Health Bill (Tenth sitting)

Gregory Stafford Excerpts

Committee stage
Thursday 2nd July 2026 Public Bill Committees

[Edward Argar (Melton and Syston) (Con)]

It is a pleasure, as always, to serve under your chairship, Ms Lewell.

I am grateful to the hon. Member for Winchester for his explanation of amendments 60 and 61. Like my hon. Friend the shadow Minister, I entirely understand what he is seeking to achieve, and also how important general practice is. Access to appointments with a general practitioner or at a practice is one of the most significant issues in Melton Mowbray. Despite the fantastic work that doctors are doing to try to manage that, the pressure continues to be intense, which on occasion is causing real anxiety for patients. Equally, I can see what the hon. Gentleman and the hon. Member for Epsom and Ewell (Helen Maguire) are trying to achieve by kick-starting a shift away from acute settings and towards front-loading—for want of a better way of putting it—people’s treatment in the NHS. As he said, Governments of many different complexions have tried to achieve that shift; what he is trying to do is give it a bit of oomph.

I can entirely see where the hon. Gentleman is coming from, but I do have some concerns, one of which was articulated well by my hon. Friend the shadow Minister, which is that the amendments are very much focused on inputs rather than outcomes. With the Health and Care Act 2022, we sought to shift the focus more towards outcomes, and I think the Minister is also seeking to move it towards outcomes rather than purely inputs—she will correct me if I am wrong—so I do worry about that.

Like my hon. Friend, I also have a slight concern about the effect of amendment 60 on the flexibility to address local circumstances and—for want of a better way of putting it—the discretion available to ICBs in determining the local health priorities. The Bill moves us away from the conception of ICBs in the 2022 Act, under which they were essentially mapped on to an upper-tier local authority geography, so that those delivering social care mapped directly on to the same geography and better integrated with it. With the removal of local authority reps and their potential replacement with representatives of a mayoral authority, and with ICBs covering much larger areas, we see a fracturing of the link with social care provision, and also perhaps a lot of local mapping and a local focus from the ICBs. None the less, my concern is that taking a prescriptive approach in primary legislation could further reduce ICBs’ ability to flex in order to address local needs. I can entirely see what the hon. Gentleman is getting at, and we all want to see primary care—general practice and dentistry—getting the funding it needs to address needs, but I am not convinced that the amendment will not have potential unintended consequences.

On amendment 61, I can again see what the hon. Gentleman and the hon. Member for Epsom and Ewell are trying to do: give the shift teeth and make sure that ICBs look at it. The risk is that if they fail to achieve it, they will face financial penalties, which risks compounding the financial challenges they face and potentially reducing the available funds for primary care, mental health and a range of other healthcare services in the vicinity. I get where the hon. Gentleman is coming from and I share the objective, but I have concerns about how it would work in practice and whether it would be overly prescriptive.

[Gregory Stafford (Farnham and Bordon) (Con)]

It is a pleasure to serve under your chairmanship, Ms Lewell.

My right hon. Friend the Member for Melton and Syston and my hon. Friend the Member for Sleaford and North Hykeham have covered a lot of the points I wanted to make, so I will keep this relatively brief. Like them, I entirely sympathise with what the hon. Member for Winchester is trying to achieve with the two amendments. I think we would all want to see more investment in primary care. As my right hon. Friend—a former Health Minister—knows all too well, we need to see growth in primary care. The fact that there is not a single dentist’s practice in my constituency taking new NHS patients is a real concern, as are the waiting times for GPs in my constituency.

However, I do have some concerns. The first is that the standard, as the hon. Member for Winchester puts it, would be mandatorily enforced with a potential financial penalty. That takes away from what I think the Government are trying to achieve, which is local flexibility. As far as I can tell from the amendment, it makes no distinction between revenue spending and capital spending. I am still hopeful that my ICB is going to build a brand-new GP surgery and health hub in my constituency—it has been promising that for eight years and it is not here yet, so this may be hope over experience—and that would be a significant capital investment. Would the ICB be able to include that as spending on primary care services and get around the potential financial penalty?

I also worry about pitting one part of health spending against another. The hon. Member for Winchester said that the proposed standard would be similar to the mental health investment standard, but I believe that the Government—I am sure the Minister will correct me if I am wrong—have relatively recently changed the mental health standard to be in line with inflation rather than overall total spending. Therefore, if the amendment were to pass, primary care budgets would increase in line with total overall spending, whereas mental health budgets would increase in line with inflation. If those two things were out of sync, there would be a problem.

I totally accept what the hon. Member is trying to achieve. We all want to see more spent on primary care. The Government’s stated intention is to bring healthcare closer to home, and that can only be delivered, in my view, through primary care services. But there are some unintended consequences of the two amendments, which at least need more exploration before I could vote for them.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Ms Lewell. I am grateful to the hon. Member for Winchester for bringing this discussion to the Committee. As has been said, we all know how important investment in primary care is, particularly as this Government shift to neighbourhood health, and that is why we have invested so heavily.

Although we are absolutely interested in the outcomes, the inputs merit some attention too. We have provided an additional £601 million for general practice to reinforce the front door of the NHS, bringing the total spend on the GP contract to £14 billion in this year. That builds on last year’s £1.1 billion of investment, which was the biggest increase to GP contract funding in over a decade. In community pharmacy, we have increased funding by £340 million, bringing the total spend to £3.636 billion. That represents a 10.3% uplift on the back of an uplift of more than 19% across 2024-25 and 2025-26, which again was the largest uplift in funding of any part of the NHS at the time.

In 2024-25, we invested around £3.7 billion in primary care dentistry, and we reduced the underspend from £392 million in 2023-24 to just £36 million in 2024-25, maximising the treatment provided across all our constituencies from taxpayers’ money. We are investing £20 million to support digital integration between primary care optometry and secondary care, supporting more eye care in the community.

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[Gregory Stafford]

I will start by addressing Liberal Democrat amendments 9 and 10; once again, I see the impetus and reason behind tabling them. As the hon. Member for Winchester said, new clause 27, tabled by the Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon, has a similar but subtly different—in my view, usefully different—impetus and emphasis.

I am a member of the Health and Social Care Committee, and we published a report into community mental health in December last year, which laid bare the shocking state of mental health services in this country, especially community mental health services. Mental health accounts for over 20% of the demand for health services in this country, but in the period 2025-26, it is forecast to receive only 8.7% of NHS expenditure.

The spend in that period is expected to be higher than in the previous year, 2024-25, but it will actually be a smaller proportion of total NHS spending, decreasing from 8.78% to 8.71%. That reduction also means that 2025-26 will be the first year since 2016-17 in which mental health spending will not rise as a proportion of total health spending, which is in contravention of the mental health investment standard that has been introduced. In fact, on 17 November last year, NHS England confirmed that the proportional increases will not take place over the next two years to 2028-29, and that there will instead be “flat real funding growth”.

Overall, although I accept that the Government have increased spending on mental health, the fact that it is going down as a proportion of the total bill is one of the many reasons why we on the Health and Social Care Committee were very concerned about the future of mental health funding. It is also why we supported our Chair, the hon. Member for Oxford West and Abingdon, in tabling new clause 27.

The differences between new clause 27 and amendments 9 and 10, tabled by the hon. Member for Winchester, relate to the financial penalty. If we want people to spend more on mental health, it would seem perverse to punish them by taking money away from them, because there might be reasons why they could not meet this requirement. I totally accept what the hon. Member is trying to achieve, because as he said, Claire Murdoch, the national director for mental health, resigned in September over the fact that she did not feel that the Government were spending the right amount on mental health.

New clause 27 would put 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. It also differs from amendments 9 and 10, in that rather than increasing the amounts as a total of expenditure—an approach for which I have sympathy—it has the more realistic requirement that it must only go up every year. Over some years, I would like the amount to increase as a total proportion from the current figure of 8% or 9% to 20%, which is the real cost or burden of mental health care in this country. I think new clause 27 is a much more fair and appropriate way of achieving that.

I accept the arguments of my hon. Friend the Member for Sleaford and North Hykeham about a potential loss of local flexibility, but I think the new clause is written in a way that gives ICBs at least some flexibility to decide how they spend that money. Also, unlike amendments 9 and 10, there is not a financial penalty if for some reason they do not manage to do so it.

In principle, I see merit in new clause 33. Like my hon. Friend the Member for Sleaford and North Hykeham, I represent a semi-rural seat, so I know that understanding delays in accessing mental health treatment is essential if we are to have services that meet patient needs and ensure greater transparency on waiting times. All this can help identify inequalities and inform better policymaking. The requirement to examine the disparities between rural and urban areas is particularly welcome given the challenges that rural communities can face in accessing specialist mental health services. However, it should be noted that the new clause would primarily deliver a reporting mechanism rather than a solution to the problem. Although annual reviews might improve our understanding of treatment delays, they do not in themselves guarantee improvements in access, workforce capacity or service provision. There is also a question as to whether the health service already collects much of this information in other ways, and whether a new statutory review would add significant value beyond the existing reporting arrangements.

Better evidence about the scale and geographic distribution of mental health treatment delays could support more targeted interventions and help to ensure that patients are not disadvantaged simply because of where they live. The challenge will be ensuring that the findings of any review actually lead to meaningful action, rather than just becoming another reporting exercise or inquiry.

[Joe Robertson (Isle of Wight East) (Con)]

Does my hon. Friend agree that reporting between urban and rural, which runs through these amendments, is particularly useful? Many of the solutions put forward throughout this Bill involve mayoral areas or authorities, which of course do not currently exist in many rural areas, and in some may never exist.

[Gregory Stafford]

My hon. Friend is absolutely right. We have talked about this issue while debating numerous clauses of the Bill. If someone were being ungenerous, they might say that there is an urban bias to this Bill. I think that it is less that than the fact that the Government have decided to use, as my hon. Friend rightly says, these mayoral structures to base health services on, when in fact, in so many areas, they either do not exist yet or, as far as we can tell, will never exist. Maybe Manchesterism will change that; we do not know. The Minister is smiling, so maybe she knows.

Regarding new clause 34 and the promotion of positive mental health, the prevention of mental illness and the reduction of stigma are obviously vital and important goals. I welcome the intention of the new clause to ensure that mental wellbeing is taken seriously across the health service. However, I have a few concerns about placing such a broad duty on a statutory footing, not least because, as my hon. Friend the Member for Sleaford and North Hykeham asked: is that not the job of the Secretary of State anyway?

As far as I can tell, new clause 34 essentially duplicates many of the responsibilities that already exist. The Secretary of State and NHS England—as currently exists—along with integrated care boards and other public bodies, are already subject to duties relating to improving health, reducing inequalities, promoting public health and improving the quality of services. Many of the objectives listed in the new clause are already capable of being pursued under those existing powers and obligations. The question therefore arises as to what additional legal effect the new duty would have.

Secondly, the concept of “mental health wellbeing”, while perhaps being a term we kind of understand, is inherently broad and rather difficult to define when we are talking about writing it into law. Unlike things such as waiting times, staffing levels, or access standards, “wellbeing” is not really a measurable outcome. I have some sympathy with my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt), who said in evidence that he wanted to see fewer targets, because they often have unintended consequences and skew the system towards the targets rather than what is actually required.

Mental health wellbeing could encompass life satisfaction, emotional resilience, social connections, employment, housing security and many other factors. As a result, I do not think it is clear what compliance with the duty in this new clause would look like in practice, how the success would be measured or how public bodies could demonstrate that they had fulfilled the obligations.

Finally, although the requirement for an annual report may improve visibility, as with the provision in new clause 33, there is a risk that new clause 34 could create an additional reporting obligation without necessarily improving services or outcomes. Before Parliament imposes a new statutory duty, it should be satisfied that there is a clear objective, a measurable standard against which performance can be assessed and a distinct purpose that is not already served by existing legislation or rules. I am afraid that, unless the hon. Member for Winchester comes back with a devastating argument in his wind up, I am not yet convinced that new clause 34 amendment meets that test.

[Karin Smyth]

I am grateful to the hon. Member for Winchester for bringing this discussion to the Committee. I will turn to amendments 9 and 10 along with new clause 27, which address similar points. These amendments would require integrated care boards to increase their spending on mental health services at least in line with their growth in their total programme funding. Amendment 10 would enable the Secretary of State to implement financial penalties for non-compliance, and new clause 27 would also place the mental health investment standard, or MHIS, on a statutory footing by requiring the Secretary of State to specify an annual increase in the proportion of mental health expenditure for each integrated care board and require integrated care boards to meet that level of expenditure.

I want to be really clear with the Committee: mental health remains a priority for this Government, and the Government are already making record investments in mental health services. Spending on mental health continues to increase in real terms and is forecast to reach a record £16.1 billion in 2026-27. That represents a real-terms increase of around £140 million, compared with 2025-26 and around £900 million of real-terms growth since 2023-24.

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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.

[Dr Johnson]

My hon. Friend is talking about uncertainty. Essentially, those powers could not be used at all to direct or they could be used to micromanage. It is not clear what the intent is.

[Gregory Stafford]

My hon. Friend is right, and I have mentioned that in relation to other clauses. I am perhaps a cynic in my belief that if stuff is being written into legislation, that probably means that the Department has some idea of what it wants to use those powers for. It would be useful to hear from the Minister what her and the Department’s intentions are for these powers. How directing or otherwise will they be of ICBs?

Specifically, proposed new section 223GB to the NHS Act 2006, relating to service integration, also exposes that inherent contradiction. It enables the Secretary of State to require ICBs to allocate designated funding into pooled budgets with local authorities, and at the same time to impose centrally approved spending plans and performance objectives. It is not possible to take the clause forward without having some clarity on exactly how those powers are going to be used in future.

As my hon. Friend the Member for Sleaford and North Hykeham said, clause 44 is shorter. She covered most of the points that I was going to make, but I think the Government should explain how effective oversight of the system-wide financial discipline that we have talked about will be maintained in the absence of the provisions omitted from the 2006 Act and the Health and Care Act 2022 by the clause.

[Dr Johnson]

I note that proposed new section 223GA to the 2006 Act, inserted by clause 43, includes the duty to “publish any directions” but there is no timing for that. Does my hon. Friend agree that it is important to understand how soon after the direction is made we should expect the Minister to publish it?

[Gregory Stafford]

My hon. Friend is right again: there is a lack of clarity in these two clauses, as I have highlighted. I am sure the Minister, having heard my hon. Friend’s question, will respond when she gets her moment.

[The Chair]

That moment is now. I call the Minister.

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[Dr Johnson]

Clause 45 makes technical changes to the licence conditions, allowing the Secretary of State to use those conditions as a tool to ensure compliance with legal requirements beyond those in the Health and Social Care Act 2012. That power is somewhat open-ended, which reduces certainty for providers, particularly independent ones, as they will not be able to easily anticipate what additional legal duties might be folded into the licence. The Minister said that there would be a consultation, but does she have any more details on how long the consultation process will be, or on how much notice of changes providers can expect? Like other clauses in the Bill, despite the Government’s discussion of devolution, the clause introduces another centralising power.

Clause 46 is about the specifics of to whom legal documents can be served and through what mechanism. I understand the Minister’s argument on the need for modernisation, but everyone will have had emails that were bounced by spam filters or the like. How will she ensure that the emails are not just sent but received, so that there is a fair playing field for everyone?

[Gregory Stafford]

I understand the purpose of clauses 45 and 46, as there is clear public interest in ensuring that providers that hold licences in our health and care system comply with the law. Patients, taxpayers and staff are entitled to expect high standards, proper governance and accountability. Where a provider delivers vital public services, it is reasonable for the licensing scheme to help to uphold those obligations. In that sense, the intention of the clauses is good.

My hon. Friend the Member for Sleaford and North Hykeham outlined a number of questions for the Minister. Could the Minister explain in more detail how clause 46, which essentially provides for the enforcement of the provisions in clause 45, will operate in practice?

[Karin Smyth]

I do not have any more details on how the clauses will operate in practice and follow through into guidance; that will obviously be in the usual guidance on the operation of the system. It is usual practice for people doing the work to make contact with the receiver of the email to check that they have received it and are acting on it appropriately.

Question put and agreed to.

Clause 45 accordingly ordered to stand part of the Bill.

Clause 46 ordered to stand part of the Bill.

Clause 47

Single patient record

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[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.

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[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.

[Dr Johnson]

I understand what my hon. Friend is saying; he is making a very good speech. I wonder whether he agrees that one of the challenges for us as legislators, in looking at all the amendments on the single patient record, and indeed at the single patient record itself, is that while the principle of a single patient record might be a good, it is all about the devil in the detail and the delivery. We do not have a delivery plan or a vision of more of the detail relating to how it will look, so it is difficult to make judgments on many of the clauses.

[Gregory Stafford]

As ever, my hon. Friend is entirely right. It would be helpful to have more clarity on what the single patient record will look like. I will not repeat my earlier questions, but I think they are prescient. I hope that the Minister—even if she cannot answer now, which I accept—has those in mind when she and her colleagues start to look at this.

Even if the Minister cannot provide detail, all I ask is that she provides reassurance that access to the single patient record will be based on explicit consent, limited to what is necessary for either the caring role—as in the amendment of the hon. Member for Winchester—or the clinical role overall, subject to some kind of regular review and supported by some robust audit mechanism. If we are to create a system on this scale, we must ensure that the safeguards are just as strong as the benefits.