Cyber Security and Resilience (Network and Information Systems) Bill
I beg to move, That the clause be read a Second time.
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Cyber Security and Resilience (Network and Information Systems) Bill
As the director of the National Cyber Security Centre has said, “Every organisation delivering the UK’s critical services…relies on uninterrupted digital operations. Disruptions to those operations isn’t simply an IT issue; it’s a…national resilience issue”. The Liberal Democrats wholeheartedly support that point, and it is why we welcome the measures introduced by this Bill, which strengthen existing cyber protections to enhance national security. However, as the Liberal Democrats have made clear throughout the Bill’s stages so far, there are many missed opportunities to truly future-proof our country’s cyber-security to protect our democracy, economy and national security. I will speak to the Liberal Democrat amendments to the Bill, which we think would achieve that. First, on the scope of the Bill, last year we saw the costliest cyber-incident in UK history. The financial damage caused by the attack on Jaguar Land Rover is estimated to have cost between £1.6 billion and £2.1 billion—a cost shared between JLR directly and its supply chain. In the public sector, cyber-attacks are causing eye-watering costs too—just look at Redcar’s cyber-attack, which cost them a staggering £10.4 million. Despite that, the Bill takes no consideration of the significant economic cost of such cyber-attacks, excluding retail and manufacturing industries as well as local government from the scope of the Bill. New clauses 4 and 5 address a crucial gap. New clause 4 would bring the manufacturing of critical transport equipment and the retail of food and essential goods, where they form part of a large-scale distribution chain, within the scope of essential categories under the Bill. That means that companies such as Jaguar Land Rover would finally receive the protections that their strategic importance demands and protect their supply chains too. New clause 5 extends that same recognition to local authorities, whose digital infrastructure underpins the delivery of services that millions of people depend on. The Government’s own industrial strategy recognises that sustainable and secure growth requires strong levels of cyber-resilience across the economy, but their own cyber Bill does not live up to this. If a cyber-attack brought JLR’s production lines to a halt or crippled the digital infrastructure of a council, the damage to our economy and people’s daily lives would be enormous. Those are not the only issues within the scope of the Bill. Safeguarding our democratic processes must be treated as a national security priority, and here, too, the Bill falls short. At a time when foreign interference in our elections is not a hypothetical but a documented and growing threat, the Government have chosen not to act. New clauses 8 and 9 would begin to change that. New clause 8 would designate the administration of elections and voter registers as essential services within the meaning of the network and information systems regulations—a straightforward recognition that the machinery of our democracy is as critical as any power grid or hospital network. New clause 9 would designate political parties as essential services for the purposes of cyber-security, extending meaningful protection to the organisations through which the British people exercise their democratic voice. I understand that the Bill is not a silver bullet for cyber-security, but these amendments make the modest, targeted and entirely reasonable ask that vehicle manufacturing, food retail supply chains, local authorities, our elections and our political parties are brought within scope. In turning to online-generated fraud and scams, we can see the impact of a lack of action to secure online and cyber-spaces. Fraud makes up 44% of all UK crime, and online technologies—especially artificial intelligence—are supercharging that. According to reporting in The Times a few weeks ago, research by Lloyds bank found that Meta’s social media sites are a starting point for 76% of purchase scams in the UK, with the value of losses to UK customers estimated at around £66 million in the last year alone. Not only does the Government’s fraud strategy completely overlook the role of social media giants and big tech in the proliferation of online scams, but the Bill fails to address explicitly the risks that fraud and scams pose to critical infrastructure and organisations. That is especially striking when we consider that the Government’s official statistics on cyber-security breaches show that phishing attacks—scams—remain the most prevalent type of breach or attack by far in the UK. Amendment 1 would change that. It would amend clause 8 to add “risks arising from fraud” explicitly to the list of security threats facing relevant digital services so that those threats can be identified and managed. That is also why the Liberal Democrats are calling for social media giants to be financially liable for scams originating on their platforms and for an online crime agency to tackle these issues and standardise AI labelling. We must not forget that these threats do not fall solely on large institutions and critical infrastructure. Small and medium-sized enterprises are on the frontline of cyber-crime; they are disproportionately targeted and too often without the resources or expertise to defend themselves. Many of the businesses caught up in the supply chains of our critical industries and exposed to the fraud and cyber-risks that I have described are SMEs, yet there are no provisions in the Bill to help potentially under-resourced SMEs cope with the increasing threat of cyber-attacks. New clause 2 would require the establishment of dedicated cyber-security support services for those businesses. For the Liberal Democrats, backing British small businesses means ensuring that they are not left to face those threats alone. The Liberal Democrats have also tabled a series of further measures that would make the legislation fit for purpose over the long term. A law is only as good as its enforcement, which is why we are pressing for board-level accountability for cyber-resilience under new clause 10, regular proportionate testing of systems under new clause 11 and more frequent Government reporting every three years—rather than every five years—under amendment 2. Last week, at London Tech Week, as I was surrounded by experts across the industry, one thing became clear. We think that technology is moving quickly now, but with the growth and development of AI this is the slowest we will ever see change happen. That is why we need the framework to evolve, which means reviewing the security risks posed by foreign-linked critical suppliers, which new clause 3 would do, modernising the outdated Computer Misuse Act 1990, which new clause 6 would do, and assessing whether regulators have the resources they actually need to do their job, which new clause 7 would do. Those are not radical tasks; they are basic conditions for a cyber-security regime that works today and will continue to work in the future. If there is one matter that cuts to the heart of what the Bill should be about, and asks the fundamental question about Britain’s place in a contested digital world, it is digital sovereignty. All the protections we have discussed for our industries, our democracy and our small businesses will mean little if we do not first answer who controls the digital infrastructure on which all of them depend, and question whether, at every level of the stack, we have critical control over that. That is echoed loudly by the industry itself. A study by Civo, a UK sovereign cloud provider, found that 83% of IT decision makers in this country worry about the impact of geopolitical developments on their data sovereignty. When we look at the numbers, it is not hard to see why. About 55% of central Government organisations report that over 60% of their estate is on the cloud, and the vast majority of that is with just two providers, both of which are American. We have handed the keys to significant parts of our national digital infrastructure to foreign corporations, subject to foreign laws and exposed to foreign decisions entirely outside our control. That includes our public services. The Liberal Democrats are alarmed at the NHS’s growing reliance on complex, opaque digital systems set up by Palantir. With Palantir’s background in security and surveillance, that marks a divergence from the traditional relationship between the NHS and firms with specialised medical knowledge. The procurement process for the federated data platform, which was awarded to Palantir in 2023, is worryingly opaque.
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Cyber Security and Resilience (Network and Information Systems) Bill
I thank the hon. Member for his question. That is why we need a strategy—we need to be clear about the Government’s priorities. On procurement, we have heard from the National Audit Office that cost is often a priority, but at what cost? When the Government are looking for suppliers, what do we value? There must be a strategy for that, and we need to have that conversation so that the direction is clear, whether on hardware or software. Working internationally is vital, but it is also important to be clear about what is important for us, especially in the tech stack. That is the thing: it is about our security and resilience as well as our economy, strengthening those developing technologies as well as using technology. It is also about working together internationally and knowing that we have the resilience to look after and trade our technology stack.
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Cyber Security and Resilience (Network and Information Systems) Bill
I thank the hon. Member for his intervention. I absolutely agree. Across the United Kingdom, including in Northern Ireland, there are incredible British tech firms. Many of them have said to me that their services are being procured by other Governments in Europe and around the world, yet they find their own British Government not using them or getting the value out of that British technology here by developing skills and jobs. The Liberal Democrats welcome the Government’s hardware strategy, announced last week, which at least acknowledges the importance of British procurement, but acknowledgment is not a strategy. New clause 13, which I am pleased to say has drawn support from across the House, would make it one. In an increasingly unstable world, the case for British digital resilience, British technology and British sovereign capability has never been stronger. I therefore urge hon. Members to vote for the new clause. Cyber-security is no longer a technical matter confined to server rooms and IT departments. It is a question of national resilience, economic strength and democratic integrity. The Bill before us takes important steps, but important steps are not enough in today’s digital age. With these amendments, we have the opportunity to close the gaps, broaden the protections and build a framework that is genuinely fit for the digital age.
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Cyber Security and Resilience (Network and Information Systems) Bill
I do not think that the hon. Member has understood our amendment, which is about having a strategy. It does not say that everything should be sovereign, but we need to look at our tech stack and have a strategy for what is sovereign and what requires the procurement of elements. I ask him to look at our amendment again.
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Cyber Security and Resilience (Network and Information Systems) Bill
Before I withdraw new clause 2, I want to draw Members’ attention to my entry in the Register of Members’ Financial Interests in reference to my earlier speech. I beg to ask leave to withdraw the clause. Clause, by leave, withdrawn. New Clause 13 Digital Sovereignty Strategy on risks posed by foreign interference and reliance on foreign technologies “(1) The Secretary of State must, within 12 months of the passing of this Act, publish a strategy (“a Digital Sovereignty Strategy”) which sets out the Government's approach to maintaining the security and resilience of relevant network and information systems by— (a) assessing, managing and mitigating risks— (i) associated with foreign interference, (ii) arising from reliance on foreign-supplied technologies, and (b) preventing over-reliance on foreign providers by building domestic capacity. (2) For the purposes of this section, a “relevant network and information system” is a network and information system belonging to— (a) an operator of an essential service, (b) a relevant digital service provider, (c) a relevant managed service provider, or (d) a critical supplier, within the meaning of the NIS Regulations. (3) A Digital Sovereignty Strategy published under this section must— (a) include risks associated with— (i) hardware, (ii) software, (iii) supply chains, and (iv) procurement processes; (b) include a specific focus on security and resilience in government digital procurement processes, detailing how the Government intends to reduce strategic dependencies on foreign-owned service providers to mitigate the risk of systemic disruption; (c) include a commitment to prioritise the use of technologies developed in the UK by UK organisations in relevant network and information systems to reduce reliance on foreign technologies, and (d) where risks are identified under subsection (1)(a)(i), state how the Government intends to address these risks by supporting the use of domestic technologies or systems for the purpose of ensuring the security of those systems.”—(Victoria Collins.) This new clause would require the Government to publish a Digital Sovereignty Strategy setting out how it intends to address risks to relevant network and information systems posed by foreign interference and reliance on foreign technologies, including by supporting the use of domestic technologies. Brought up, and read the First time. Question put, That the clause be read a Second time.
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Cyber Security and Resilience (Network and Information Systems) Bill
I reiterate the importance of a digital sovereign strategy for our cyber-security. It is about our resilience, our security and our economic strength as a country and collaborative sovereignty. We very much welcome the extended scope of the Bill and we support it moving forward. Question put and agreed to. Bill accordingly read the Third time and passed.
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National Planning Policy Framework and Tring
The people of Tring have spoken. This petition, signed by over 500 residents, rejects the top-down, developer-led approach to planning from this Government, which threatens to impose significant large-scale development on their community with little regard for its character, infrastructure or precious environment. That has been made even worse by the latest power grab from Whitehall, which will now take over large planning applications. Residents are not opposed to housing, but they are righty alarmed by the burden being placed on their town and deeply frustrated by the lack of a meaningful voice in shaping proposals that will define Tring for generations to come. Following is the full text of the petition: [The petition of residents of the United Kingdom, Declares that Tring faces significant large-scale development proposals driven by top-down national planning policy, which is being imposed on local communities with insufficient regard for the views of residents or the detrimental impact on Tring’s character, infrastructure, and environment. The petitioners therefore request that the House of Commons urge the Government to schedule a debate in the House of Commons on the Government’s review of the National Planning Policy Framework and how communities like Tring can be better protected from inappropriate over-development, and how local residents can be given a genuine and effective voice in the planning decisions and infrastructure provision that shape their towns and affect their daily lives. And the petitioners remain, etc.] [P003209]
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Thames Water
I start by associating myself closely with the Secretary of State’s remarks about Jo Cox. It was a privilege to serve alongside her in this place, and we still miss her deeply. I am grateful to the Secretary of State for advance sight of the statement and for the helpful briefing that I received earlier. Since Conservative privatisation more than 35 years ago, some £85 billion of billpayers’ money has flowed out like a torrent into the pockets of mostly overseas shareholders and executives paying themselves unearned bonuses. That money could and should have gone into cleaning up our waterways and modernising infrastructure. Instead, sewage was released into our lakes, rivers and seas for 1.8 million hours last year, and more than 100,000 of those were in the Thames region alone. Some 20% of our water leaks out of its pipes before it even reaches our homes. For Thames Water, the figure is even worse, with 25% of that water wasted. Now Thames Water’s investors are asking for more time for more opportunity to take money before they inevitably run. The Secretary of State is right, then, that the creditors’ offer is a disgrace. They get to keep making money, and Thames Water billpayers get to pay even more to keep them going, while getting the privilege of seeing long-overdue infrastructure improvements delayed for yet another decade. Thames Water is taking the mickey. The Liberal Democrats say, “No more, and no thanks.” It is clear that Thames Water has failed in its basic performance as a water company, and that gives the Secretary of State all the reason she needs to place it into special administration, so why is she not doing that instead? Her letter to Ofwat is, I am afraid, a sign of dreadful weakness. She has to beg an equally weak Ofwat to show a resolve that it institutionally lacks. Thames has failed in its performance, so just put it into special administration and migrate the company to a mutually owned model, where the billpayers own the company and call the shots. That way, investment will be made, sewage spills will stop and water leaks will cease. By doing that, she could begin the process whereby all our water companies are owned not by private equity, overseas investors or the sluggish state, but by the people. If she did that, she would win the favour of people from Witney to Windermere. Why does she not stop faffing about and do that instead?
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Thames Water
Communities such as Chalfont St Peter have suffered appalling circumstances in recent years, including flooding and sewage bubbling up through the drains. Thames Water has promised capital investment to address these issues. What assurances can the Secretary of State give that customers will not be asked to pay the price for years of financial mismanagement through higher bills, and that any future restructure or special administration regime will not mean that existing capital investment commitments are lost?
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Community Hospitals
It is an honour to serve with you in the Chair, Sir Jeremy. I am grateful to my hon. Friend the Member for South Cotswolds (Dr Savage) for providing us with this opportunity to talk about community hospitals. In particular, I pay tribute to the fantastic NHS staff who work across Devon. They pull off an incredible level of service in spite of the constraints they are working under. In my constituency, we have five community hospitals across Axminster, Honiton, Ottery St Mary, Seaton and Sidmouth. Years ago, they all provided in-patient beds, minor injuries units and rehabilitation services, acting as halfway houses after discharge from the acute hospital, which for us was the Royal Devon and Exeter hospital, and before home. They also provided support after operations, cared for the elderly and freed up beds in the RD&E and other acute hospitals. Today, much of that capacity has been stripped away. Of those five community hospitals, only Sidmouth retains in-patient beds—and a mere 25 at that. For a region of 150,000 people dealing with constant discharge pressure from Exeter, that is plainly insufficient. Honiton is the only one of the five that still has a minor injuries unit. I wrote to the new interim cluster chief exec for NHS Cornwall and NHS Devon two months ago to demand assurance that our community assets and services would remain safe from closures; it concerns me that, two months later, I have not had a reply. I ask Members to imagine being an elderly resident in Axminster faced with a medical emergency. A constituent who came to see me at a surgery in Axminster was dreadfully worried about the discharge of her husband from the acute hospital, the RD&E, because she was so frail and elderly that she felt unable to look after her frail and elderly husband. Apart from anything else, she was absolutely distraught with worry about not being able to look after him. The nearest major hospital from Axminster is an hour away at Exeter, and the journey there through the countryside is not just inconvenient for people at that stage of life; it is unmanageable. In preparation for this debate, I spoke with the president of the Community Hospitals Association, Dr David Seamark. David is not only president of the CHA but a constituent and a GP based in Honiton. He told me that community hospitals were designed precisely to face down these sorts of challenges. Community hospitals are embedded in rural and coastal areas, which is particularly good for older and more vulnerable populations. Across the UK, there are around 500 community hospitals, and many of them are located in these sorts of places, outside of cities and where access to centralised care is far more difficult. This is not the stuff of romance. These are not leftover legacies from a bygone era, and they are not historical; they are well placed assets for this era. They are adaptable, thanks to their autonomy, and they are capable of delivering wide-ranging, complex medical services. Our east Devon hospitals perform X-rays, surgeries and diagnostics. Despite losing their in-patient beds 10 years ago, they remain vital hubs of care for the local community. We have seen proposals to close wings and services, and even to demolish facilities, as was the case in Seaton, where the local community understood what was at stake. It was impressive to hear about the petition that my hon. Friend the Member for South Cotswolds put together, which so many people signed in support of her community hospital. In Seaton, more than 9,000 people signed a petition to retain the community hospital there, and we had a public meeting in Colyford where people queued out the door to show their support. These are cherished institutions, built on decades of trust and born from community investment. The chief medical officer, Professor Sir Chris Whitty, agreed when he spoke at the Community Hospitals Association’s annual conference last month. He echoed the words from his 2023 annual report, “Health in an Ageing Society”, which is well worth going back to, and said that ageing and the resulting increased frailty were key issues for the future of UK healthcare. He argued that community hospitals are in just the right places to be on the frontline and tackle this issue for generations to come in our rural and coastal communities, and described community hospitals as “an essential part of provision for both inpatient and outpatient care for many citizens in England and the wider UK.” That clashes with the Government’s insistence that centralisation and the creation of large neighbourhood health centres will deliver progress and better outcomes. Neighbourhood health hubs are being exposed as a contradiction in terms. They misunderstand both geography and demography: geography, because they do not fit rural and coastal areas and suck resources into the nearby conurbations, and demography because, if the challenge facing our health service is an ageing population, solutions must be about proximity, accessibility and the continuity of care. The choice is plain for all to see: do we continue down this path of centralisation—closing, cutting and consolidating—or do we build on what we already have and cherish? When Seaton hospital was built in the 1980s, people were told that they should be a brick and buy a brick. We need to build on that legacy. Community hospitals should not be sidelined; they should be strengthened. They should be the backbone of genuine neighbourhood healthcare, not displaced by some remote health hub that, in an Orwellian turn of phrase, is moved further away and deemed to be a “neighbourhood health hub”. If the Government are serious about delivering care closer to home, supporting our ageing population and relieving pressure on our hospitals, they must invest in, not abandon, our community hospitals.
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Social Media Disinformation
At the end of March, the Foreign Affairs Committee published a report into disinformation diplomacy. We investigated how malign actors are seeking to undermine democracy in the UK from overseas using information manipulation and interference, with such techniques as spoofing, bots and co-ordinated inauthentic behaviour. The Committee recommended that the Government demand greater transparency from social media companies in relation to the algorithms exploited by malign actors overseas. What discussions are being had with other Government Departments to make that so?
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Community Hospitals
I thank my hon. Friend the Member for South Cotswolds (Dr Savage) for giving us all the opportunity to shine a spotlight on the challenges facing community hospitals, particularly in rural areas. Neighbourhood health and care in the community are the thrust of this Government’s health strategy. That is admirable and right, but good intentions alone are not a health strategy, and intentions mean very little if the infrastructure to deliver them does not exist. In constituencies like Tiverton and Minehead, it increasingly does not. Let us take, for example, the removal of the CT scanner from Minehead community hospital. I have been stopped in the street more times than I can count by constituents expressing how big a blow that has been. The whole point of a scanner in Minehead was proximity—for it to be accessible to people across west Somerset who face long journeys to reach secondary care. Its removal is therefore curious, and a direct contradiction of the Government’s stated commitment to bring care closer to people. The strategy says one thing and the decisions say another. It is not hard to understand why we are where we are. West Somerset is, in effect, a cul-de-sac, with limited transport, limited infrastructure and a long schlep to Musgrove Park hospital in Taunton for most things approaching secondary services. That has consequences beyond access; we are not an easy posting for healthcare workers either, precisely because of the geographic reality. There are no meaningful incentives attracting people to train and practise there, and there is no laser focus on local recruitment efforts, which I believe is our best bet. We live in a beautiful part of the world—it is true—but why would a newly qualified clinician choose a remote, poorly connected posting when better resourced options exist elsewhere? The south-west, as my colleagues know, is haemorrhaging healthcare capacity, and my constituency feels the effects acutely. Frankly, we are not being resourced as though those difficulties matter at all. Every missed appointment is not just a missed check-up; it is a missed diagnosis. When people cannot reach care, conditions worsen. Some will inevitably end up in A&E, placing further pressure on an already stretched urgent care system, in a region with one of the country’s least accessible healthcare networks. We end up paying more for failure, and the approach has not acknowledged that an ounce of prevention is worth a pound of cure. When we talk of community care, it must reflect the needs of the community it serves. Rural areas tend to be older in demographic make-up, and healthcare provision is sparse. That cannot be treated as a marginal factor; it is the central planning reality. The rural premium in healthcare need is real, documented and consistently under-weighted in funding decisions. My party has always been a proud champion of rural areas. We recognise the postcode lottery of care provision and the health inequalities it perpetuates. It is why we have called for the establishment of the strategic small surgeries fund, specifically designed to prop up buckling services in remote parts of the country and ensure that where someone lives does not determine the quality of care they receive.
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Draft Digital Waste Tracking (England) Regulations 2026
I rise to speak on behalf of the Liberal Democrats, who broadly support the establishment of a digital system to track the movement of controlled waste. We have long campaigned—as people would expect us to—for stronger waste regulation and enforcement to protect our environment and tackle waste crime after years of inaction by the Conservative Government. As waste is a devolved matter, with separate legislation and systems being developed in Wales, Scotland and Northern Ireland, the Government must work closely with the devolved Administrations to ensure that these digital systems are interoperable and provide effective coverage across the whole UK. Although we support the draft regulations, we urge the Government to go further in tackling the waste crime national emergency by taking up our calls to increase fixed-penalty notices for fly-tipping to £2,500, transferring responsibility for investigating major waste crime to the National Crime Agency, and introducing rewards of more than £5,000 for information leading to a successful prosecution of criminal gangs.
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Thames Water
The Government have been very clear in their support for Thames Water’s proposed £5.7 billion White Horse reservoir in Oxfordshire. Given that Thames Water may run out of money in months, what assessment has the Secretary of State made of the risk that a collapse could lead to the Government having to bear the cost of the reservoir?
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Topical Questions
The world has failed Sudan. We know that the international fact-finding mission has noted evidence of a genocide following the fall of El Fasher. What is the UK doing as penholder at the UN to ensure that the belligerents responsible are being held to account, as well as the state actors aiding and abetting them?
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Thames Water
My constituents are facing an average water bill of £658 a year, yet Thames Water continues to fail them. Sewage has poured into the River Mole, which runs through my constituency. The rec next to the Esher treatment works, where children play, has had sewage in it. I told the House last week that there was sewage outside the local primary school in Thames Ditton, as well as in the middle of the village. Will the Government get a grip on this regulatory and state failure, put the company into special administration, and create a public interest company that serves my constituents properly?
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Community Hospitals
I thank my hon. Friend for her passionate speech about community hospitals. In my constituency we have a fantastic community hospital with a minor injuries unit, but the unit is open only on Tuesdays, Wednesdays and Thursdays, with reduced hours. It could treat thousands more patients each year. Does my hon. Friend agree that opening minor injuries units for extended hours would help to relieve pressure on A&E departments in acute hospitals?
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Community Hospitals
My hon. Friend is very generous to give way again. In my Stratford-on-Avon constituency, the Ellen Badger community hospital in Shipston-on-Stour served the community for hundreds of years. The Coventry and Warwickshire integrated care board removed the in-patient beds, which were really important in rehabilitating and looking after patients from acute settings before they went home. Those beds were close to their home. Does my hon. Friend agree that the Government must invest in care in community hospitals to relieve the pressure on acute settings?
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Thames Water
In recent months, 35,000 houses in West Oxford have had their water pressure cut by Thames Water, in some cases by as much as 50%. Veronica in Osney Island says that her upstairs shower is now nothing but a dribble, and is barely usable. This is not a service; it is a scam, and my constituents are having to foot the bill for it. Their bills were put up last year. Can the Secretary of State explain to them what we are waiting for? Why can we not just let this failed company fail, and start again?
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Community Hospitals
I recently met the chief executive officer of the newly combined Surrey and Sussex integrated care board, and urged her to consider the potential for expanding Horsham community hospital on Hurst Road into a neighbourhood hub, including a women’s health unit, to mitigate the lack of a general hospital in the area. Sadly, her first task has been to reduce her staff by more than half. Does my hon. Friend wonder, like me, what happened to the extra £29 billion that the Government invested into the NHS? It does not seem to have got anywhere near Horsham.
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Access to Dental Services: West Sussex
It is a pleasure to serve under your chairmanship, Sir Desmond. I thank my hon. Friend the Member for Chichester (Jess Brown-Fuller) for shining a light on this important subject, which causes such distress for residents of West Sussex. The Department for Health, like many Government Departments, has promised a consultation, as well as extensive reform of the dental contract. I appreciate that the Minister wants to get this right. He has said that the dental system is complex. He has also made it clear in the past that these changes will not be rushed. Speaking to dentists across my constituency and beyond, very few people would say that taking two years just to start a consultation could be called rushing. The Government need to be clear with both dentists and patients. Dentists were told that the consultation would come last year; then they were told that it would come before the start of summer—but summer is more or less upon us, and we are still waiting. At this rate, the Government risk making no meaningful reforms to dentistry within this Parliament. This sense of political inertia is, of course, not confined to one Department, and we do not have to look far to imagine the reason for that. Alongside those delays sits an equally serious issue: funding. The Government have been clear that no new funding is available for dental reform; I imagine that the Minister himself finds that deeply frustrating. Only about 40% of adults are effectively provided for within the current NHS dental budget, and even that is propped up by an estimated £1 billion cross-subsidy from private provision. The Public Accounts Committee was clear in its assessment: without frontloaded investment, meaningful reform has no chance of success. What does this mean for residents in my constituency of Horsham? The honest answer is that we do not fully know, which is frustrating to say the least. Under the previous Conservative administration, West Sussex county council had not carried out a comprehensive oral health survey since before 2019. I have written to the new Lib Dem-led council asking it to ensure that West Sussex is included in the next survey, because without reliable data, we simply cannot design effective or targeted reforms. The data that we do have is deeply concerning. A quarter of children in West Sussex are at high risk of tooth decay compared with a national average of roughly half that level. From an early age, we are sending out the message that oral health is not a priority. At the same time, we are seeing a growing reliance on urgent dental care, but as a substitute for routine check-ups. Preventive dentistry—the very foundation of a sustainable system—simply cannot function under those conditions. We risk raising a generation that engages with dental services only at a moment of crisis, and that will have profound long-term health consequences. I am very much seeing the impact of this in my Horsham casework. One of my constituents, Gail, was recently removed, along with her daughter, from the dental register. It was not from any fault of her own, but simply because there are not enough dentists left who are willing to operate on NHS contracts. That is distressing enough for patients, but it is also deeply frustrating for dental professionals, who find themselves forced to turn away patients who they can see are in urgent need. Another constituent, Medi, does have access to a dentist, but not locally, and we have heard the same from other Members. She has to travel three hours for her appointments in another part of the country completely. She suffers from arthritis, so the journey is not just inconvenient, but very painful. However, she cannot find anyone closer, and even the waiting lists are vague about when a place may eventually be available. I have also heard directly from dentists in Horsham. One practitioner, who has worked in the NHS for over 15 years and has trained NHS dental graduates, told me that, each year, funding has become more constrained and the administrative burden continues to grow. Without proper support for preventive care, he warned, dentists simply “don’t stand a chance”.
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Access to Dental Services: West Sussex
I very much agree that this is a national crisis. Some local authorities or local ICBs are better than others, but this is basically a national problem and needs national action. The dentist I mentioned has told me that many of his peers have already stopped offering NHS services, and the ones left are increasingly considering doing exactly the same. That tells us that the entire dental system is slipping into freefall. The broader figures reinforce the local picture. Only 40% of adults in West Sussex have seen a dentist in the past two years, which is a fall of 7%. Among children, the figure has dropped from 63% to 58%. Over the past five years, the number of residents per dentist in West Sussex has increased by a fifth. That is a huge jump, and further evidence that the system is heading for collapse. From my conversations with the chief executive officer of the newly merged Surrey and Sussex ICB, I know that dentistry is a priority area for her and that the team are doing their best to introduce flexibility where possible. However, they face cuts of up 50% in budgets and staffing, which are enormous challenges not just for the leadership, but for the NHS teams on the ground. There is real concern that, unless we change now, dentistry risks becoming an expensive luxury, rather than a universally accessible service. To conclude, the combination of delayed reforms and reduced funding is leaving patients without access to care and professionals without the support they need to provide it. Oral health inequalities continue to widen. I appreciate that this Government are once again picking up the pieces from their Conservative predecessors, but the obligation now falls on today’s Ministers. Unless we see a change in trajectory, we will be left with exactly what the Public Accounts Committee warned us about—no money, no reform, no teeth.
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Access to Dental Services: West Sussex
I beg to move, That this House has considered access to dental services in West Sussex. It is a pleasure to serve under your chairmanship, Sir Desmond, to have secured this debate—on Sussex Day, no less; I am confident that the Minister will have some excellent responses on behalf of all constituents in Sussex—and to have the opportunity to lay out the impact of the historic failings within the dental contract before the Minister. The state of access to NHS dental services across the country is utterly disgraceful. In Sussex, 63% of adults had not seen a dentist in the two years prior to June 2025. Similarly, four in 10 children had not seen a dentist during that time. Fourteen million people were unable to access NHS dental care in early 2025 across the UK. The result of people locked out of NHS dental services has been a rise in cases of DIY dentistry, with a survey earlier this year suggesting that 7% of UK adults had attempted some form of DIY dentistry. All that contributes to an alarming increase in hospital admissions for tooth-related issues. Tooth decay is now the most common reason for hospital admission among children aged between six and 10, with more than 100,000 children admitted to hospital with rotting teeth between 2018 and 2024. Those figures outline a dire situation that is only getting worse. Improvements in oral health are being wiped out, and tooth decay rates are at levels not seen since the 1990s.
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Access to Dental Services: West Sussex
I thank the hon. Gentleman for his passionate advocacy for NHS dentistry in West Sussex. I am grateful to him for caring about access to NHS dentistry across the whole country. He is a fierce advocate for Strangford and makes the important point that the situation we are in is a damning indictment of the failure of the previous Government—a failure that the Prime Minister himself referred to regularly in the run-up to the general election. It was a stick that he used to beat the Conservative Government with in every televised debate, when he spoke about rotting teeth falling out of children’s mouths. We are still going backwards, dealing with problems on a scale not seen for generations, all at a time when the British Dental Association has warned that NHS dentistry is facing an existential threat. Parliament often hears the term “postcode lottery”, but I cannot think of a more applicable example than NHS dental services for residents in Chichester and West Sussex. Last week I had the opportunity to conduct a little bit of research with a staff member who has recently moved to London and needs to register with an NHS dentist. Within two miles of his new postcode in London, 10 surgeries were accepting NHS patients. Entering the postcode of my constituency office in Chichester into the NHS search tool produced a very different result: zero surgeries accepting new adult NHS patients within a 12-mile radius. There were none within the city itself, and only one surgery was accepting new patients under the age of 17. That means that residents not registered locally have to travel to other towns and cities. At the time of looking, the closest surgery was in Littlehampton in the constituency of the hon. Member for Bognor Regis and Littlehampton (Alison Griffiths). That is not close to the city of Chichester. I ask the Minister what his solution would be for people attempting to register locally, people living in the area already and people moving to it after years of increased mandated development in my constituency. I would like to share with the Minister a few examples of what this means for my constituents in Chichester, who very kindly got in touch with me to share their stories. Kathryn moved with her family to the area four years ago. She still travels to Three Bridges for dental care. Christine still returns to the Isle of Wight for treatment. Marina and Denise moved to Bracklesham in 2011—15 years ago—and have never been able to register for an NHS dentist locally. Jim contacted me to say that he undertakes a 140-mile round trip just to receive routine dental care.
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Access to Dental Services: West Sussex
My hon. Friend makes an excellent point about his local ICB. The underspend issue has plagued the dentistry contract over many years. The ICB for Sussex did manage to commission more urgent dental care using its underspend, meaning that it had very little to give back to the Treasury. That was absolutely the right thing to do; I commend my hon. Friend for recognising that that is an opportunity that Cornwall ICB could take. However, the Sussex ICB invested in urgent dental care while not addressing the problem that we have in routine dental care. Residents in Chichester cannot access routine dental care in their own city and are forced to travel considerable distances. That takes time out of people’s lives, costs money, and creates additional risks. Imagine someone making that 140-mile round trip for a routine appointment, only to discover that they require an emergency procedure. They would be miles away from their home and family, and might not be capable of driving themselves home afterwards. That is completely unacceptable in today’s society. To make matters worse, a number of individuals told me that they had been removed from their surgery’s patient list, particularly during the pandemic when they did not want to be in close contact with others. They had no notification that that was happening. Others were informed out of the blue that their surgery was switching to private care and that, unless they paid, they would need to seek treatment elsewhere. Given the costs involved, as reflected in the national figures, many simply choose to go without care altogether. On top of that, individuals who have been lucky enough to secure an NHS place often face enormous waiting times for treatment. Jade shared her experience of being placed on a waiting list for routine root canal treatment and then being ignored for months. At 28-weeks pregnant, she suddenly found herself in excruciating pain and required emergency surgery. As we know, that costs the taxpayer a lot more than if the issue is addressed before it becomes an emergency. Another mother contacted me to say that three years ago her son developed an abscess over Christmas. They were unable to secure emergency treatment so they joined a waiting list at three separate practices. They still have not secured an appointment. Those examples all point to a broken system in Chichester and across the country—one that is failing my constituents and worsening health outcomes. In the long run, it is also making the country poorer: the failure to invest in preventive care means that individuals require more serious and expensive treatment further down the line. This has to end. That view is shared by the dentists I spoke to ahead of today’s debate. A key issue raised by them and many across the profession is the state of the NHS dental contract. The British Dental Association identified it as a major factor driving NHS dentists into the private sector. The current settlement has been widely criticised since its inception back in 2006. The Health and Social Care Committee published a report in 2023 calling for an urgent overhaul of the system, and the Labour party promised to renegotiate the contract in its manifesto. One former dental nurse who contacted me described the contracts as being like “tying dentists’ hands behind their backs.” That is hardly practical if they are trying to perform a root canal procedure. The contracts are failing patients because the number of patients a dentist can see on the NHS is limited according to the units of dental activity that they have been commissioned to deliver. The nurse I spoke to suggested patients are being referred to hospitals for routine procedures because contractual arrangements prevent practices from carrying them out themselves and being renumerated. The Government promised to reform the contracts, but they have been slow to address problems that are widely recognised across the sector. The consultation that the Government announced in April must lead to a contract that is genuinely patient-focused, with greater flexibility in commissioning. When it was announced, the Government committed to bringing out the consultation before the summer, but the official line has changed slightly to “in due course”. I share the concern raised by campaigners that any further delay will mean that a new system will not be implemented before the end of this Parliament. Will the Minister commit to bringing out the consultation before the summer and to a firm deadline for when formal contract renegotiations will begin? Frankly, we cannot afford any further delays. Another issue is costs. Lab costs went up 9% last year, but NHS contract holders got just a 3.55% uplift—add to that the hikes in national insurance contributions, which have exacerbated an already dismal situation. The British Dental Association believes that an average NHS dentist is losing £25 per routine dental check. Without support and changes to the contracts, many practices will continue to be pushed into the private sector, as we have already seen happen to many. In West Sussex, the number of dentists with NHS activity has dropped by 13% since 2019. I imagine that that figure is actually an underestimation, because a practice can offer just one NHS appointment a year and still feature on the list of NHS providers. Local dentists are also concerned that the merger of the Surrey and Sussex ICBs, alongside a 50% reduction in ICB running costs, could undermine the local commissioning expertise and local relationships with providers. Can the Minister today provide any reassurance that, at a time of significant change within our ICBs, they will be given the resource to maintain and improve relationships with contract providers? The Government talk a good game on dentistry, but they are tinkering around the edges and leaving major issues such as the contracts so far unresolved. They quietly dropped their manifesto pledge of delivering 700,000 more dental appointments, under the guise of broadening the definition of urgent dental appointments for clinical reasons. That is a sticking plaster that addresses the requirement for more urgent dental appointments, but does not address those who cannot get routine care, which in many cases would prevent them from needing the emergency care. The Liberal Democrats have long called for reforms that will address the root of the crisis. Our £750 million plan would begin to undo years of underfunding, guarantee urgent and emergency dental care for everyone who needed it, and hopefully bring an end to DIY dentistry. That would be needed to address the backlogs in emergency care. I have heard of wait times of up to 18 months at St Richard’s in Chichester for complex dental treatment such as difficult extractions. It is clear that the system is broken. Nobody is naive enough to believe that it can be addressed overnight, but the Government have had two years. All the while, residents in Chichester continue to have a lack of access to basic dental services. Dentists want to help patients, but it is not currently financially viable for many to stay in the NHS. That has to change, and I urge the Government to listen carefully to contributions from all Members in today’s debate, and take the steps that they promised in their manifesto.
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Access to Dental Services: West Sussex
Will the Minister give way on that point?
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Access to Dental Services: West Sussex
I promise that I will not give the Minister a lesson in geography, although what he said suggests that he may not have frequented the A27. If somebody can get to a dentist in Portsmouth in 20 minutes, they are setting off at 3 am to do so, because that is the only time it can be done in about 20 minutes.
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Access to Dental Services: West Sussex
I am sure the Minister will join me in congratulating Chichester college, which is creating a programme to train up the next generation of dental assistants and nurses. Staff there are excited to be able to contribute to addressing the recruitment issues in the Chichester area.
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Access to Dental Services: West Sussex
I thank all the Members who took part in the debate. This will not be something the Minister has not heard before, but I ask him to take this away: when constituents write to me saying that they are unable to register with an NHS dentist, if I send an email back to them saying, “But the Minister told me there were 67,000 more NHS dentist appointments in Sussex,” I am not getting an email back saying, “Bloody brilliant—I’ll forget it then. Don’t worry.” People are still frustrated and waiting. I am really glad that the Minister has committed to reforming the system, because it desperately needs it, and I look forward to holding his feet to the fire as he does so. Question put and agreed to. Resolved, That this House has considered access to dental services in West Sussex.
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Lifelong Learning: “University of the Air” White Paper
It is a pleasure to serve under your chairmanship, Sir Desmond. I congratulate the hon. Member for Southport (Patrick Hurley) on securing the debate. I know that he is a passionate advocate and champion of the OU. I welcome the opportunity to speak on a subject that, frankly, deserves far more attention. Opening access to education, rewarding hard work and helping everyone to fulfil their potential are aims that sit at the heart of the Liberal Democrat vision for a free and fair society. Our predecessors were wholeheartedly supportive of the spirit behind the 1966 White Paper and we continue to be so. It is right that we mark its 60th anniversary by celebrating the work that it set in motion. In my constituency there are currently 240 Open University students: 210 undergraduates and 30 postgraduates. Nearly half of those undergraduates started their studies under the age of 30 and over a quarter declare a disability. That tells us something about how OU study fits around life. It is not a story that is unique to my patch. Nationally, 19% of OU students live in the most economically disadvantaged areas of the country, nearly 70% are already in work when they begin studying, and three in four arrive with no previous higher education qualification at all. That is a testament to the access mission that the OU embodies. In preparing for this debate, I enjoyed revisiting the 1966 White Paper, its proposals and the debates that led up to it. Hindsight is, of course, a wonderful thing but after reading one Member dismiss the idea as an “inflated concept” in a 1965 debate, I could not help but reflect, 60 years later, that the OU has comprehensively answered that objection, becoming a much-loved national institution. It has also been interesting to reflect on the world of adult education at the time. The White Paper was explicit that the university would sit alongside a wider ecosystem of provision, not replace it. The Government of the day promised to make full use of “existing agencies, such as the Extra-Mural Departments of Universities, the Workers’ Educational Association…and local education authorities.” In fact, the White Paper returns to that point twice. The vision was plural: a national broadcasting university—at the time—working hand in hand with local night classes, adult education centres and further education colleges, each reinforcing the other. The Open University itself has remained admirably faithful to that founding outward-facing instinct. It partners with institutions that lack their own degree-awarding powers, validating their programmes, and a high proportion of its graduates stay in their local area, contributing to the local economy. Five years after graduating, more than nine in 10 OU graduates still live in the postcode area where they studied, which I believe is precisely the kind of locally rooted impact hoped for by the authors of the White Paper. What has perhaps not survived so well is the other half of the 1966 vision—the local ecosystem that the OU was meant to complement. Public funding for adult skills and community learning has fallen sharply since its peak in the early 2000s. Spending on classroom-based adult education specifically has fallen by about two thirds over that period, and the number of publicly funded classroom-based further education courses taken by adults in England has dropped from 5.4 million in 2004-05 to just 1.7 million last year, which is a fall of about 70%. Of course, that is not the OU’s doing, and further education colleges still do excellent work within a narrower remit, but the wider tapestry of provision that the White Paper authors assumed would sit alongside a “University of the Air” has thinned out considerably since. Even the OU is feeling the strain of operating in that emptier landscape. Its own accounts for the last financial year show an accounting deficit of £27 million, which was brought back into a small underlying operating surplus only through a sustained programme of costs reduction, including the loss, sadly, of over 300 full-time equivalent roles last year. That should be seen less as a reflection on the OU, and more as a reflection on a much deeper structural problem. The part-time higher education market in England has been shrinking for years, and the OU, even as the strongest player in that market, cannot grow the pool of adult learners on its own. That is a job for Government policy, not for one institution’s marketing budget. That is exactly why the choice of funding mechanism matters so much for mature and returning learners. The lifelong learning entitlement that the Government are bringing forward is a welcome step in the right direction, but the evidence consistently shows that loans are not a strong enough incentive on their own to get more people from that group into education or training. Financial anxiety is already one of the biggest barriers preventing people from returning to study. Older learners are understandably more risk averse than 18-year-olds, and asking someone to take on the very debt they are trying to avoid to access more flexible and modular learning is not necessarily the answer. Instead, we Liberal Democrats have long called for grants of between £5,000 and £10,000 to be made available to people at key stages throughout their life to support retraining and reskilling. To ensure that that funding is well spent, we would pair it with good guidance on the options available and make sure that it is usable across a wide range of institutions, from local further education colleges to national universities and, of course, the OU. I hope the Minister, hearing praise from across the Chamber for the OU’s success in reaching learners of all ages, will give serious thought to that proposal for the long term, because it will matter more, not less, as time goes on. The world of work is changing fast, and maintaining a highly skilled, productive economy will require us to continually invest in our most precious resource—people. Learning cannot be a cost to be minimised once an initial education ends. The OU’s own record bears out the difference that can be made: it is ranked third nationally for graduate employability, and it has innovative schemes such as the virtual internships programme, which was built specifically for distance learners who could never have accessed an internship through conventional routes. That is what lifelong learning looks like when it works, but it cannot fall to one institution. Perhaps the most important insight from the White Paper is that no single institution, however innovative, can deliver lifelong learning alone. That responsibility sits with Government, who have their own opportunity to address that. Last October’s “Post-16 education and skills” White Paper restated the Government’s ambitions for the lifelong learning entitlement, which is due to come into force in January 2027. However, the secondary legislation and implementation detail that will determine whether it actually reaches risk-averse adult learners, rather than just the 18-year-olds who the loan model already works for, remain outstanding. I therefore hope that the Minister can set out not just the date for that detail but whether the detail will include any role, or ambition, for grants alongside loans. It would be fitting for the anniversary that we are celebrating today to be marked by such a step forward in adult education.
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Health Bill (First sitting)
I am a vice-president of the Local Government Association.
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Health Bill (First sitting)
Q Good morning, Dr Dash. Since hearing the evidence that was given to the Health and Social Care Committee, have you reflected on the concerns that the driver of confidence in HSSIB is its operational independence? What concerns do you have that it will lose that perception of independence and its safe space approach to learning when something goes wrong? Dr Dash: The CQC is an independent regulatory body as well. The hope and expectation is that we have a high-calibre, independent regulatory body that is the prime regulatory body for looking at how well health and care services are delivered and, as well as observing how well they are currently performing, is able to carry out specific, focused investigations when it spots systematic problems across the healthcare system, or indeed when particular problems are identified. In terms of safe space, clearly, confidentiality is important. Confidentiality is important right across the board; staff need to feel able to report within NHS organisations and to the CQC where they have concerns. I have to say that I was concerned in that Health Committee session to hear an example given by Jeremy Hunt, who said that if a midwife is concerned about quality of care in their maternity unit, they need to be able to go somewhere and report that, and to know that HSSIB would not tell anyone else about it. I looked at Duncan, our chief nursing officer, who was there with me, and we were shocked to hear that. How can that possibly be right? We need to have a mechanism whereby if there are concerns about quality of care, they are properly investigated, and mechanisms to deal with those problems and improve services. Yes, we need confidentiality, but I was not convinced by what I heard then—that we needed a completely separate organisation that was duplicating the work of others.
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Health Bill (First sitting)
Q I should have declared that I am a member of the patient safety APPG. Let me turn to similar concerns about Healthwatch and its independence. If it is absorbed within ICBs locally or within the Department of Health at a national level, do you have concerns that those organisations will essentially be marking their own homework rather than listening to impartially collected evidence about patient experience? Dr Dash: I will talk first about providers and then about the commissioners, the payers, the ICBs. We absolutely should expect all providers—GP practices, community trusts, hospital trusts—to see patient experience as a crucial part of their role and not to outsource it to someone else; it has to be a crucial part of what they do. They need to get way better at collecting patient experience, they need to understand it from different groups, wards and medical teams, and they need to be playing that back. Ideally, that should be part of everyone’s appraisals: “Here’s the sort of feedback that we’ve had. Here’s what we’ve heard. Here’s how we’re acting on that.” We need to put that in the places where healthcare is delivered, and that is in those provider organisations. The ICBs have a different role, which is to commission healthcare services in order to improve health and ensure high-quality care, and it is their responsibility to speak to communities. They all have considerable teams of people who are doing that—speaking to different members of society and conducting usually frequent events to get input and hear what people are looking for from their health and care services. When they are looking to design particular services, whether mental health services or children’s services, they go much deeper into that and speak to specific groups, often involving the providers as well. Those mechanisms are already embedded within ICBs, but we need to continue to ensure that they do those as well as they can. When I was speaking to people, I found some fantastic examples of different healthwatch organisations across the country, but that is not at all consistent and they are often too far removed from what is actually happening in terms of day-to-day services to have a significant impact on improving patient experience.
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Health Bill (First sitting)
Q Good morning. Sarah, the Bill transfers a lot of NHSE’s powers to the Secretary of State. Do you have any concerns about the additional powers conferred upon the Secretary of State? Does that go too far? Sarah Woolnough: There are probably two concerns in a couple of different areas: appointments and the power of direction, which is very broad. We think it would be helpful to probe the detail and understand the intention a little more to see whether the legislation could do with amendment. There is more general point. If the narrative is that this is a straight transfer, of course, you cannot legislate for culture and how those powers will be used. Our concern is that, while the narrative is about a straight transfer, empowering local systems and earned autonomy, the legislation pulls a lot of power back to the Secretary of State, and you cannot legislate for how a future Secretary of State may enact those powers.
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Health Bill (First sitting)
Q Jacob, how prepared are ICBs and local authorities to take on the healthwatch functions? Is there a concern that splitting the local healthwatch function will lead to a lack of joined-up focus on health and on the social care element that resides with local authorities? Jacob Lant: I will pick up the second part of the question first. The majority of the worst experiences of care—the worst incidents, where people feel most lost—tend to be in the gaps between services. Hospital discharge is a really good example of where the transfer between the NHS and social care services does not always work in the best interests of patients. That sort of insight will be lost entirely under the current structure, unless we build in a requirement for ICBs and local authorities to share the intelligence that they are hearing and to work collaboratively to understand patient and care user experience. That then raises the question, “Why are we splitting them?” If they have to work closely together to comment on the worst experiences of care, I do not understand the rationale for splitting them. In terms of preparedness, I said earlier that ICBs will not have any additional resource for doing this. They have their own engagement teams at the moment, but even those that have been doing this very well have been leaning on their healthwatch for many years to help them engage with seldom-heard communities and build additional capacity. I worry about the capacity of ICBs to deliver once that is cut, particularly given the headcount and budget reductions in ICBs generally. Local authorities are probably more experienced in doing direct community engagement and more confident about their ability to pick up the responsibilities. Indeed, I suspect that many of them will continue to commission some sort of external support to help them do this, but their budgets will be restricted. They will get only half the money for healthwatch, so that will be a concern.
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Health Bill (First sitting)
Q Can I also ask about the single patient record? We have heard concern from GPs about their role in being the data controller and what that might mean when data is shared beyond their initial remit. What do you think is most desirable: for the GP to remain the data controller, or for that role to sit elsewhere? Dr Dickson: I am not a general practitioner. The key thing for data control and data sharing is the trust that patients have in us to share and to hold their data in a way that is beneficial for them as individuals, and potentially sometimes beneficial for the population, but not to share it for what you might call retail use. One issue with data control is that most general practices are small businesses with a small number of staff working flat out. That legal obligation of a data controller looms large for them, whereas it does not loom as large for large NHS organisations—although, technically, the impact is as hard. I do not mind who controls the data; what we need to do is to find a way to enable that data to be shared safely and with a belief that it is done for patient benefit. I do not think it matters whether GPs maintain data control, with something else happening to support them, or whether it is taken away from them; it is about how we enable that to happen. But I do think that general practice struggles more with resilience. Kay Keane: I think that is true, in that we are generalists, not experts in a lot of areas. Certainly, we can be very good data controllers of our own data—the stuff that we produce, and that we write and code about our patients. We have to code things to be able to respond to our contract, so we have to be good at that. Things fall down when information comes from other providers, which we have no control of. That would be an area of real concern—that such information would be part of our property and our jurisdiction. I guess it is about the detail of how that record will be structured. If it is a brand-new thing and we all feed into it, that is very different from all the data coming to the current healthcare record that we hold. I think the detail is not there yet to enable us to describe who should be the data controller, but certainly I do not think that any practice manager would want to control data generated by someone other than themselves.
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Health Bill (First sitting)
Q Do you think anything else should be on the face of the Bill to give us clarity so that that GP concern is mitigated? Kay Keane: The patients need to understand exactly who has access to that record and exactly who is feeding into it. There is a huge amount of trust between a patient and a GP, and a patient and a healthcare professional in a general practice, and we do not want that trust to be diminished so that the patient stops telling us the things that are worrying them—the whole story. We want them to continue their trust, but if they think that information is spreading further and further across the system, we might lose some of it.
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Health Bill (First sitting)
Q I re-declare that I am a member of the all-party parliamentary group on patient safety. We have heard this morning about a tension between needing to be able to report when something has gone wrong that HSSIB has become aware of to ensure that it is dealt with—the example given by Dr Dash earlier was a maternity failing—and the importance of a safe space, so that people can report to HSSIB when something has gone wrong and then HSSIB can make the appropriate recommendations to change the problem within the system that has led to that issue. Can you talk a bit more about that tension? What is the best way to manage that? Dr Benneyworth: First, we do not replace local investigations. If something goes wrong, the local teams are very much responsible for investigating their work. Dr Dash talked about the new processes around PSIRF and the new investigation processes, which we fully support. In fact, our education team have had 40,000 people enrolled over the last three years, free of charge in the NHS, to support them in developing those investigation skills, really supporting that excellence in local investigation. We have a long way to go there, because they are variable in quality. We do not replace that immediate, “There has been an incident and it needs investigation.” We know that, quite often, the things that need to change are not sitting within one provider. We know that the same things are happening in Cornwall and Cumbria and everywhere in between, and that they often need national solutions to change. As a recent example, we published a report a few weeks ago looking at the care of people in mental health crisis in emergency departments. That showed that the legislation around the care of mental health patients is not supporting people in emergency departments to look after these people properly. That is not something that can be changed by a regulator. The CQC going to look at that emergency department will not impact that. It is not something that the individual provider can change, but we can make national recommendations about it to change the national system to enable people on the ground working in health and care to do their job properly. We can make sure that the systems and processes really consider how things work, and really change them so that providers and systems locally can do their job.
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Health Bill (First sitting)
Q What could be changed in this legislation to ensure that HSSIB can retain trust and independence from the regulatory body? Dr Benneyworth: There needs to be much more clarity about governance and how that will work in the legislation to protect independence. There are potential compromises that could happen, such as a Healthwatch-style model that has its own independent leadership within the CQC, its own governance arrangements and, importantly, its own identity. That would enable it to keep its independence, while being part of a larger organisation. In the legislation, it is vital that there is a legal duty for the CQC to protect safe space.