Joe Robertson
MP for Isle of Wight East · Conservative · United Kingdom
“(3) In preparation of the report under subsection (1), the Secretary of State may have regard to any such measures or information that they consider appropriate, including— (a) an assessment of any variation in dementia services and outcomes between integrated care board areas, (b) information on workforce capacity, capability and trainin…”
“The clause fits into that and would require the collection of data on the provision of dementia services in health and social care. I do not propose to speak too long, but I do want to make a couple of remarks on the current situation, which sets these new clauses in context.”
“That will, of course, impact many more friends, families and carers who support those living with dementia. More than a third of people living with dementia in England do not have a formal diagnosis. Those who do receive a diagnosis live with the condition for an average of three and a half years before that diagnosis.”
“The data requested is imperative to ensuring that the Government can measure and monitor progress against relevant national targets, standards and guidance, including the new modern service framework on dementia, the forthcoming Care Quality Commission statutory guidance and outcome measures that may be set in future NHS operational plann…”
“I thank the Minister for pausing the MCA’s brutal decision about coastguard rescue officers, and for convening meetings on cross-Solent ferry transport to the Isle of Wight, which will start next month.”
“It is a pleasure to serve with you in the Chair, Ms Lewell. These two new clauses, the latter of which is in my name, deal with the publication of an annual report detailing NHS and social care provision for dementia care and how the Government are performing against targets, standards and outcome measures set out in national guidance and…”
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“They should be the ones bringing patient voice to the heart of decision making—I am sure that they do, of course—and there are other means by which the Department formulates policies and decisions; it does not need to remove an independent patient voice through Healthwatch England, which serves a different purpose, to enhance that. That different purpose is this: some of the things that Healthwatch England advocates for and shines a light on are uncomfortable truths for decision makers and the Department of Health. It looks far too cosy to now bring that function into the decision-making process. Some of these issues need the light shedding on them that comes with an independent organisation providing patient voice.”
“It is a pleasure to serve with you in the Chair, Ms Lewell. This is another example of the Government seeking to abolish an independent voice and merge its functions into an organisation that, frankly, will probably benefit to some extent from not having that independent scrutiny, but it is not for the betterment of patients or indeed the system. Healthwatch England is effective specifically because it is an independent voice for patients. We have not heard any compelling arguments for why, just because the system is not perfect, this change is better than leaving it alone. The argument has been advanced that this brings patient voice closer to decision making, but I would hope that the directly elected Ministers who represent people are what bring the voice of the people closer to decision making in the Department of Health.”
“The ICB may give some regard to the cost of ferry travel and the implications of the disruption caused by having to travel on a ferry in order to access a hospital service that is not available on the Island, but its decision making will be much devalued in weight if it does not have the unique, independent patient voice coming from the Isle of Wight via our Healthwatch.”
“Particularly unique to my constituency and Isle of Wight West is health travel—that is, the reality of having to cross the Solent on a ferry to access so many health services. That is something that Healthwatch Isle of Wight uniquely understands through its direct consultation and work with island patients. Indeed, the people who work for our local healthwatch and its trustees are islanders. They do not just get it because they hear it; they get it because they live it. If that entire function is taken up to the Hampshire and Isle of Wight level, that unique insight will be lost.”
“There are over 150 local healthwatch branches, but there are not 150 integrated care boards. In the case of the Isle of Wight—I use that as an example because it is my own patch, but it will be the same situation up and down the country—we have our own Healthwatch Isle of Wight, which represents the unique insight and views of patients on the island. If those powers go to the integrated care board, that will cover Hampshire and the Isle of Wight, a population nearly 10 times as big. Our unique patient voice will be watered down into the patient voice of Hampshire; while the Hampshire patient voice is equally valid, that will nevertheless reduce the unique insights of smaller populations all over the country by including them in something bigger.”
“Member, local councillors and me to make an argument against the proposal, directly to the ICB, in the media and to councillors at county hall. Without the tools that Healthwatch provided, it would have been so much harder to make that case. The ICB backed down on that proposal, but, if all that infrastructure, and all the information that Healthwatch independently provided, had sat behind closed doors within the ICB, we would not have had the opportunity to make our case and reverse the decision. That is one of the many thousands of real-life examples across the country where the affected patient voice was aired and properly used to reverse a bad decision, and it is an ability that will be lost. Another issue is the fact that the centralisation of powers will inevitably water down the patient voice.”
“Not so long ago, the integrated care board for Hampshire and the Isle of Wight proposed to reduce funding for Mountbatten hospice on the island and to redistribute that money to the mainland—it was, in my view, outrageous. The integrated care board had all the information available at its fingertips to realise that that was a bad proposal, and it had all the patient voices and views that it could possibly come across to realise that it was a mistake. It did not first consult representatives, such as me, my neighbour the hon. Member for Isle of Wight West (Richard Quigley) or local councillors, before making its proposal. It was then Healthwatch’s data on the views and voices of patients, which had already been gathered, that helped the hon.”
“Guess who is often on the sharp end, or who is often critiqued by the evidence provided by Healthwatch? It is the ICB itself. Therefore, it is no wonder that Professor Croisdale-Appleby, the chair of Healthwatch England, agreed with the characterisation that this looks like the ICBs or other bodies marking their own homework. They will get to decide which part of the patient voice is acted upon, and which part is ignored, without the public gaze or scrutiny that is provided by an independent report that decision makers, parliamentarians, local councillors and the independent media can also use. I will give a particular example from the Isle of Wight.”
“I would far prefer for us all to be able to see reports that have not been implemented sitting on a shelf and try to do something about them than for the patient voice to be heard behind closed doors and not acted upon. That is the inevitable conclusion from this merger—this abolition of the independent patient voice. I want to talk about my experience on the Isle of Wight of the important work that our local healthwatch does. It assists me in my role as a parliamentarian and representative of the people, which is to scrutinise the decision-making of my local integrated care board and others, by providing the objective and unfiltered voice of patients through data, statistics and records, all of which will be lost within the ICB when this abolition takes place.”
“If she wants to achieve those things, she can achieve them while maintaining Healthwatch as an independent patient voice. That independent voice ensures not only better decision making, but more effective scrutiny of decisions that have been made, and it does it by ensuring there is no blending or conflict of interest within a certain organisation—the decision maker. It does it by ensuring that light is cast on the critique, the scrutiny and the voice of patients, and that that process takes place outside the closed doors of, in this case, the integrated care board, not behind them. I suspect that the Minister will say that the system is not working, because there are too many good reports by Healthwatch that sit on a shelf and have not been implemented.”
“The Government’s proposal to abolish the independent voice of patients is a mistake. It is a backward step, and I have seen no compelling reason why it should happen. Apparently, the voice of patients is going to be realised through integrated care boards and local authorities themselves, but that is not an independent patient voice. The very point of independence is that that voice is represented through an organisation that has no other function—no other skin in the game other than to represent that voice. It is remarkable that the Government are taking this step. I suspect the Minister will say—she has already given a number of reasons—that this is happening in order to bring the voice of patients closer to those who make decisions, but that is not the function of Healthwatch.”
“Nowhere is the summer job more important for young people finding work than on the Isle of Wight, but employers are telling me that it is increasingly hard to employ young people because of the tax and the red tape that this Government have put on them, so it is no wonder that youth unemployment is up. I have an idea for the Minister: why does he not reform welfare and reverse the decisions made by his Government so that young people can find a job?”
“Does my hon. Friend agree that reporting between urban and rural, which runs through these amendments, is particularly useful? Many of the solutions put forward throughout this Bill involve mayoral areas or authorities, which of course do not currently exist in many rural areas, and in some may never exist.”
“However, they have some pretty clear views on what they expect, whether that is confidentiality or their records being used and stored in such a way that does not inadvertently act as a barrier to accessing healthcare in an efficient and timely way. That is why the Government have introduced these proposals, which I mainly support.”
“It is a pleasure to serve with you in the Chair, Ms Lewell. I wish to speak on this aspect of the single patient record. Although I support the general intention and aim of the single patient record, I have some wider concerns about how it will be implemented. I will restrict my remarks to the issues related to this group of amendments, and particularly amendment 49 in the name of the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham. Plainly, most people—I would probably include myself in this—are not immediately familiar with all the ins and outs of how their medical records are kept and used, and why should they be?”
“I am always slightly reluctant to use analogies from other sectors, because plainly there are differences, but in my former life as a family law solicitor, even within a small private law firm, there were structures in place to ensure that only people who needed to access data could do so, and much of it was arguably less sensitive than patient records. That was the case in a small firm, and because we have a national system of healthcare in this country, which is a good one, the scale of fallout and harm that could arise from such mistakes or deliberate acts is so much greater. I urge the Government not to see the amendment as seeking to undermine their overall plans, but as a means of strengthening them.”
“Plainly, there is already scope for this to happen and sadly patient records are wrongly accessed, either inadvertently through mistake or deliberately in bad faith. However, from a technological and design point of view, the single patient record inevitably makes that easier and more likely, whether through mistakes or deliberate acts. That is just one of the many considerations and downsides of a single patient record that is otherwise beneficial. It is incumbent on the Government to do what they can to mitigate against those inevitable structural problems that the record will produce, and amendment 48 is an entirely sensible way of achieving that.”
“The hon. Member has hit the nail on the head. A single patient record is not the same thing as mandating that 450 record-keeping systems become one. In fact, the single patient record will work as a theory on paper only if there is interoperability between different databases. That is a massive challenge that is not dealt with here. It cannot be dealt with here, in the real world, and the single patient record will not be realised until it is dealt with, which could take years. Does the hon. Member have a reflection on that point?”
“Of course, the major global technology companies have faced legal action in the US, Europe, this country and elsewhere to ensure that their systems talk to each other, and primary legislation has been required to make them do that.”
“It is not just a technological issue; there is also a cultural issue of the lack of nimble, joined-up decision making. Some health bosses, not necessarily those in my area, are unable to take advantage of the financial benefits of changing or adapting to using new systems. Until that is resolved, a single patient record will remain ever wanted but never actually delivered. To use an analogy, different companies provide the services on people’s mobile phones—the internet access, social media; software and even hardware. Most of us end up with a smartphone that does pretty similar things to every other smartphone and, broadly speaking, all the different apps co-operate with each other.”
“Indeed, the Bill does not mandate a single preferred electronic record-keeping system, and nor should it; there is a competitive market out there in which NHS trusts are free to engage and contract with different providers of electronic record-keeping. I wrote to the local health bosses in my area after being made aware that the provider of one of their main electronic record-keeping systems had offered to extend the system further throughout the trust in order to save money. However, the trust has not yet responded. I am not in a position to say whether that offer is a better one, but on the face of it, it certainly looked like it would save money because it was a record-keeping system that the trust was already using; it just was not being used across all parts of the trust. That letter has gone unanswered for a year.”
“Member for Lichfield said, sometimes there can be dozens, even hundreds, within even one NHS trust. That should not be a problem today, but it is, and the Bill will get us no further on the technicalities and the technology problems we have. These systems are already meant to speak to each other, and we do not need legislation to realise that should be happening. Indeed, there are still paper record-keeping systems in many places up and down the country. The theory of a single patient record is a good one, but it will mean nothing in practice until those paper record-keeping systems have become electronic and then all the electronic systems speak to each other. That makes me wonder whether a single patient record will ever be realised, regardless of legislation on the model that is supposed to exist.”
“I will pick up where the hon. Member for Lichfield left off. I make it clear that a single patient record is not a single electronic record-keeping system. Also, the single patient record is a theory, and it will remain a theory long after this legislation has been passed, as I am sure it will be, unless and until the electronic record-keeping databases and software in this country are able to speak to each other. I have experience of working for a national nursing charity, and my role specifically dealt with the legal and governance issues of trying to embed community nurses in different settings. However, that work was beset by the problem of different databases—different electronic record-keeping systems—that did not speak to each other. Even those systems that were supposed to speak to each other did not do so. As the hon.”
“I am not even saying that it should be addressed in the Bill, because there are all sorts of issues around competition law and state support for particular companies. It is not a criticism per se of the way in which the Bill drafted, but this is an opportune moment to make the point that absolutely none of the clause will be delivered until a major issue that the Government have not yet addressed is dealt with. That issue is the interoperability of different electronic record-keeping systems provided by the private sector. They are all in competition with each other to get a bigger share of the market; unless and until that is addressed, the Government are not going to realise any of this. I do not want that to be the case. I want the single patient record to be realised, broadly speaking.”
“That was a long intervention, but it was helpful. I disagree with the hon. Gentleman, because the legislation is not seeking to require technology companies or the providers of electronic record-keeping systems to be able to talk to each other. It is trying to create the concept of a single patient record, which is good, but it does not mandate a way to achieve that. I do not particularly want to name companies, but a big provider that is already in the health space and that provides electronic record-keeping systems might say, “We can already provide a single patient record. It is for other providers to adapt and feed into our record-keeping system,” and there is nothing in the Bill that says one technology company must adapt to another. The technological issue is completely unaddressed.”
“The hon. Gentleman is making the point that I have been trying to. He referred to a number of companies that each provide an electronic record-keeping system. The Bill does not mandate those companies to speak to each other and create a single patient record; there is no requirement on those private companies to do anything. As they are in competition with each other, their answer could be, “We can provide the single patient record—we are already doing it—if you just use more of our system and pay us more money.” I am not suggesting that this is the hon. Gentleman’s responsibility, but does he have anything to say about the practicalities of a single patient record as a theory and the interoperability of electronic record keeping—a practical thing not dealt with in the Bill?”
“I thank the Minister for clarifying that the data will continue to be stored and held in the databases in the electronic record-keeping system where it is currently kept. I am not looking for her to give me a detailed solution on the spot, but does she accept that unless there is seamless interoperability across all those systems the single patient record will not be realised, and that we are still an awfully long way from seamless interoperability across England, let alone the UK?”
“On a point of order, yesterday in Westminster Hall, the Maritime Minister, the hon. Member for Selby (Keir Mather), may have inadvertently misled the House. I confirm that I have given the required notices. The Minister stated on three occasions that a Court of Appeal judgment changed the legal status of maritime coastguard rescue officers. That simply is not true. The Court of Appeal confirmed worker status that already existed and has existed for years; it is the Maritime and Coastguard Agency, backed by the Government, that is now seeking to change the status of those brave heroes to that of unpaid volunteers. Madam Deputy Speaker, can you advise me on how I can seek to get the record corrected?”
“I thank the right hon. Gentleman for giving way and congratulate him on securing this really important debate. Does he share my concern that, from the Isle of Wight to Orkney and Shetland, the management of the Maritime and Coastguard Agency are showing a lack of heart and a callous approach when it comes to their problem resulting from the model that they have developed for how to protect our coastline? It seems that they are driven by their problem with HMRC payments, when they should be putting the coastguard rescue officers first—brave men and women working on the frontline to keep our country safe.”
“Will my hon. Friend reflect on the fact that, even if the Government get through the combined mayoral authorities they are trying to in this Parliament, there are still great swathes of England where there are no active plans for a mayoral authority at all. Even if the Government get their own way, some areas will not have a mayor for many years—if they get one at all.”
“Friend the Member for Farnham and Bordon has already said, the combined area of Hampshire and the Isle of Wight—or the Solent, as the Government like to call the Isle of Wight, despite the fact that fish cannot vote—is not set to get a mayor for a couple of years, but it will be at the vanguard of the Government’s plans. What about those areas for which there is no date, or even no plan for a mayor at all? It seems extraordinary that the Government would do away with the current set-up, imperfect as it is, and replace it with something that does not yet exist. The Government have time deal with this problem. I am sure they quietly understand that there could be a problem. It is now on their shoulders to deal with it. I welcome the Minister’s reflections.”
“Member for Chelsea and Fulham (Ben Coleman), who made some excellent points, which I will not repeat or paraphrase as they are on public record. The gist of his argument was that local authorities have been ignored for too long when it comes to joining up health and social care services. This measure puts local authorities in an even weaker position and threatens what the Government are trying to achieve with social care, particularly for areas such as mine that have an older population and a relatively small unitary authority with so much responsibility to deliver on. As my hon.”
“What we have seen to date is not an ideal system, or even a system that works particularly well, so I understand that the Government want to strengthen it, but we should not do that by removing the local government voice or making it indirect via a mayor who does not have the direct responsibility for delivering social care locally. Mayors may have some strategic oversight, but that is different. Just last week, the Minister of State for Care appeared before the Health and Social Care Committee and was questioned on this very issue by me and others. His view was that the mayoral strategic partnership would be more than sufficient to make up for the local authorities losing their seat, but he faced particular scrutiny from the hon.”
“It is a pleasure to serve under your chairmanship, Sir Jeremy. There is a consensus—not just in this room, but within Parliament and going back several decades—that we want more integration and partnership working, particularly to bring together health and social care services, but this clause drives a coach and horses through that, and does so in a way that weakens rather than strengthens the Government’s plans to replace the system. Local authorities bear responsibility for social care and public health in their areas, but they will no longer have a direct voice when it comes to integrated care boards.”
“Given that there are so many unanswered questions and such little information, rather than estimates day, wouldn’t the better name for this debate be “a complete stab in the dark” day?”
“Those not in employment, education or training stand at nearly 1 million. That is not good for them, it is not good for the economy and, crucially, it leads to the welfare bill that we have today. The Government’s response to their failure to get their legislation through their own Back Benchers a year ago was to put the questions to the Timms review. But of course, the Timms review is there to consider, in the words of the Prime Minister and the Government, “fair and fit for the future” funding for personal independence payment. It does not have a remit to look at future savings and reductions in the spending on PIP, so the aspiration has gone. The Milburn review into youth unemployment makes it clear: we are not talking about getting young people back into work—six out of 10 are not in work and have never had a job.”
“I congratulate both hon. Members who gave their maiden speeches a few moments ago. We know that the outgoing Prime Minister wanted to cut welfare spending—or at least he did a year ago when he brought forward some pretty rough and ready proposals to cut it by £5 billion—but, of course, his plans withered in the chill winds of the Labour Back Benches and the Minister literally tore up the proposals at the Dispatch Box during that debate. The messiah from Makerfield may be here in just a few weeks’ time, but he faces the same Back Benchers in this place, and that same environment within the Labour party exists even if the new Prime Minister actually wants to do something about the welfare bill. The situation we find ourselves in today is that youth unemployment—among those aged 16 to 24—is over 16%, which is 729,000 people.”
“Any Government will bring in welfare reform—they should plan for it in opposition—but over time, loopholes and cliff edges emerge that were unintended. When a new Government come in, we expect to see them implement their plans for welfare reform. Of course, this Government had none. They tried to develop plans on the hoof, but failed to do it. It is not just young people; more than 2 million people over the age of 50 but of working age are now not working either. Most of those people would like to work—they are looking for the opportunities and the Government support to help get them back into work.”
“I do agree with the hon. Member. Indeed, it is in the tourism sector that a lot of young people in my constituency and, I am sure, in his—and in constituencies up and down the country—find their first job. It is the flexibility in the tourism sector and the fact that there is work to do when young people have the time and want to do it that make it such an enabler. The changes to the rate of national insurance and the fact that it now applies to part-time working are major disincentives to work, as are the cliff-edge incentives for young people and, frankly, people of any age to remain on welfare. Of course, the Government came into office without a plan to deal with those cliff edges, which inevitably develop over time.”
“We have an option to achieve our intention to have joined-up decision making, and to ensure that every decision in any Department that has the potential to impact health inequalities is considered, whether in a formal impact assessment or just in the ordinary day-to-day decision making and mindset of the relevant Ministers, Secretary of State or departmental officials.”
“That is the probably the key departmental relationship that will be relied on to deliver the reduction in health inequalities. The Department for Transport also has responsibility for this. If we refer to its responsibilities for reducing health inequalities outside the context of this argument, people might scratch their heads and wonder what we are talking about. but as soon as it is brought into a real-life example within this debate, it makes sense that the Department for Transport has some responsibility for reducing health inequalities. However, we will not achieve all we want to unless that responsibility is made more obvious and specific, named somewhere in some Bill.”
“It is a matter of public record that the funding decisions made by the current Government at the beginning of this year have meant an effective reduction in funding for my local authority, notwithstanding its responsibility for an older population and the existing challenges in delivering social care. That is an argument that I and my constituency neighbour, the hon. Member for Isle of Wight West (Richard Quigley), are making to the Government in an ongoing conversation about how we can resolve that issue. We are having that conversation with MHCLG, notwithstanding the fact that it has a very direct impact—the biggest impact, in my view—on health inequalities in my constituency and the effectiveness of the Government’s 10-year health plan and their intention to improve the general health of the population.”
“It is a well-known feature of the system we have in this country that healthcare is free at the point of use and delivered effectively by central Government, while social care is a combination of different provision but private funding and local government have the largest role to play, and too many people fall through the gaps in those fundamentally different ways of funding two parts of the system. Unless MHCLG is bound into the way we reduce health inequalities, even with the best intentions of the Secretary of State for Health and Social Care, it clearly will not be delivered in a comprehensive and holistic way. I refer again, as an example, to my area, which has a higher age demographic but a small unitary authority with a lower funding base.”
“The more we think about the various inequalities that exist in this country, the more we realise that other Departments have considerable responsibility. We hear from politicians—of all parties, but particularly the Labour party in government—about better joined-up working between Departments, but without something more concrete in Bills such as this one, that will remain one of those aspirations that many talk about but few actually achieve. The most obvious Department to help achieve the reduction in health inequalities is the Ministry of Housing, Communities and Local Government, given its responsibility for local government funding. Of course, local government has primary responsibility for delivering social care and public health within its area.”
“For my constituents, accessing specialist services means crossing a body of water, which is not only a physical barrier—a ferry has to be taken—but a cost barrier, because ferries cost money. I understand where the hon. Gentleman is coming from, given the challenge in my constituency, but of course other places have different but challenging hospital transportation issues. Amendment 30, tabled by the hon. Member for Oxford West and Abingdon (Layla Moran), the Chair of the Health and Social Care Committee, refers to cross-departmental working to ensure that health inequalities are taken into consideration. I think this is key. Of course the primary responsibility for health inequalities rests with the Department of Health and Social Care, but it is by no means the only Department with that responsibility.”
“The Isle of Wight has a small local authority. We are fairly unique, in that we are surrounded by water and have a higher age profile, which, taken together with other challenges, makes health equality a challenge for the entire population, not just older people. The issue is aggravated by other considerations, primarily relating to geography. Amendment 34, tabled by the hon. Member for Winchester, refers to hospital transportation access. That can mean a lot of different things in different places. I support at least the aim of putting more pressure on the Secretary of State and the Department and encouraging them to recognise and eradicate inequalities in hospital transportation access.”
“I have concerns about what “persons of different descriptions” means. Certainly, in everyday English, every individual could be described as a person of a different description, so the phrase does not have any particular legal meaning. If the phrase means something equivalent to protected characteristics, I wish to say something about health inequalities affecting those of different ages. I am the Member for Isle of Wight East, which, of course, has an older population. I want people of all ages to have equal access to health and social care, and inequalities in access to be levelled out and removed, but it is not only older people who find accessing health services difficult, not least for reasons of physical access; the entire population within an area with an older age demographic is affected.”
“It is a pleasure to serve under your chairmanship once again, Sir Jeremy. I will speak generally about the amendments on health inequalities, and specifically about some points that the group of amendments homes in on. On the general principle of dealing with health inequalities, the sentiment behind amendment 13 is important, and I support hon. Members’ motivation for tabling it, but I question exactly what “persons of different descriptions” means. Does it relate to protected characteristics, which employment law deals with, or to geography? I suspect that it is both, and I wonder whether there are more considerations than those two. It would assist us if the amendment were clearer on that, notwithstanding the fact that clarification may be made during the debate or to the amendment itself if it is accepted later.”
“My hon. Friend hits the nail on the head. Although all these amendments come from a very good place, they are so obvious that they should already be happening, and are too obvious to be enshrined in some overriding duty in a Bill.”
“The clause, and amendment 58, deal with innovation. Although the NHS is responsible for some great healthcare innovations, not only in this country but around the world, unfortunately, it is often an example of a complete failure to innovate, or even to use fairly basic technology that has been around for a long time—I am thinking of using computers for patient records, as paper records have lasted for far too long. Promoting innovation is clearly a good thing—it is essential—so I support the amendment. I will speak about the details in a moment.”