Sir Jeremy Wright
MP for Kenilworth and Southam · Conservative · United Kingdom
“I applaud my right hon. Friend’s passion and clarity on this issue. On the subject of democratic accountability, he knows that if, as the hon.”
“I welcome the intent that the Secretary of State has set out this afternoon, and the urgency with which she will require the relevant companies to act.”
“The Electoral Commission has made no formal assessment of this. It would be a matter for Parliament to introduce such legal protections. It is prescribed in law that poll cards and ballot papers must be provided in English or Welsh, but there are no other prescribed language requirements relating to election materials.”
“We can all cynically speculate about the reasons why this sudden about-turn has taken place this week, but, as my hon. Friend the Member for West Suffolk (Nick Timothy), who spoke from the Front Bench, said earlier, it is our job to scrutinise this legislation and to ensure that whatever we put in place does justice to the determination o…”
“In today’s version of the amendment paper, for the first time, that amendment has disappeared and been replaced not with the detailed compromise that Intelligence and Security Committee members, who have been engaged with this process, have been working towards, along with many others, but with Government amendment 157.”
“As the House would expect, we engaged with that process as diligently as we could, with no partisan politics, in an effort to make good law in the pursuit of greater state transparency while preserving our national security equities. As the hon.”
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“If the public are to have confidence in the system and remain engaged with it, they must also have confidence in how police priorities are assessed and implemented. It seems perfectly right, as the Green Paper says, that we should look at the vulnerability of the person who makes the phone call and expects the police visit when determining whether the request for such a visit should be viewed as a priority. It is also important to look in a wider sense at how we define vulnerability. Of course, in many cases, it is not a priority to respond to an incident of domestic violence or harassment, but if that violence and harassment occurs in the context of a long-running saga, repeated events or perhaps when a violent partner returns from a period in custody, it should be viewed as a priority.”
“Sometimes, too, the public do not receive a visit when they expect or as quickly as they would like. I was pleased to see that the Green Paper made reference to that in respect of the new national standards on how quickly people should be responded to. In order for that process to make sense, there must be a reasonable way in which to assess police priorities in terms of response times. We all understand that the police cannot be everywhere at once and cannot respond quickly to everything, so there must be a reasonable method according to which the police may determine which cases are a priority and which are not. I cannot be the only Member who has had long arguments with their local police forces about how that process is carried out.”
“It has been clear throughout the debate that the proposition we are discussing is not only about public engagement in fighting crime, but, linked to it, whether public confidence is sufficient to enable them to engage in an enthusiastic manner. I want to focus on two particular aspects of the process that is followed by all those who have engaged with the police and the criminal justice system. Let me start with the police and with the point at which people first make contact with them, which is hugely important. First contact may be made by phone. As my hon. Friend the Member for Upminster (Angela Watkinson) mentioned earlier, it can be difficult getting through to the police by phone, and when that happens the public’s perception of the police does not start on the right footing.”
“I wonder whether my hon. Friend would agree, based on his experience of criminal practice—and I ask him this based on my experience—that the mystifying thing about paperwork is that there are seven, eight, nine or 10 forms for a police officer to fill in, but no more than one or two find their way to the criminal prosecutor whose job it is to secure a conviction. Does he wonder, as I do, what happens to the rest of them?”
“Does my hon. Friend agree that it is even more important that we have a good legacy for tourism? Those whom I represent in my part of Warwickshire are unlikely to receive a direct legacy from the sporting events and are unlikely to see a significant increase in grass-roots sports. They might see an increase in tourism from those who come to London and are then persuaded to leave London and to visit the rest of the country. If they do not see that legacy, it will be harder to persuade them to get fully behind the Olympic ideal, as we would all wish them to do.”
“Does the Minister agree that along with the undoubted advantages of alternative business structures comes the risk that the public will perceive that they are not receiving advice as independent as the advice that they previously received from a separate set of professionals? Will she make sure that when the structures are implemented, particular attention is paid to the independence of each of those professionals under one roof, to make sure that the public not only get independent advice, but perceive that they do?”
“Does the Minister agree that if there is a good argument for the retention of DNA samples in the circumstances that we are describing, it would be far better for the Government to make the argument for a comprehensive DNA database straightforwardly to the House and the wider public, so that we could debate the merits of the proposal? If he is looking for an opportunity for such a debate, I notice in the Order Paper that there is a chance for a general debate on a home affairs related topic next Thursday.”
“When the relevant report just referred to was written, I was a member of the Constitutional Affairs Committee, along with the hon. Member for Southampton, Test (Dr. Whitehead). The report makes it clear that the reform will work only if it is a package of measures that hangs together. Does my right hon. Friend agree that what is most disappointing about the Bill is that it deals only with a few of the reforms proposed by the Constitutional Affairs Committee, and that the ones that are not proposed seem to be those that are most inconvenient to the Labour party?”
“I apologise to my hon. Friend and to the House for arriving even later for this debate than he did. On his point about role models, does he agree that one place that the young boys without father figures whom he describes look to for a male role model is either the sports industry or the music industry? Is it not a good idea for those seen as role models in those fields to send out precisely the right messages not just about gun crime, which they have done, to their credit, but about knife crime?”
“Of course information should be available to self-funders. As the Minister knows, they often end up on the doorstep of the voluntary sector, which does a fantastic job in pointing them in the right direction. Does he think there is any scope for the Government to do more to help that sector to provide advice, rather than providing it directly?”
“The Minister will anticipate part of what I am about to say. He rightly says that the right place for these very vulnerable individuals to be is not an acute medical ward. Let us suppose that the right place is the proper type of care home with the necessary staff and resources to deal with their condition. Would it not be true to say that those people also need to be provided with some medical support from a specialist mental health team, and that such teams should come to care homes more often than they do now to offer support to the staff in those homes?”
“Does the hon. Gentleman agree that one of the difficulties with charging is defining what is a social care need and what is a health care need? The Minister described a number of times the Berlin wall between health and social care. Is not the problem that sometimes some of the issues are being smuggled in or over the Berlin wall between those two, so that what is really a health care need, which should be funded entirely by the state, is called a social care need, and the person receiving the care has to make a contribution?”
“We are patronised and talked down to and we know the people whom we care for much better than social services do.” There has to be a better relationship between carers and social services departments to ensure that carers remain keen and enthusiastic to do what they do against all the barriers to their doing so, which will always exist. Any programme to deal with social care must address that problem. We need to talk about funding and social services departments but, as the hon. Member for Worsley said, we must never forget the substantial portion of care that is provided by those who do it voluntarily, and who do it very well.”
“The more elderly are more likely to fall victim to illness, and we know already that carers are more vulnerable to illness. We know that the physical requirements of moving someone around get more difficult the older the carer gets. Some of the problems that face all carers face older carers more dynamically. I shall focus on two of those. First, respite care has already been mentioned and it is crucial to all carers, but one tends to find that the older generation are less willing to ask for respite even though they are more in need of it. The second problem is the relationship between carers and social services departments. That seems to me to be a major structural problem. Among carers of all ages, there is the constant refrain, “We are not listened to. We are not respected.”
“Those people face particular challenges. It seems remarkable, looking at the figures, that 8,000 carers are over 90. How those people manage is completely beyond me. It shows that a large number of people who have considerable problems of their own are carrying out the functions of a carer. As I say, the phenomenon will only grow because families will become yet more far-flung as time passes. There will be less support from other members of the family and spouses will often be the carer. Given that those being cared for are predominantly elderly, their spouses will be, too, and, because of increasing life expectancy, a carer might be a son or daughter of pension age. We have to think about the particular requirements of those people, which are obvious in many ways.”
“According to Carers UK’s last assessment, carers save the state some £87 billion through the work that they do. It does not take much more advanced mathematics than even I can manage to work out that if those carers, for whatever reason, were unable to do even 10 per cent. of what they now do, we could swiftly more than double the deficit. Of course we have to think about ways to solve the financial crisis facing social care, but if nothing else we should not make it worse. That means ensuring that whatever we do, we support carers in all that they provide to the system and make life as easy as we possibly can. I want to focus briefly on a minor subset of the people whom the hon. Member for Worsley described. Some 1.5 million of the 6 million carers are over 60 years of age, and I suspect that that proportion will only increase over time.”
“Member for Worsley mentioned what is sometimes referred to as “informal care”, which forms a substantial part of the care provided. I personally do not like the term, as it suggests care that is casual or sporadic, whereas in most cases it is neither. In fact, it involves people sacrificing their own lifestyles for the benefit of the lifestyle of another. People prepared to do that deserve the greatest possible consideration in any debate on the future of social care. Nor can we ignore the economics of the issue. It is correct that we will face a huge funding shortfall if we continue to provide only the level of support that is currently provided. The hon. Member for South Thanet (Dr. Ladyman) was probably right to say that the current figures are an underestimate, but the Government predict a £6 billion shortfall over the next 20 years.”
“Dementia will have a much wider impact on the social care system—either the existing system or one that we will construct in the future. The Minister knows the figures: 700,000 people have dementia now, and that will rise to well over 1 million in less than 20 years. Those people will put extra pressure on the care home sector and on the care delivered in the community. The Minister knows, because we have had this conversation, of my strong view that we should have mandatory training for those who work in the care home sector who will inevitably deal more and more with people with dementia. That argument applies equally to those who provide social care to the two thirds of people with dementia who live in the community. The care providers must understand the condition and the symptoms it presents. The hon.”
“As those with dementia find it progressively more difficult to feed themselves and to deal with other care needs, those needs are assessed not as health needs but as social care needs, resulting in a contribution being necessary—where appropriate—from the individual or their family. They regard that as bitterly unfair, and I am sure that the House can understand why that is. People with dementia and their families are by no means the only ones in that position, so any system we develop must find a fair way to identify needs. It is accepted that some contribution will be needed in the appropriate cases, but we need a way of distinguishing which those cases are, without trying to pretend that what arises from a medical condition does not in fact do so. That is an issue that we must consider.”
“I hear that phrase all the time, but I do not see much evidence of it taking place. It is common ground that we need more joined-up thinking, but the problem applies to cases in which assessments have been made and when short stays in hospital break up what was previously a reasonably effective social services provision. It is impossible to ignore the economics in the context of this debate. The problem arises from the dysfunctional relationship between health and social services over exactly what is classed as a health need and what is classed as social care need. I make no apologies—nor would the Minister expect me to do so—for raising again the issue of dementia. As the hon. Member for Kingswood (Roger Berry) made clear, dementia is a classic example of the problem.”
“There is a gap between health and social services into which too many people regrettably fall. To give just one example, there is the game of pass the parcel between health and social services when someone who is in receipt of social services support is admitted to hospital—perhaps a rehabilitation hospital for a short time to get them back on their feet. That seems to be a signal to social services that the person should no longer have any action taken on their file, which is put into a drawer. The person is now a health service responsibility, and no further work will be done on that file unless or until the person comes back to the front door of social services. That is regrettable, if we are serious about the sort of joined-up working that phrases such as “multidisciplinary teams” suggest should already be happening.”
“Providing this sort of advice on how to find the right social services and how to gain access to these networks is something that rural sub-postmasters and sub-postmistresses and, indeed urban sub-postmasters and sub-postmistresses, could do very effectively. That is because of the relationship of trust that they have already built up with the sort of people who are likely to be the main customers for social services, in addition to being regular customers in their local post offices. I hope that we can also explore that. Much of the complexity and many of the problems arise from the relationship, or lack thereof, between the health care sector and the social services sector. The Minister described it as a Berlin wall, but in many ways it is more like the Grand canyon.”
“It does tremendous work in this area, on which we should congratulate it, and I am sure that there are ways we can support the sector further. I heard what the Minister had to say about that, and it is encouraging. We can perhaps be more imaginative still, by finding other ways of providing that assistance, support and guidance in other scenarios and circumstances with which people who use such things are familiar. We have spent a good deal of time in other debates in this House trying to think of ways of supporting the rural sub-post office network; we have tried to think of things that we can allow sub-postmasters and sub-postmistresses to do that will give them a ready supply of income.”
“It also means that it is more difficult for anybody living at the house—perhaps a permanent, so-called, informal carer—to say, “If they’re five minutes late, I’ll leave the door open”, or “I feel happy to go out and have them in the house when I’m not there.” These minor, personal issues have a huge effect on the quality of care provided and on the overall experience. It has been said—this point goes back to the macro level—that one of the major issues is the system’s complexity. There is no doubt that those who have not previously experienced it are befuddled by how someone goes about finding the care they need, and where they go for the help they want. As has been mentioned, one of the places people often end up looking for that help is the voluntary sector.”
“I shall identify one such problem that will be familiar to all hon. Members who speak regularly to carers. In any system that involves people supplying care from social services departments or elsewhere, we should find a way of ensuring that as often as possible it is the same individual who turns up at a person’s door, because one difficulty we face is that often a different individual rings the doorbell each time. That means that it is difficult for a good relationship to be built up with the person who is being cared for.”
“Lady and with others that it is too easy to talk only about the challenges that we face and not enough about the opportunities that the development of modern technology has presented to us—telecare is one of those. It is hugely encouraging and exciting that we can now examine ways of providing people with the reassurance that they and their families wish to have, while preserving their independence and their dignity, as the Minister mentioned, with a form of care that is not intrusive, but which works well for them. Those aspects of telecare give us some reason to be cheerful. Of course, we face a number of problems and we cannot ignore them. Some operate at a very high level, being widespread and difficult to resolve, whereas others operate at a very small, personal level.”
“I am pleased to follow the hon. Member for Worsley (Barbara Keeley), whose commitment to and enthusiasm for carers’ issues I recognise and entirely share. The debate has made yet clearer the scale of the challenge we face in constructing a social care system that is adequate and decent, and that covers to a good standard those whom it needs to cover. It is right that funding plays a large part in that, and we have talked a little about how that funding might be found. It has also been sensibly said that we first have to decide what kind of system we wish to fund, and I wish to discuss that initially. I agree entirely with the hon.”
“This follows up the point that my hon. Friend the Member for North-West Norfolk made. There clearly must be a case for simplifying and speeding up the CRB process. Does my right hon. Friend agree that, given cases such as that of a constituent of mine who underwent all kinds of checks to enable him to be employed at a young offenders institution, only to be told that he would need another CRB check when he approached the Scouts to offer to help on a Thursday night, we should, at the very least, ensure that one check will suffice for all similar activity?”
“I raised this point with my right hon. Friend the Member for Horsham (Mr. Maude). I understand the Minister’s point and it is generally accepted that CRB checks are necessary for those who work with children, but surely it is not necessary to require multiple checks for the same individual when they wish to work in the same general field. Can the Minister reassure us that part of his changes will include a considerable streamlining of that process?”
“The Secretary of State will recognise that much of what he is describing is precisely reflected in the motion tabled by my right hon. Friend the Member for Witney (Mr. Cameron). Given that the right hon. Gentleman has moved an amendment to the motion, from which we can take it that the Government will be voting against the Opposition motion, will he explain in the course of his remarks precisely what it is in our motion that he disagrees with?”
“I welcome the statement made by the Home Secretary today. May I invite her to recognise that the period of time when cannabis has been a class C drug has persuaded many young people to believe that it is neither as harmful nor as illegal as it once was? I want her to focus on two things. First, in the education programme that she has mentioned, will she focus on the strength of cannabis now, so that people are persuaded that it is not the same drug that they perceived it to be during its period of lower classification? Secondly, will she have a word with the Crown Prosecution Service to ensure that, in prosecuting offences where class B drugs such as cannabis appear on the same indictment as class A drugs, it will not quietly forget about the cannabis offences? The CPS should continue to prosecute cannabis offences fully.”
“Does my hon. Friend agree that there may be something else that we are in danger of losing—the post office branch as a social safety net? There are those who are alone and possibly elderly, who come into the post office regularly for benefits or pensions. If they do not come in one week, perhaps the only person who will notice is the sub-postmaster or sub-postmistress. If the branch is no longer open, who does my hon. Friend think will fulfil that role?”
“In respect of ClearSprings hostels, particularly the accommodation of offenders on home detention curfew, will the Minister confirm, first, that subject to any risk to the staff working in the hostel there is no exclusion for violent offenders and, secondly, no exclusion for persistent and prolific offenders? If he can confirm both those points, is he surprised that there is a significant level of local opposition to the hostels?”
“The right hon. Gentleman knows, and the report reflects, that the technology required for sealed envelopes is not available yet and therefore was not available during the Bolton trial. How much does he think that weakens the effectiveness and relevance of that trial?”
“On flagging up access to a patient’s record, the right hon. Gentleman will know Dr. Paul Thornton, a general practitioner who gave written evidence to the Select Committee—he is, in fact, one of my constituents. I have contacted him about this subject. He has told me that he has been able to change on the system a flag that indicates to those who look at the system that the patient does not want certain information disclosed. He was able to change that flag without notification. The right hon. Gentleman accepts that one of the crucial safeguards is that the patient in question should be notified if a record is looked at, which is even more important if a record is changed. Does he share my concern that that must be put right, if the system is not working?”
“On the question of the review, may I ask the hon. Gentleman two things? First, does he consider that it is impossible for a review, such as the one that has been suggested to the Committee by various witnesses, to be carried out while work on the system continues? Secondly, does he think that against the background of the problems that the Government have had in the management of personal data, and concerns that the public will have about that in consequence, the case for a review is stronger than it was when the report was written?”
“Member for Rother Valley quoted, indicates the “perplexing lack of clarity about exactly what NPfIT will now deliver.” Indeed, the report later states: “There is an explanatory vacuum surrounding DCR systems and this must be addressed”. If those issues are not properly understood and dealt with, the system cannot be effective, and that is why a full review is necessary.”
“Paragraph 115 states: “The Committee was dismayed, however, by the lack of clarity about what information will be included in the SCR and what the record will be used for”, which has already been quoted. Paragraph 131 states: “There was a stark contrast between the specific and detailed vision set out for the ‘Integrated Care Records Service’ in 2003, and the vague and shifting vision set out for the DCR in 2007.” Further, at paragraph 192, the Committee states “that other parts of the project are beset by significant problems. The most serious of these are: the lack of clarity about the ultimate vision for the shared DCR record, particularly the area which will be covered and the level of information which will be shared; the absence of a clear timetable for implementing shared DCR records”. Finally, paragraph 229, which the right hon.”
“Taylor) made. It must be an option for any such review to say that we should go back to square one. If the review, properly conducted, came to that conclusion, we would be well advised to listen, but the process of reviewing need not stop the process of developing the programme. There is clearly room for doubt about whether the programme will deliver what it is expected to. Although the Committee was right to reject the option of a full review, in the areas that the report covers, it seems to me that the Committee made a pretty good case for one. Several extracts from the report have already been quoted. I will not read them all, but it is worth noting several fairly trenchant criticisms that were made about the general direction of, and grip on, the project, which is clearly not there.”
“Secondly, in his view, confidentiality and security of electronic patient records was not a significant concern, which is not entirely similar to what he has said today. Be that as it may, we should concentrate on those two issues: first, whether a wide-ranging review of the system is appropriate; and secondly, whether issues of confidentiality and security have been adequately dealt with. On the question of a review, we have already heard that the National Audit Office makes multi-billion pound estimates of the system’s cost to the taxpayer, but it seems that a full zero-based independent review of the project, which can be conducted while the work on the system continues, would allow us to know whether the investment will deliver the improvements that it should. I take entirely the point that the hon. Member for Wyre Forest (Dr.”
“It does not, for example, include choose and book, which has been mentioned, or the electronic prescription service. That is worth noting. Secondly, the report was not unanimous, as the right hon. Member for Rother Valley (Mr. Barron) said. It is true that part of the reason why was the perception—I am sure that it was inaccurate—that the right hon. Gentleman had, to some extent, made up his mind at an early stage about some of the issues that the report covers. He spoke on 6 June 2007 in an Opposition-day debate about the more general subject of NHS information technology, and he made two points of note for today’s debate. First, he appeared to indicate that an independent review of the electronic patient record project would not be in the interests of the NHS, which is entirely consistent with what he said today.”
“I begin on a note of complete consensus; I shall not pick up on that last point, which is definitely one that I shall leave to the Minister. We totally support the use of information technology to improve patient care. Although I accept entirely, as my hon. Friend the Member for South Norfolk (Mr. Bacon) said, that the process began long before 2002, there is complete agreement among contributors to the debate that it is a good thing in principle. I shall make two general observations about the report, and then I shall deal with matters in more detail. First, the NHS IT programme covers a good deal more ground than the report. Mr. Weir, you would not wish me to go into detail about the stuff that the report does not include, so I shall restrict myself to that which it does.”
“However, it is also right to point out that the NAO and the PAC are primarily concerned, quite rightly, with value for taxpayers’ money. However, that is not the only issue; indeed, it is not the only issue—far from it—that has been canvassed in the debate so far. As I have already observed, the Health Committee’s report covers only part of the NHS IT programme, and even in the part that it covers, which is the topic of our discussion, it is not complete. It does not deal, for example, with security of data, to which I shall turn next.”
“It is under way, and I am sure that the hon. Lady will be fascinated to hear the results. However, it should not be up to Her Majesty’s Opposition to do that work; it should have been done by the Government. There is still an opportunity—if the Minister takes it—to engage in the process, because I maintain that it is possible to do so while the work on the programme continues. The case for it, which was made in the report by the Committee of which the hon. Lady is a member, is very strong indeed. The Committee rejected the review, at least in part, on the ground that the programme had already been scrutinised by the National Audit Office, the Public Accounts Committee, which is represented by my hon. Friend the Member for South Norfolk in the Chamber today, and of course by the Health Committee itself.”
“We need to be concerned about not just an organised attack on the database but what might be described as a disorganised attack. That is where we come to the events of the past few months. I agree entirely with the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) that it would be much better if we did not have to consider the issue against the background that we now must, but we cannot escape the fact that people outside this place will assess the likely utility and safety of the NHS databases against the Government’s capacity properly to manage data on everyone from children to criminals, which has been called seriously into question. Patients will need serious reassurance that they should entrust sensitive medical information to a central database.”
“My hon. Friend is entirely right, and that underlines the need for a review. The Committee says that it rejected a review on a number of grounds, one of which was that it expected the Government to engage in further reviews internally and to publish the results. It indicated that it would like to know, and have available in the public domain, the result of any assessment of the system’s security implications. In their response, the Government indicated clearly that they were not prepared to make such information available. The case for a review seems stronger now than it has ever been. Even if the security and safety of the system was not a big issue and foremost in the Committee’s mind when its investigation began, it must surely be so now.”
“They need to know whether their information will be shared with Government Departments outside the NHS, and, if so, to what extent and for what purpose. It would be extremely useful if the Minister were clear on that today. They also need to know that the system will be resilient to attack. If patients are not sure of those things, they will, as the hon. Member for Staffordshire, Moorlands rightly pointed out, be reluctant to provide information. As a result, the doctor-patient relationship and the cause of medical research will suffer. Patients and clinicians need to be persuaded of all that against a background, I am afraid, of serial, large-scale incompetence on the Government’s part in the management of personal data. That is why the Government have much to do to make the system successful.”
“Apart from the concerns that have already been expressed, one possible outcome is that an individual who is unwilling to allow their medical information to be used for a specific form of medical research of which they strongly disapprove will be unable to prevent that from happening. Those are important questions of detail, but I return to the larger questions raised by the subject of the report. As I have said, we support the principle of using technology to improve patient care. There is no doubt that in some areas, that is already being done very well, but in the crucial field of electronic patient records, both patients and clinicians must have full confidence in the system. Patients need to know what their information is to be used for, and must understand how to protect that which they do not want to be shared widely.”
“I must say straight away that I recognise the huge value of more information being available for medical research, but I hope that the Minister can deal with some specific concerns about it. Can he confirm that patient information goes to the secondary users service in a non-anonymised, non-pseudonymised form, and that it for the SUS to make it anonymous or to pseudonymise it? It follows that any leak of information from the SUS would be in a form by which individuals could be identified. There needs to be clarity on that, because people will be concerned about it and we would all appreciate some reassurance. Contrary to the report’s recommendation in paragraph 121, the Government clearly intend to make information in sealed envelopes available for research.”
“Lady said, we discover from the Government’s response to the report that NHS Connecting for Health issued detailed specification for local sealed envelopes to suppliers only on 3 April. As she said, it would be helpful to know what took it so long. Can the Minister confirm that the national roll-out of the summary care record will therefore begin without the sealed envelope technology being available, and that it might not be available for the detailed care record until 2009, as indicated in the Committee’s report? We have no guarantee that that crucial aspect of the electronic patient record will work effectively, nor any real idea of when it will be ready. The secondary users service has also been mentioned.”