Health Bill

Baroness Coffey Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

Debate on Amendment 53 resumed.

[Baroness Coffey (Con)]

My Lords, where do we start? Where did we end and where are we going? That is part of the challenge of a mid-group break, especially when this is a large group which covers a number of important areas. I am conscious that the noble Lord, Lord Austin of Dudley, has said a fair amount of what I had planned to say. I am concerned that a single company is being singled out and about comments made regarding wacky views of somebody who has an ownership in it. I think that the Church of Scientology is wacky. It does not stop me watching a Tom Cruise film. Wackier is the statement made by Green Party members that Zionism is racism. That is pretty wacky. Nevertheless, it is for them to decide and a matter of freedom of speech and freedom of thought.

Coming back to the substance of this group of amendments, I am conscious that we will come back in more detail to the single patient record. Looking at aspects of the amendment tabled by the noble Baroness, Lady Kidron, there is a lot of merit in thinking about how we put a shell around data in this country. I understand the sovereignty approach. For example, all the DWP data, on very vulnerable people, used to be held in Ireland because the data was held by Amazon Web Services. That saved money for the taxpayer. We had no problem at all, until we left the European Union and made the decision to bring all that very precious data back into the UK in case of other rule changes which may have restricted our access to that data or new laws applying because of where it was held. Therefore, there is a lot of merit in saying that it must be here.

It is worth noble Lords looking at the letter sent by the Health Innovation Minister, James Frith MP, to Layla Moran, who chairs the Health and Social Care Committee in the Commons. It tackles some of the issues that have been raised. People do not want their data to be all around the world. They are scared that it might expose them to something. That should be safeguarded against. That letter covers a lot regarding IP rights and how the NHS either owns it or has, effectively, a permanent licence or right to deploy the technology that was there.

However, I am concerned when we start getting into, “If this prioritisation of researchers is in the UK, that’s sort of okay and we prioritise public over private first” and so on. We are missing the point that this data is being released in an anonymised way for the benefit of patients. It is not a bad thing that a private company can make some money. It is not a bad thing that GSK or Pfizer may start to make tailored medicines and medications based on the evidence of what has been happening with patients in the UK. I accept that is a very rich dataset. Not then being allowed to develop new medicines and, therefore, make profits feels an unnecessarily Soviet-style approach when we are trying to ensure that a lot of this linking together is being done to improve the health of people in this country. Approaches could be modified.

I am also a bit of a purist. We should not be legislating about how the NAO should do its work or the work it should do. The NAO is a body of Parliament. Its chief executive is an officer of Parliament. It is not in legislation but under our Standing Orders it is responsible exclusively to the Public Accounts Committee and has a broader duty regarding understanding value for money and the use of taxpayers’ money. Some of the actions that are being referred to may well be stuff that it will wish to take forward in its analyses.

However, it would be helpful for the Government to appreciate that Minister Frith’s letter to the Commons Select Committee was targeted only in a particular response to certain points that had been made during that evidence session, correcting an important error that had been made in the DPIA. It would be helpful for the Government to have a more open approach in sharing how this will all work and how it is already working, and in giving assurances to parliamentarians of both Houses on how it will work in practice to quash this myth that, all of a sudden, stuff is being done that will expose vulnerable people.

This is the wider point about IT and digital sovereignty. We have a National Data Guardian, which has already been put in statute. By the way, I recall that, when NHS Digital was a separate legal entity, it refused to give information to the chief executive of NHS England when certain data was requested. At one point during the Covid crisis, it refused to give information to help the Government function more effectively. With these sorts of issues, it is almost as if what is perfect for privacy, or for this, that or the other, becomes the enemy of the good in what we are trying to achieve, which is the good use of technology and the federated platform to improve productivity.

I know that there have been disputes. It is important that the Office for Statistics Regulation, the parent organisation of the ONS, did that review. It pointed out issues that need to be addressed in future, but it did not say: “Actually, the information that the NHS has given out is largely wrong”. How do we try to improve from where we are right now and not miss out on the genuine opportunity of trying to work through, and make the most of, our technological advances?

I appreciate that there are also thoughts about whether it should just be a UK supplier. Again, this is the wrong approach and mentality. The DHSC and the NHS have got more sophisticated in their way of doing procurement, so to rule out any IT company that is not headquartered here in the UK would be a huge error.

There are other broader elements around where we are heading. I will leave some comments for our later debate on SPR, but there is something here about making sure that there is privacy by design—I think that was the phrase used by the noble Lord, Lord Clement-Jones. I have been weighing this up, and I will come back to it on SPR, but it concerns me somewhat, because we might think that we will happily hand it over to this or that clinician, or it will be used more broadly, but who really gets to see it? All this data is being used in an anonymised fashion. If, for example, GSK was purchased by a foreign pharmaceutical company, some of these amendments—I appreciate that they might be probing, although their level of detail suggests that this is exactly what noble Lords want them to achieve—would start to allow legal challenges about how this could be done. As I say, do not let perfection in one aspect be the enemy of the good in another, which is making the best of NHS resources to improve people’s health. I am sure we will return to this on Report, but I encourage noble Lords who will be writing amendments to reflect on how far into that level of detail they need to go.

[Lord Kamall (Con)]

My Lords, I am grateful to all noble Lords who have brought forward amendments in this group. I well recall the debates that the noble Lord, Lord Clement-Jones, and I had during the Health and Care Bill in 2022. I think he was surprised to find that we agreed on far more than he thought we would. What was very helpful in that Bill, if I remember correctly, was that there was an official who had been seconded from the Cabinet Office to the Department of Health, whom we were both able to trust to find a solution that we were both happy with in the end. Sadly, having reached that really good solution, it has all been undone by this Bill. I therefore completely understand the reasons for the amendments tabled by many noble Lords in this group.

I will speak briefly to the amendments tabled by my noble friend Lady Neville-Rolfe, who is not in her place, and by the noble Lord, Lord Austin of Dudley. Although these amendments approach the question of NHS procurement slightly differently, they raise important questions about the principles that underpin the way in which taxpayers’ money will be spent. While NHS procurement should always support the delivery of safe, effective and high-quality care for patients, we know that the NHS is not only a provider of healthcare but one of the largest purchasers of goods and services in this country and a major employer. It has an enormous impact on the wider economy, with the potential to support British businesses, to encourage innovation and our domestic manufacturing capabilities, and to create skilled employment in areas such as medical technology and life sciences research, where the United Kingdom already possesses considerable experience.

My noble friend Lady Neville-Rolfe probes the Government on how we use that purchasing power intelligently, not only to secure the goods and services that the NHS requires but to support resilience, innovation and wider economic prosperity in the country while adhering to the principle of value for money. It also raises an important question about how we assess value for money. As the noble Lord, Lord Tarassenko, said, the cheapest initial purchase is not necessarily the best in the long term.

[Baroness Coffey (Con)]

Amendment 277 is not in this group, according to the list circulated today, unless there has been more than one of them.

[Lord Kamall (Con)]

My understanding is that it is in this group, but maybe other noble Lords can confirm. There is a slight disagreement between my noble friend’s and my understanding of that.

I repeat that important point made by the noble Lord, Lord Tarassenko: the cheapest initial purchase is not necessarily best in the long term. There is also a legitimate question about whether procurement requirements have become unnecessarily complicated, which the noble Lord, Lord Austin of Dudley, calls for in his amendment, around clarity and consistency about the objectives against which procurement decisions are assessed.

I turn to the wider concerns raised in this group about patient data, digital sovereignty and the security of NHS information systems. Patients need to have confidence that their data is secure and their privacy is respected. I quite often like to quote my favourite philosopher, Jimi Hendrix. I have cited this more than once. He talked about building castles made of sand that fall into the sea eventually. What we do not want is the single patient record or the federated data platform to be that castle made of sand that falls into the sea eventually because there is no confidence from patients and they want to opt out of the system. We have tabled our own amendments on the single patient record that speak directly to some of these concerns. I will return to those points when we reach that group.

The crux of the matter is Palantir, what people really think about Palantir and whether it should be here. When I was the relevant Minister, I was told quite clearly by my officials that Palantir had by far the best solution to deliver the federated data platform. We should acknowledge the contribution it has made in increasing discharges, reducing discharge times, identifying and contacting patients who need to come back, making sure cancellations are reduced, and all those sorts of metrics that we want to see.