinician to realise something they would not have realised if they did not have access to notes previously taken elsewhere. I genuinely think that is one of the most valuable things that will come from this.

On a wider stage, the ability to aggregate data and properly track what is going on within the health service, and for people to be able to track what is going on with their care, with a wider view of what is going on, will be so valuable to clinicians and wider afield.

[Dr Johnson]

I am interested in what the hon. Gentleman is saying. Does he agree that, in many ways, the NHS dataset will be one of the most valuable datasets in the world, not only to patients themselves—in terms of the value to them and their privacy—but in the ability to analyse it and perhaps understand parts of medicine that we do not understand at the moment and so improve patient care?

[Dave Robertson]

I am not entirely certain that I want to agree with “one of” the most valuable datasets in the world; I think it could potentially be the most valuable dataset in the world.

We know that the NHS is the largest healthcare provider in the world. We know that the data is potentially very valuable. Creating this will allow our NHS to be at the forefront of managing how it works, in a way that no other health system will be able to, and certainly to a scale that no other health system anywhere in the world will be able to. That obviously comes with risks.

I have been listening carefully, and it is important that we tease out those risks and make sure that we stay as red hot as we can on all the issues that hon. Members have raised. I go back to the salient point of whether this clause should stand part. I fully support that this measure should be part of the Bill and that we should be moving in this direction.

I have spoken about the more global ideas and the reasons why, intellectually, I think this is a good idea, but let me take an example from my home county of Staffordshire up in the west midlands. There are reports that one hospital in Staffordshire uses 450 different electronic systems, which is absolutely bananas.

For so long, we have not had a single patient record. We have not had one unifying system. Over a cup of tea with the Minister a couple of days ago, I got very excited and started talking about primary keys because, although I am not a data scientist, I like the use of data. I do not think we need to get into a situation where there is a single primary key that is instantly recognisable to everybody and where we are necessarily using some machine learning to assess that. That could potentially come later down the line. That is not what the clause is doing, and it would need a much wider discussion than we are currently having.

If we take the example of Staffordshire and its 450 different data systems in one hospital—I do not know that number for certain, although it has been reported to me by two or three colleagues—I cannot imagine the difficulties that the IT team has in trying to get that number of systems to talk to each other. It will be nigh on impossible. All it leads to is delays. All it leads to is people having to reproduce data from one system to another manually. By creating an overarching single patient record, we will force it to happen.

[Joe Robertson]

The hon. Member has hit the nail on the head. A single patient record is not the same thing as mandating that 450 record-keeping systems become one. In fact, the single patient record will work as a theory on paper only if there is interoperability between different databases. That is a massive challenge that is not dealt with here. It cannot be dealt with here, in the real world, and the single patient record will not be realised until it is dealt with, which could take years. Does the hon. Member have a reflection on that point?

[Dave Robertson]

I appreciate the intervention, and it is nice for the hon. Member to get me back after I got him the other week. He is absolutely right. I do not think anybody in this room expects that after we have this discussion and the clause forms part of the Bill, and after the Bill goes through the parliamentary process and hopefully becomes an Act very soon, the next day there will instantly be this magical, ethereal thing called a single patient record and everything will drop into place immediately. I have a bridge to sell to anybody who thinks that.

What the clause does is put the NHS on a path to being able to deal with data appropriately, in a 21st-century way, by adding the ability and requirement for the NHS to use data appropriately. In terms of how that is done technically, I am very far from a computer programmer—I have done a tiny bit in parts of my life, and it always drives me absolutely wild—but there would be a number of architectures that could be used to make this work. I am not an expert and would not profess to be or to give anybody advice on that.

An advantage of the way the Bill is written is that things can be picked up by secondary legislation, which can go into a lot more technical detail. That is a real strength of how this is drafted. If we tried to mandate in primary legislation, in an Act of Parliament, far too granular a level of data science and information technology architecture, we would run a real risk of falling behind. Everybody is very aware of AI, and it is rare that I go a day without hearing people talk about it. Quantum is just behind it, and it is potentially much more disruptive and much more beneficial to huge parts of the economy, especially healthcare.

Trying to do everything through primary legislation is absolute folly. However, making sure we have primary legislation that allows us to drive the NHS into this space and to require and enable the NHS to stay on top of the proper use of data and to modernise its structures and practices can only be a good thing.

I close by saying that I absolutely support clause 47 standing part of the Bill. It has the potential to drive huge improvements in the NHS, both on a local scale and on a more global scale.

[Joe Robertson]

I will pick up where the hon. Member for Lichfield left off.

I make it clear that a single patient record is not a single electronic record-keeping system. Also, the single patient record is a theory, and it will remain a theory long after this legislation has been passed, as I am sure it will be, unless and until the electronic record-keeping databases and software in this country are able to speak to each other.

I have experience of working for a national nursing charity, and my role specifically dealt with the legal and governance issues of trying to embed community nurses in different settings. However, that work was beset by the problem of different databases—different electronic record-keeping systems—that did not speak to each other. Even those systems that were supposed to speak to each other did not do so. As the hon. Member for Lichfield said, sometimes there can be dozens, even hundreds, within even one NHS trust.

That should not be a problem today, but it is, and the Bill will get us no further on the technicalities and the technology problems we have. These systems are already meant to speak to each other, and we do not need legislation to realise that should be happening. Indeed, there are still paper record-keeping systems in many places up and down the country. The theory of a single patient record is a good one, but it will mean nothing in practice until those paper record-keeping systems have become electronic and then all the electronic systems speak to each other.

That makes me wonder whether a single patient record will ever be realised, regardless of legislation on the model that is supposed to exist. Indeed, the Bill does not mandate a single preferred electronic record-keeping system, and nor should it; there is a competitive market out there in which NHS trusts are free to engage and contract with different providers of electronic record-keeping.

I wrote to the local health bosses in my area after being made aware that the provider of one of their main electronic record-keeping systems had offered to extend the system further throughout the trust in order to save money. However, the trust has not yet responded. I am not in a position to say whether that offer is a better one, but on the face of it, it certainly looked like it would save money because it was a record-keeping system that the trust was already using; it just was not being used across all parts of the trust. That letter has gone unanswered for a year. It is not just a technological issue; there is also a cultural issue of the lack of nimble, joined-up decision making.

Some health bosses, not necessarily those in my area, are unable to take advantage of the financial benefits of changing or adapting to using new systems. Until that is resolved, a single patient record will remain ever wanted but never actually delivered.

To use an analogy, different companies provide the services on people’s mobile phones—the internet access, social media; software and even hardware. Most of us end up with a smartphone that does pretty similar things to every other smartphone and, broadly speaking, all the different apps co-operate with each other. Of course, the major global technology companies have faced legal action in the US, Europe, this country and elsewhere to ensure that their systems talk to each other, and primary legislation has been required to make them do that.

[Dave Robertson]

The phone analogy is really valuable. I am not an expert on the various architectures that make up phone operating systems, but I know a little about drivers and a little about computer programming languages. The hon. Gentleman is right that all the different bits of hardware in every single phone speak to themselves in a different language. Lots of them use different computer programming languages, and they all require drivers to translate that into whatever the operating system uses.

There are two or three major providers when it comes to mobile phones in the UK: Google and Android, and iOS. There is effectively a requirement on the phone companies that says, “If you want your app to be on our phones, it’s going to have to be able to use this language.” Depending on the operating system, the language will be slightly different, but the commercial requirement that apps must be able to use a certain language obliges the individual app producers and the individual pieces of hardware to have the driver to translate whatever language they use to talk to themselves into the one that works with the operating system.

Does the hon. Gentleman think there is a parallel in the Bill? Having a piece of legislation that requires a single patient record, whatever that looks like and whatever language it uses, potentially shortcuts some of the problems he is talking about with using a plethora of systems. Rather than having 450 systems, which could potentially use 450 languages, and trying to teach all of them all 450 languages, we create the requirement to use a specific language. We then teach all 450 one additional language and they will all be able to feed in—

[The Chair]

Order. This is a very long intervention. Will the hon. Gentleman please wrap it up?

[Dave Robertson]

Apologies.

[Joe Robertson]

That was a long intervention, but it was helpful. I disagree with the hon. Gentleman, because the legislation is not seeking to require technology companies or the providers of electronic record-keeping systems to be able to talk to each other. It is trying to create the concept of a single patient record, which is good, but it does not mandate a way to achieve that. I do not particularly want to name companies, but a big provider that is already in the health space and that provides electronic record-keeping systems might say, “We can already provide a single patient record. It is for other providers to adapt and feed into our record-keeping system,” and there is nothing in the Bill that says one technology company must adapt to another.

The technological issue is completely unaddressed. I am not even saying that it should be addressed in the Bill, because there are all sorts of issues around competition law and state support for particular companies. It is not a criticism per se of the way in which the Bill drafted, but this is an opportune moment to make the point that absolutely none of the clause will be delivered until a major issue that the Government have not yet addressed is dealt with. That issue is the interoperability of different electronic record-keeping systems provided by the private sector. They are all in competition with each other to get a bigger share of the market; unless and until that is addressed, the Government are not going to realise any of this. I do not want that to be the case. I want the single patient record to be realised, broadly speaking.

[Sojan Joseph]

I wish to speak in support of clause 47. I spoke on Second Reading about my strong support for the introduction of a single patient record. I am not a tech expert like my hon. Friend the Member for Lichfield—

[Dave Robertson]

I don’t know about that!

[Sojan Joseph]

It really surprised me to hear my hon. Friend talk about his experience of 450 systems in the computer system in his local hospital. I was shocked, because as a clinician who previously worked in the NHS, I wanted a system that made patient records readily available so that we could care for patients.

My understanding is that the clause amends the National Health Service Act 2006 to enable the Secretary of State to make regulations to establish a system to make patient information readily available to patients and to those involved in providing health or social care in England. Under the current system, care and treatment across different parts of the NHS are not as co-ordinated as they could and should be. All too often, that means that patients have to repeat their medical history every time they see a different medical professional. The shadow Minister, the hon. Member for Sleaford and North Hykeham, talked about how that can sometimes be useful for getting the diagnosis right, but it can be very traumatising for someone to have to explain the same story again in such a short period of time.

Speaking in the Chamber, I previously gave the example of a mental health patient going to A&E on a Friday. They tell their story to the professionals there and they tell the same story later when a mental health professional comes to see them. When they are admitted into a mental health hospital, they have to explain the same story when going into the ward, and then again to the nurses. Having to repeat their story again and again is traumatising for most patients.