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1. 2 Jul 2026·Parliament·Gregory Stafford

   Health Bill (Tenth sitting)

   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.

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2. 2 Jul 2026·Parliament·Gregory Stafford

   Health Bill (Tenth sitting)

   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.

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3. 2 Jul 2026·Parliament·Gregory Stafford

   Health Bill (Tenth sitting)

   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.

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4. 2 Jul 2026·Parliament·Gregory Stafford

   Health Bill (Tenth sitting)

   While I agree with the points made by the hon. Member for Winchester, I note the irony that he is talking about how he wants more independence in this clause, whereas the amendments he tabled previously would have taken independence away from the ICBs—but hey, ‘twas ever thus with the Liberal Democrats. On the new powers in clause 43, we have previously discussed the power of the Secretary of State to direct how ICBs use and manage both financial and other resources, impose expenditure limits, require approval of local decisions and compel repayment of funds where directions are not followed. These provisions substantially weaken the operational independence of ICBs, transforming them from organisations that are intended to exercise local strategic leadership, as my hon. Friend the Member for Sleaford and North Hykeham said, into bodies primarily responsible for implementing centrally determined priorities. Such centralisation risks diminishing the flexibility required to respond to local, demographic, clinical and population health challenges. The timing of these legislative changes also raises significant concerns, because they coincide with the abolition of NHS England, the redistribution of its functions and the requirement for ICBs to reduce their operating costs by at least 50%--and, in some cases, even more than that. Collectively, those reforms represent one of the most significant reorganisations of NHS governance. However, there remains little clarity regarding which responsibilities will remain with the ICBs. The clause makes it even less certain which responsibilities will transfer to regional teams or providers, and how accountability will operate across the system. Introducing substantially enhanced ministerial powers before the future operating model is fully defined, as we have discussed with regional mayors and other bodies, will essentially risk creating uncertainty, duplication and potentially gaps in oversight.

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5. 2 Jul 2026·Parliament·Gregory Stafford

   Health Bill (Tenth sitting)

   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.

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6. 2 Jul 2026·Parliament·Gregory Stafford

   Health Bill (Tenth sitting)

   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.

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7. 2 Jul 2026·Parliament·Gregory Stafford

   Health Bill (Tenth sitting)

   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?

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8. 2 Jul 2026·Parliament·Gregory Stafford

   Health Bill (Tenth sitting)

   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?

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9. 2 Jul 2026·Parliament·Gregory Stafford

   Health Bill (Tenth sitting)

   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—

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10. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Tenth sitting)

    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.

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11. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Tenth sitting)

    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.

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12. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    In essence, we debated the amendment in a Westminster Hall debate some months ago, when I had the dubious honour of being the shadow spokesman for the Conservative party despite not being a Home Office shadow Minister. It became clear in that debate that mandatory medical markers do not exist. It is still a voluntary system. How does the hon. Gentleman propose to make the system equitable? The hon. Gentleman and I support mandatory medical markers, and there seemed to be cross-party support for them in the Westminster Hall debate. If they are not mandatory, some people will potentially be put under a different system, because their sufficiency or ability to hold a shotgun licence could be taken away from them, while those who are not on the system, because it is not mandatory, would not lose theirs. How does the hon. Gentleman deal with the equity issue and the potential for some people to be missed?

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13. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    It is a pleasure to serve under your chairmanship again, Ms Lewell. On amendment 71, I ought to declare that I am a supporter of the Countryside Alliance. Although I do not own a shotgun myself, I represent a large shooting community and I have been on a shoot relatively recently, but without a gun, so I did not shoot anything. As I alluded to in my intervention on the hon. Member for Winchester, I spoke on this issue in Westminster Hall some months ago, when it was clear to me that there was a significant level of cross-party support for the idea of mandatory markers for GPs. As mandatory markers for firearms licensing are technically a Home Office issue rather than a Department of Health and Social Care one, the Under-Secretary of State for the Home Department, the hon. Member for Dover and Deal (Mike Tapp), responded to that debate, but he was unable to reassure us that provision would be made. I did not understand the arguments he made, because I think mandatory markers are probably the way forward. Given that they are supported by organisations such as the British Association for Shooting and Conservation and the Countryside Alliance—organisations that one might not have expected to be in favour of them—the Government should look into the idea. There would clearly be a benefit to the proposal in amendment 71. If a patient who holds a firearms licence presents a serious medical risk because of a mental health crisis, suicidal ideation or behaviour that raises concerns about risks to themselves or others, an immediately visible marker would help clinicians to make informed decisions and take the appropriate safeguarding action. But a firearms licence is obviously not a medical condition, nor is it health information in any traditional sense. This goes back to the point I made in the debate on a previous amendment, about how broad the information that we keep on the single patient record will be. The inclusion of such a marker across the single patient record could lead to issues relating, as we talked about in previous debates, to who would want to see that information. For example, there may be people out there who are not in favour of recreational shooting, and someone may hold a firearms license for recreational shooting. Of course, section 2 firearms licences, especially for shotguns, are often held by farmers and people involved in conservation, and for all sorts of other reasons, including the control of pest populations. But if someone has a licence for recreational use, there may be people who, for whatever reason, find that to be against their own beliefs and opinions. That might lead to a patient being subjected to a level of intrusion or bias, or perhaps not receiving the care they deserve, because someone has made an assumption about what they are like based on that information. We need to be careful about that.

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14. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    I thank my hon. Friend for that helpful intervention; I had not appreciated that. If that is true, the security and safety of the individual who holds the firearms licence, and indeed of anybody else in the vicinity, is paramount, and we generally would not want people to know precisely where guns are held, because that could be a security risk. I think the hon. Member for Winchester has the best of intentions, but the consequences have not been fully thought through.

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15. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    I will, but first I want to be kind to the hon. Gentleman and say that, as with his previous amendment, he has opened up a conversation about the single patient record that we really need to have, to ensure that what is on it needs to be there for the treatment of patients. As legislators, we need to have a wide conversation to decide what it includes and how it is going to be used.

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16. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    I admire the hon. Gentleman’s optimism. I am not belittling his point—I, too, hope that no one would be treated, both in the traditional sense and in the medical sense, based on their background or anything else, including their recreational hobbies. Unfortunately, we have seen cases in the NHS in which someone’s religious background has led to antisemitism and other unfortunate issues. Unfortunately, sometimes the system itself has a problem. The Health and Social Care Committee published a report relatively recently on black maternal health. We could see the difference and the fact that, unfortunately, black women experience a worse level of care, often because of assumptions made about their backgrounds. I agree with the hon. Gentleman that I hope everyone is treated dispassionately, but I am afraid it does not always happen. We need to make sure that we root out that kind of behaviour, but we also need to protect people from it. Amendment 72 is another that was tabled with the best of intentions. The improved identification of veterans is an interesting idea, because I do not think many veterans actively identify themselves when they access healthcare. A visible marker could help to ensure that healthcare professionals are aware of a patient’s service history without relying on self-disclosure. There may be direct benefits to a veteran, because they may be eligible for dedicated NHS services—including mental health, rehabilitation and other veterans’ healthcare pathways—through the armed forces covenant. A marker could, then, assist clinicians in directing patients to appropriate support more quickly.

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17. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    As we move towards a single patient record, we have to ensure that technological progress does not come at the expense of those who are least digitally connected. As others have said, I am particularly concerned about older patients and many disabled people, who often rely most on NHS services but can face the greatest barriers when healthcare systems—and all systems—become increasingly digital. For some elderly patients in my Farnham and Bordon constituency, navigating online platforms is challenging, and others may not have regular access to the internet at all. Unfortunately, my constituency has one of the worst full-fibre broadband roll-outs in the country, and it has extraordinarily poor mobile phone reception in the central rural parts of the constituency, despite my best efforts with BT Openreach and others. Disabled people may also face accessibility barriers that these systems do not always anticipate in their design. Modernisation should never mean creating a two-tier NHS—one for those who are digitally confident and another for those who are not. The people at risk of being left behind are often those with the most complex healthcare needs and the greatest reliance on the continuity of care. A proper assessment of digital exclusion is therefore not just a bureaucratic exercise, as some may describe it; it is an essential safeguard. We need to understand how the single patient record will affect elderly patients, disabled people, carers, those with learning disabilities and those who may struggle to engage with digital services.

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18. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    For me, the key thing is that we must have equity of access to the single patient record. If somebody wishes to see their own medical record, they should be able to do so, whether they are digitally savvy or not. As far as I can tell, that is the intention behind the Liberal Democrat amendment. However, the hon. Gentleman raises an interesting point. We are seeing this already, but the more we go down the digital route—because it is more efficient and straightforward, and takes out the unnecessary bureaucracy of having a human interaction to book an appointment or whatever—the more likely it is that this will become the portal for all interactions. I am not saying that that is the Government’s intention, but he raises a point, perhaps inadvertently, that we need to think about. To conclude on amendment 70, before we proceed any further, the Government should be able to demonstrate that no patient will receive a worse service, face greater barriers to care or lose access to information simply because they are older, disabled or less digitally connected than others—that goes to the heart of fairness and equity of access in our NHS. I am absolutely certain that the Minister does not wish that to happen, but it would be interesting to hear how she will ensure that it does not happen. Amendment 49, in the name of my hon. Friend the Member for Sleaford and North Hykeham, would prevent the Secretary of State from making regulations to establish the single patient record unless a public awareness plan had first been published and laid before Parliament, and a minimum three-month public information campaign had been conducted before the system went live. That seems eminently sensible, and I hope it is something that would be not just welcomed by Ministers, but on their agenda already. Patients clearly have a right to know what information is being held, who will have access to it, how it will be used, what safeguards are in place and what rights they have in relation to their own data before the system goes live. A three-month campaign to give them that opportunity would be appropriate, because the things that I have outlined are not technical details that need to be buried in some Government website or hidden in the small print of a privacy notice; they are fundamental questions that deserve proper public engagement. I am especially supportive of amendment 49 because of the impact on older people, disabled people and those who are less digitally engaged. I do not think that most of my constituents spend their time reading NHS policy documents online—my notes say “most”, but I think none of them do, unless they are involved in the health world themselves—and they should not wake up one morning to discover that a major change to the management of their health information has already been implemented without their knowledge. A public information campaign is not a bureaucratic hurdle; it is a democratic necessity. If Ministers are confident that the single patient record will improve care, strengthen efficiency and protect privacy, they should be eager to make that case to the public and should therefore welcome the scrutiny, transparency and informed debate that a three-month public information would bring.

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19. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    On a point of order, Ms Lewell. Are we not voting on amendment 49?

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20. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    As my right hon. Friend has just said, this is a unique system that will have unique benefits, but it will also have unique risks. Almost in answer to the point made by the hon. Member for Ashford, I do not think there is anything—[Interruption.]

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21. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    Before I was rudely interrupted by the fire alarm—I am not taking it as a hint, much to the Minister’s disappointment—I was saying that this is a unique system and that with the unique benefits come unique risks. I was trying to answer the points made by the hon. Member for Ashford. As my hon. Friend the Member for Sleaford and North Hykeham and my right hon. Friend the Member for Melton and Syston have mentioned, we already know that despite the regulations, whether they are from professional regulators or the ICO, people will get round the system. One of the biggest concerns that patients will raise is not simply whether patient records will be accessed by nefarious people from outside, such as cyber-hackers, hostile states and so on, but whether they are secure from inappropriate access by people who have access to the system. As my hon. Friend the Member for Sleaford and North Hykeham pointed out, those people could be situated anywhere across the country. Patient records should be accessed only where there is a clear clinical, professional need. The public rightly expect robust safeguards, strong audit trails and meaningful consequences where the rules are breached. Amendment 48 raises that important issue. The Minister should explain how inappropriate access will be prevented, how misuse will be detected and what sanctions will apply when the standards are not met. My hon. Friends have already mentioned a number of cases and I pick another one: the unfortunate case of the three-year-old boy who was hospitalised after being attacked by a crocodile at a zoo. Cambridge University Hospitals trust is currently investigating 40 members of staff who appear to have accessed that boy’s medical records inappropriately. While we would always hope that that would not happen, unfortunately it clearly does. This single patient record means that someone will potentially be able to look at patients’ records regarding anything and from anywhere in the country. My hon. Friend the Member for Sleaford and North Hykeham slightly generously described some people as “nosey”. Along with those who have an actual ulterior motive, that presents a real challenge. I say to the hon. Member for Ashford that just because the current system is in place to protect patient records as they currently exist, that should not be a bar to making sure that we make the system even more robust given its potential risks. It goes directly to proposed new section 250F(4B)(b) of the National Health Service Act 2006, which is the system of audit logging to be applied to each record, so that every time someone accesses a patient record or part of that patient record, the identity of the person obtaining that information should be recorded. I believe that the patient should be able to easily see, hopefully in real time, who has been accessing their record and at what time. We on this side have mentioned a number of big events: that poor boy with the crocodile, terrorist attacks in Southport and so on. I suspect that those data breaches have been identified because they were big events. People have gone out to check that nobody has been inappropriately accessing those records. I worry that every patient record will potentially be available to every single person, and I doubt that there will be an ability to check every single person proactively rather than reactively. That means patients need access themselves to look at their record and see who has been accessing it. If the name of the person who has accessed the record, or the organisation they belong to is available, patients can say, “Well, there is Mr Smith, my child’s paediatrician, and that is fine. However, who is this guy from elsewhere in the country who has looked at the record?” They can then raise that. That is absolutely vital.

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22. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    My hon. Friend is right. I will not sit here and propose a solution to this problem, but what her amendment does is ensure that the Government look at this and present a plan before both Houses of Parliament, before we get to a single patient record. I have now touched on the nefarious and the nosey. I think there is also a case of inadvertent access. With this new system, despite what the professional regulators might think, and despite the best training from the Information Commissioner’s Office, there will be occasions in a new system where people do not understand the limits of what they are allowed to look at or the appropriateness of access. There could well be inadvertent access to these systems. Again, the Government need to have a plan and system in place to ensure that there is not inadvertent, non-nefarious access to patient records as well. That is why I am very supportive of amendment 48. To make sure that this system is trusted by patients, we need to have the highest level of safeguarding possible, both from external attacks and from internal misuse. My hon. Friend’s amendment goes a long way to putting some of that trust in place.

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23. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    I thank all those who have spoken so far in this debate. I have never seen the hon. Member for Lichfield so animated—Data Dave is clearly alive and well. As we have discussed, the clause creates the legal power for a single patient record in the UK. It is important to say, as others have, that the Bill does not create the system but gives the Secretary of State the power to create it later through regulation. That does not mean, however, that we should not have a debate about some of the issues that we have raised. I should state at the start that I support better information sharing when that helps patients receive safer and better care, and I think that the single patient record could well do that. Anyone who has worked in healthcare, as I have, knows the frustration that results from the records not following patients between services. Clinicians can lose valuable time in searching for information, if they can get it at all. As others have said, patients are often asked to repeat the same details over and again—not, as my hon. Friend the Member for Isle of Wight East rightly said, because it gives a richer experience but simply because people do not have the information. Better joined up records have the potential to improve care. We have, however, been here before. I was a lot younger—we all were—but back in 2002, the national programme for IT, under the last Labour Government, was a £10 billion unmitigated disaster, which the Public Accounts Committee described as “one of the worst and most expensive contracting fiascos in the history of the public sector.” I want to make sure that there are safeguards, from both a contracting and a data safety point of view, so that we do not go down that route again. As my hon. Friend the Member for Isle of Wight East clearly outlined, creating such a record is fiendishly complicated from both a technology and patient information point of view and from a data sharing and data protection point of view. The record could contain some of the most sensitive information about people, so Parliament has the responsibility to make sure that the legal framework is right. We also know that the record will work only if the data in the single patient record is worth the electronic paper that it is electronically printed on. As I am sure the Minister knows from her time in the NHS, the information is getting better but continues to be patchy across the country. Different trusts and organisations record things in different ways. I take my hat off to those who work in clinical coding, as they do one of the most difficult jobs in a trust. Again, we need to make sure that the data is accurate. Someone mentioned AI earlier; I think AI could help with that, but we are still some way off. I want to canter through my concerns about the breadth of the powers being given under the clause. The Bill allows the Secretary of State to make regulations establishing the system and to decide how it operates. Those regulations may require or authorise the sharing and processing of patient information, decide who can access the information and create enforcement powers and financial penalties. Some of those important questions are not answered in the Bill. Parliament is being asked to approve a broad framework before seeing some of the detail. My second concern is that the Bill says little about patient choice. There is no clear statement about whether patients will have the right to opt in or out and no explanation of whether patients can restrict access to all or part of their records. There is no mention of whether someone could choose to limit access to particularly sensitive information, such as mental health records, sexual health information or information about substance dependence. There are major questions for public trust but those are left, I would say, entirely to future regulations. We need clarity about them now. My third concern is the scope of the information that may be included. The definition of “patient information” is extraordinarily broad. It covers information about physical health, mental health, diagnosis, treatment and care, including social care. The definition of “patient” includes people receiving social care or having their care needs assessed. What we do not know from the Bill is exactly how that data will be presented. Will it use language that a patient can understand? Will it talk about having a heart attack, or will it use medical information that a medical professional will need to assess? Or will it include both, so that the patient knows that they have had a heart attack, for example, but the medic can see the precise detail on what sort of transient ischaemic attack it was. We need to understand what the data is recording and at what level of detail.

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24. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    Precisely. These questions need to be thought about when the Government are creating this system. As hon. Members have described in their speeches and in their amendments, the system could contain much wider information, including highly sensitive information about disability, safeguarding, care assessments, addiction, pregnancy, military service, caring responsibilities and many other personal matters. This is not simply about a hospital record; it is about bringing together health and social care information. That makes it even more important—indeed, essential—that safeguards be clear and robust. That leads me on to my fourth issue, which is confidentiality. The Bill says that where information is processed under the regulations, doing so will not breach any duty of confidence. I think that that is a significant legal challenge and change. Confidentiality has been one of the foundations of healthcare. Of course there are already situations in which information can and should be shared, but where Parliament is creating a new legal basis for disclosure, it is reasonable to expect strong safeguards alongside it. That brings me to my next concern. The Bill says that the Secretary of State must have regard to the need for “adequate safeguards”. That is welcome, of course, but the Bill does not say what those safeguards are. There is nothing in it about role-based access controls, audit logs or whether patients would be able to see who had looked at their records. There is nothing about minimum cyber-security standards, about how inappropriate access will be detected or about independent oversight. Those matters may appear later in regulations or in guidance, but they are not guaranteed in the Bill.

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25. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    On the hon. Lady’s specific question, I agree: the regulations will answer these questions. But I think it is entirely appropriate to have them asked here and to have a statement of the principles, at least, on a number of these things from Ministers, so that within a broad scope we can ensure that the Bill is appropriate. The amendments tabled by my hon. Friend the Member for Sleaford and North Hykeham, for example, seek to do so. They were clearly within the scope of the Bill; otherwise, they would not have been accepted. The next issue is geographical scope, which I do not think anyone has touched on yet. The Bill allows information to be made available to people involved in “health care or social care anywhere in the British Islands”. That naturally raises questions about governance across different health systems. How will information be shared between England and the devolved nations? I think my hon. Friend mentioned some of the self-governing territories. I assume that she meant the Isle of Man, the Channel Islands and places like that—Crown dependencies. What rules will apply? How will accountability work where different organisations operate under different arrangements? Again, the Bill does not answer those questions.

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26. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    I read the clause differently. I am sure that the Minister can provide an answer, but my reading is that the single patient record could be—but not necessarily that it must be—used in Wales and Scotland as well. I do not know whether it has to be used, but the clause, as I read it, suggests that it would be. If a patient is travelling from Oswestry to somewhere in Shropshire or vice versa—

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27. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    My geography A-level has clearly departed me. If a patient is travelling from somewhere in Wales to Shropshire, the single patient record would be used. That also presents challenges the other way, if Wales and Scotland are using different technological solutions and systems and operating under different legal frameworks. That is especially the case for Scotland: it has quite a different legal system from England and Wales, so there could be issues.

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28. 2 Jul 2026·Parliament·Gregory Stafford

    Health Bill (Eleventh sitting)

    That is an interesting question. I do not know the answer, but perhaps the Minister can pick that up. The Bill also creates powers for financial penalties. It sets out a process for notices and opportunities to make representations and a right of appeal. Those procedural protections are sensible, but the Bill does not tell us who might be fined or what conduct would trigger a penalty, and it does not set out a maximum penalty level. Those decisions, again, are left to regulations. It is also important to remember that the Bill does not replace existing data protection law, as I think the Minister outlined in her opening remarks. Organisations will still have to comply with the Data Protection Act and other UK data protection rules. However, the Bill would provide a new statutory basis for processing information through the single patient record. That makes the wording of the Bill especially important. Ultimately, public confidence will determine whether the system succeeds. People are generally willing for information to be shared when it improves their care, but they also expect transparency, security and accountability and expect to know who can see their information and why. Those expectations are entirely reasonable. There are several questions that I believe the Committee should ask before these powers are granted. Will patients have a genuine choice about participation? Will they be able to restrict access to particularly sensitive parts of their records? Who exactly will be able to access the system? Will patients be able to see a record of who has viewed their information? What minimum standards will apply? How will misuse be identified and punished? What independent oversight will exist? Those are not technical details; they are central to public confidence. In conclusion, the clause will create a legal framework rather than a system itself. It will give broad powers to establish the single patient record while leaving many of the most important questions to future regulations. Clearly most people support the goal of improving patient care, but because the system will involve some of the most personal information that people have, Parliament should ensure that patient rights, safeguards, transparency and accountability are clearly built into the framework from the beginning. It should ensure that questions are asked now rather than decided on later.

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29. 2 Jul 2026·Parliament·Gareth Davies

    Supply Chain Security

    Our most critical supply chains are those that are directly linked to our national security. From autonomous vehicles to blast protection, British small and medium-sized enterprises are the vital link in the supply chain, ensuring that our armed forces have the capabilities to face down our adversaries. The Government have said that the Defence Office for Small Business Growth has an important role to play in supporting the sector, so how is the Minister co-ordinating with the office? If I am a defence SME, how will it help me?

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30. 2 Jul 2026·Parliament·Gareth Davies

    Supply Chain Security

    I am grateful for that very comprehensive answer to a very different question—less of an answer, more of an interpretive dance.

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31. 2 Jul 2026·Parliament·Gareth Davies

    Supply Chain Security

    I just want an answer! Defence SMEs have said that the delay of the defence investment plan caused great uncertainty and disruption to the sector. In addition, they are completely confused by this Government’s endless offices, initiatives and quangos. Will the Minister commit—if he is still in position in a few weeks’ time—to providing more certainty to such an important sector?

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32. 2 Jul 2026·Parliament·Gareth Bacon

    Commonhold and Leasehold Reform: Managing Agents

    I thank the hon. Member for Vauxhall and Camberwell Green (Florence Eshalomi) for securing and leading this important debate. I pay tribute to the work of the Housing, Communities and Local Government Committee under her leadership, which generated a 159-page report containing a series of recommendations. I am conscious of time, Madam Deputy Speaker, so I will not comment on the remarks made by Members from all parts of the House, but I extend my thanks to all those who made considered and important contributions. The Opposition support leasehold reform. As we have heard many times, there are approximately 5 million leasehold properties in England and Wales, and it is clear that the leasehold system comes with problems and requires change. For too many leaseholders, the costs just keep piling up. In 2023-24, the average ground rent paid by a leaseholder in England was £304. Alongside that, there was a 5.8% increase in the annual service charge, taking the average annual cost to nearly £3,000. In London, those costs are even higher, with an average of £412 charged for ground rent and service charges sitting at about £8,000 in some modern high-rises. Even at their highest, the costs continue to rise, bringing more uncertainty for leaseholders. Service charges in particular can rise astronomically, leaving leaseholders having to pay thousands of pounds more than they ever intended or believed they would pay, and some flats virtually impossible to sell. On top of that, for too many leaseholders, the costs they pay come with no transparency about how their money is spent, how spending decisions are reached, and who signs off on them. Lack of clarity around these costs is a problem that policy makers cannot ignore. Knowledge of these problems is not new. In 2018, the then Government established a regulation of property agents working group under the chairmanship of the noble Lord Best. The group examined the key issues impacting leaseholders and the need for reform in the sector. The group issued its report in 2019 and proposed a new regulator and regulatory regime, and a new enforcement system. Neither the previous Government nor the current one did a great deal to bring that about. Seven years later, we still await any meaningful Government action building on the recommendations of the report, and the draft Bill is silent on that issue. It is not the only thing that leaseholders have to wait for. In two years, the Government have not yet implemented the full measures promised in the Conservative Government’s Leasehold and Freehold Reform Act 2024. The Government have said that they have their own plans for leasehold reform, but leaseholders have been told time and again to wait for a new Bill because of significant flaws in LAFRA. For two years, we have been told that primary legislation is required to fix the Act, but nothing has been done, and the draft Bill produced by the Government in January this year does not address the supposed flaws of the previous Act. That prompts the question: where is that legislation and what is taking so long? Why are the Government proposing to bring forward a Commonhold and Leasehold Reform Bill that does not offer these fixes? If the eventual Bill remains in line with the previously published draft Bill, when can we expect the next Bill to address those changes? Assuming this Parliament lasts for a full term, we are now 40% of the way through its life, and we have had more Secretaries of State in that time than actual leasehold reforms. The Housing Minister himself spent the end of his time in Opposition highlighting the need for speedy implementation of new rights for leaseholders, pressing the previous Conservative Government to “give us a sense of the timetabling of some of the more important provisions in the Bill, because leaseholders watching our proceedings will want to know when the rights provided for by the Bill can be enjoyed.” Well, he was clearly correct, so I wonder what the shadow Minister of that day would say to the Housing Minister of today. I believe he would ask the same question as me: if not now, then when? When can leaseholders expect to see their rights come into force? At the end of January this year, the Government published the draft Commonhold and Leasehold Reform Bill. According to the draft Bill, leaseholders can expect a ban on leasehold for most new flats; a new commonhold system, including rules for mixed use, mandatory reserve funds and quicker debt recovery; a ground rent cap of £250 per year for many existing leases, which reduces to a peppercorn after 40 years; abolition of forfeiture and the introduction of a more proportionate court-based enforcement regime; and the repeal of rentcharge powers on freehold estates. Perhaps most eye-catching of those is the much-touted ground rent cap, as the Chair of the Housing, Communities and Local Government Committee set out in her opening speech. The Opposition recognise the need to support leaseholders facing high costs, but while capping ground rent may sound like a silver bullet, for many leaseholders it might be closer to a damp squib. That is because ground rent is usually nowhere near the level of service charges, which can have a genuine and very real impact on a buyer’s ability to find a mortgage. For the many leaseholders burdened by excessive and unclear service charges and rising council tax, the ground rent cap is a mirage in a desert of higher council taxes, escalating service charges and poor building management. While this move may have some marginal benefit to leaseholders, there could be ramifications elsewhere. Investors have expressed deep-seated concerns about the potential impact on investor confidence and faith in the UK system. That is because the UK has long been seen as a safe, secure and predictable place for sound investment, and ground rent investments, favoured by UK pension funds among others, have become an important part of that environment. The Government’s plans to unilaterally and retrospectively revoke key aspects of pre-existing ground rent contracts have rippled through our financial districts and risk significantly negative impacts on investor confidence, with a wider undermining of our economy. The risk of freeholder insolvencies does exist and could be dangerous, as the Government know because their own impact statement lists freeholder insolvencies as a realistic cost that could have spillover impacts on leaseholders. If the Government get this wrong, there could end up being a significant, albeit unintended, risk to leaseholders—people with families and mortgages, or those living in their first home. All of this prompts the question: why is the Government’s focus on ground rent and not service charges? I hope the Minister will take the necessary time to address these very real fears and explain his choice. As outlined by the hon. Member for Vauxhall and Camberwell Green in her opening speech, one of the main focuses of today’s debate concerns the question of the regulation of managing agents and the Select Committee’s recommendation that clauses providing for this are inserted into any forthcoming Bill. We have heard compelling arguments from hon. Members from across the House, and powerful testimonies. With the Government’s plans for a wholesale market conversion to commonhold, this issue becomes all the more pressing. That is because in moving to commonhold, there is the prospect of responsibility for building safety and management for thousands of flats moving from professionals to residents. That might work perfectly with a dedicated, well-trained and attentive residents’ committee at the helm, but what about the multitude of buildings where that may not be the case? What happens when the roof begins to crack, the water starts to seep in and the lifts begin to break down? What happens when the sinking fund has been drained and the residents’ committee chair, who might be under mounting social pressure, is forced to cut service charges to unhealthily and impractically low levels? If commonhold is to become the norm, we must ensure that the Government are not laissez-faire in how they implement the system. They must not blindfold residents who may sleepwalk into a situation in which their homes are under management without proper training, a strong mandate and adequate knowledge of building safety and flood risks. To guard against that, it may very well be that commonhold residents choose to hire a managing agent to care for their homes. Managing agents exist today—some are good, and some are not—but, as I outlined at the start of my speech, many leaseholders have spoken about the bad experiences they have had at the hands of some agents. The difference between managing agents being appointed under a commonhold system rather than a leasehold one is that the managing agent’s client would be the homeowners themselves, not a distant freeholder. The residents themselves would have the power to hire and fire the managing agent. That is why the Committee’s recommendations are so important. If there is to be a regulator, it must have teeth, as the noble Lord Best said in his 2019 report and implied again in his evidence to the Committee on 10 March, and as the hon. Member for Vauxhall and Camberwell Green said in her speech. If there is a regulator, it is absolutely crucial that it works as intended. It would need to have the requisite expertise, personnel and budget to discharge its duties efficiently. Lessons must be learned from the failings of other regulators, such as the Building Safety Regulator. The Government are considering bringing their Bill forward and examining the Committee’s work. If the Government decide to heed the recommendations of the Committee, I hope the Minister will commit to working across parties and with the whole industry to ensure that the Government get it right the first time.

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33. 2 Jul 2026·Parliament·Edward Argar

    Health Bill (Tenth sitting)

    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.

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34. 2 Jul 2026·Parliament·Edward Argar

    Health Bill (Eleventh sitting)

    I want to speak primarily to amendment 49, in the name of my hon. Friend the Member for Sleaford and North Hykeham, the shadow Minister, and to agree with what my hon. Friend the Member for Farnham and Bordon has just said. Sadly, there will be a large number of people who do not follow the debates in this House or this Committee in great detail, however fascinating they may be. That is perfectly understandable. The single patient record has genuine potential. It has the potential to put all the different bits of data in one place, so that when, for example, someone is blue-lighted to hospital, their consultant or the doctors treating them in A&E can access the information they need about their medical history and any medications they are on, which could improve clinical outcomes for patients. I can entirely see the potential of the single patient record, but I am also conscious of the genuine concern among those of our constituents who are aware of this about what it might mean in practical terms for them and their data—it is important to remember that it is their data. They will have concerns, as my hon. Friend the Member for Farnham and Bordon set out, about who can access it, what safeguards are in place, whether they can opt out, and a range of other legitimate questions about how it will work. I have to say that amendment 49, tabled by my hon. Friend the Member for Sleaford and North Hykeham, is not unreasonable. It would give the Government an opportunity to reassure our constituents and bring them along on this journey, rather than leaving questions unanswered or just addressing them in a Q&A on a Government webpage. People have genuine questions, and in many cases I am confident that the Minister will be able to allay those concerns or put them to rest, but some campaign of that sort is needed. Such campaigns happen regularly on a range of subjects. The Department of Health and Social Care spends a significant amount of money on public health and awareness campaigns, and His Majesty’s Revenue and Customs spends a large amount of money on reminding everyone to get their tax returns in on time, in the lead up to that, or to remind them of the penalties if they do not. Government do that day in, day out across a range of services and where major changes are being made. The Government have a genuine opportunity to accept amendment 49, which will help them to bring the people we serve on this journey, and potentially help to realise the benefits and allay people’s concerns. I genuinely hope that the Minister will be able to accept the amendment or will commit to take it away, look at it, engage with my hon. Friend the shadow Minister and possibly bring back a Government amendment that does exactly this on Report.

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35. 2 Jul 2026·Parliament·Edward Argar

    Health Bill (Eleventh sitting)

    The hon. Member for Ashford made his point very clearly about what happens when something goes wrong and someone behaves inappropriately—the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham, has highlighted some very concerning recent incidents—and was right to highlight the ability to follow an audit trail and take action. He is also right to highlight the importance of training. However, taking action once inappropriate access is known, and then following the audit trail, deals essentially with the consequences rather than preventing it from happening in the first place. That is why amendment 48, and particularly proposed new section 250E(4B)(a) of the National Health Service Act 2006, is important. It describes the technical controls. That goes beyond the audit process and what happens after something has gone wrong. It is about what can be done to build safeguards into the system to make it much harder for anyone to circumvent their obligations, and to build those technical safeguards into the overall design of the single patient record. That is a reasonable ask, because such incidents, while hopefully rare, as the hon. Member for Ashford alluded to, do happen and understandably cause concern. The challenge is that there is potentially a lot more information in one place, rather than being held in different pots, trusts or GP surgeries. For those inclined to break their legal obligations and behave outside the rules, the potential opportunity to access a wider range of information is more significant. The design of the record needs to have those technical safeguards strengthened and built in.

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36. 2 Jul 2026·Parliament·Edward Argar

    Health Bill (Eleventh sitting)

    That is the challenge. The Minister knows her brief very well—if I may say, I hope that whatever happens in a few weeks’ time, she retains it. She is that rare thing among Ministers in Government: someone who comes to their position with a hinterland of knowledge, experience and interest, which she has demonstrated through her period in office thus far. I hope that she retains her role, because continuity of Ministers in Government is a good thing. Can the Minister reassure us on the shadow Minister’s point, which is one that I have been seeking to make? Can she reassure us that the system will include barriers to prevent whoever builds and operates it—whether a third party or someone internal—from having inappropriate access to the records? The data must be ringfenced and protected, so that it does not go out of the country and cannot be accessed by those who are technically running or providing the platform. Even within the social care system, there must be very clear and technical restrictions on who can access the records for legitimate purposes, as the hon. Member for Ashford has highlighted. I think that would just reassure people. As I said in response to previous amendments, I think the potential of the single patient record to improve clinical outcomes in care is very significant, but we need to bring people with us. I suspect that if anyone can reassure us on those points, it is the Minister.

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37. 2 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Tenth sitting)

    The amendments would introduce a primary care investment standard, requiring the ICBs to increase spending on primary care services at least in line with the growth of the total funding that they receive. The Secretary of State would be able to implement financial penalties if ICBs failed to comply. As the hon. Member for Winchester said, we do not need to talk about the importance of primary care, because we all know it is very important and quite efficient. The Darzi report said that primary care is one of the most financially efficient parts of the NHS. The challenge is that demand is increasing across the whole system, and unless overall funding is increased, then giving primary care a bigger share must mean giving somebody else a smaller one. My other concern is about how the hon. Gentleman thinks this will be measured. Is measuring inputs rather than outputs really the right way to run the health service? We have tested almost to destruction the idea of just giving more and more money, which I suppose is why the Government have introduced this Bill: to try to reform things and make them more efficient. We can argue about whether they are doing that well or not, but that is the thrust of what they are trying to do. I think the idea behind the amendments is interesting, but I would be interested to hear more about how the hon. Member thinks the standard would work, and in particular whether he thinks it could be justified if there was huge unmet demand in the secondary care or mental health sector. The balance of need may change over time, and if it does, then legislating for a set proportion to go on this or that type of care, rather than on delivering this or that type of outcome, might not be the right approach.

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38. 2 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Tenth sitting)

    Amendments 9 and 10 have some similar issues to the last two Liberal Democrat amendments. They referred to the primary care investment, while these amendments refer to the mental health investment standard, which seeks to define the proportion of NHS money spent on mental health and maintaining it at a static position. Essentially, similar arguments apply. In 2016, the mental health investment standard was brought in, albeit not on a statutory footing, to ensure that mental health got the attention it deserved and that the resources provided to it were higher, because the number of people with mental health problems was increasing. There was good sense to that. However, the challenges to the NHS evolve over time. If the standard were to be fixed in statute, what effect would that have? Would that create an upper limit on spending on mental health at a time when mental health was increasing in prevalence as a problem? Would it increase the lower threshold when the reverse was the case? The Government need flexibility. I would hope that the Government make the right decisions, but that is the democratic process, and they need the flexibility to make the decisions that are appropriate for the time, rather than having this fixed in place. If we look at current waiting list figures on the Government’s referral to treatment dashboard, in general, the number of people waiting has risen in the last month for which figures are available. If we look in particular at people who require an admission to hospital for a procedure or operation, the numbers are higher over the last month, and also over the last year, for all types of admissions. Not all mental health figures are covered in the dashboard, but those that are have improved slightly in the last month. The point I am making is that things fluctuate over time, and the Government need flexibility to deal with that. Let me turn to new clauses 33 and 34. As a rural MP, I have some sympathy with the point that the hon. Member for Winchester made about rural healthcare. It is more difficult to get to the major, tertiary centres that provide the most up-to-date treatments. People might have to travel quite long distances to get to the doctors they need to see or to visit in-patients. Of course, those individuals also face transport costs, as we discussed in a previous sitting. I note for the record that I am a member of the Royal College of Paediatrics and Child Health and the British Medical Association, and an NHS consultant paediatrician. Last week, the Children’s Commissioner published a report that found that 60,000 children were waiting for more than two years for support; the Royal College of Paediatrics and Child Health has also sounded the alarm about the number of children attending A&E because of mental health service issues. In that sort of the situation, the Government might want to move money from A&E services to mental health support to prevent A&E admissions. They may also need to do the reverse, in order to treat those A&E admissions in the first place. Flexibility is required. New clause 34 would create a duty for the Secretary of State and any relevant body or authority carrying out functions under this Act or the Mental Health Act 2025 to “promote mental health wellbeing among the people of England.” That is a statement of his job, and a statement of the obvious; if the Minister is responsible for the mental health services of the country, of course he has a duty to make sure that they do their jobs properly. It is a nice amendment—it is one of those things that it is politically difficult to vote against—but I would ask the hon. Member for Winchester what practical effect he thinks it would have on mental health. Does he think the Secretary of State is not thinking about mental health? I do not sit on the same side of the House as the Secretary of State, but I think he is interested in mental health and wants to do his best job. Does the hon. Member for Winchester think that is not the case? What does he think the new clause would achieve in practice?

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39. 2 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Tenth sitting)

    Clause 43 is particularly long: it runs to almost two pages of text. Essentially, clause 43 transfers the responsibility for funding ICBs, and deciding how they use the resources, from NHS England to the Secretary of State. In many cases, that is consistent with the Government’s plan to abolish NHS England, take decisions and responsibility in-house, and get some more control. One thing that does not make sense to me is that the Government are talking about devolving control and decision making, yet this clause gives the Secretary of State powers to control spending, direct how ICBs spend money in different areas, and penalise them if they do not do what they are told. The Minister has also talked in this Committee about a vision for the future in which ICBs are consistent with mayoral authority areas, and mayors sitting on ICBs to provide some sort of democratic accountability. But how can mayors be held democratically accountable if they are, or might be, overruled by the Secretary of State? How does the Minister see that working? Also, greater financial intervention powers for the Secretary of State, if used, could expose ICB budgets to short-term political pressure, such as funding for a specific health area that has received celebrity or media attention. How would the Minister guard against that? If the Secretary of State is able to contest financial decisions taken by ICBs, will that slow down decision making and make things more “sticky”? Essentially, the changes seem to go against the Government’s stated aim of a more devolved and autonomous operating model for the health service. I would be grateful for the Minister’s comments on that. Clause 44 is a little shorter. It essentially makes changes to the joint duties of ICBs and providers. Some of those changes are again necessitated by the abolition of NHS England; keeping some of the sections would result in overlapping systems, so those make more sense. But the duties requiring ICBs and their partner trusts to achieve overall system balance are repealed. That goes against the collaborative principle behind the creation of integrated care systems, and makes it more difficult to manage financial pressures across a geographical footprint. If, in a particular year, there is financial pressure in one area of an ICB but less so in another, it is not able to transfer things so easily between those areas. How does the Minister expect that to work? Clause 44 also allows the Secretary of State to set objectives for “one or more” partners. Is that discretionary or are there criteria for it? If it is discretionary, what would prevent the Secretary of State from selectively choosing which trusts are bound by joint objectives and which are not? How will that decision be made? How will trusts know whether it is likely to be made, or in what circumstances it could be made? This could undermine consistency of treatment across different ICBs and trusts. I will be interested in the Minister’s comments on those points.

    Hansard source
40. 2 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Tenth sitting)

    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.

    Hansard source