Dr Danny Chambers
MP for Winchester · Liberal Democrat · United Kingdom
“The Government invested more than £560 million in AMR programmes between 2020 and 2024, so it is reasonable that Parliament should receive an annual assessment of AMR-related deaths to ensure that that significant public investment is delivering results, represents value for money and is targeted where it can have the greatest impact.”
“Surveillance has already identified significant variations by age, deprivation and geography. Understanding where deaths are occurring, and in who, would help direct resources to the communities and services that are most affected.”
“I thank the Minister for her comments. I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 32 Review on deaths related to antimicrobial resistant infection “Within six months of the passage of this Act, the Secretary of State must conduct and publish a review into the number of yearly deaths in the UK which…”
“This is not simply a matter of people dying from infections that could not be treated; nearly all the advances in modern medicine over the last 50, 60 or 70 years would be null and void.”
“We very much welcome the Government’s initiative to give children free bus travel throughout the summer—it is a great idea. The only problem is that in Winchester and its surrounding area, Hampshire county council keeps cutting funding for bus services.”
“I thank the Minister for her comments. We understand that the Government take this matter very seriously, but we are working on estimated numbers of deaths for something that will eventually be killing more people than covid. We really need some tangible figures, so I will press the new clause to a Division.”
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“That seems like an ill-judged move, given the ongoing stand-offs we have on the funding of social care and continuing healthcare up and down the country, and it is hardly encouraging the integrated working that everyone accepts is needed to address the joint issues in social care and the NHS. We are worried that there are multiple measures in the Bill that are separating social care and the NHS at a time when greater integration and closer working are so clearly needed. If we want to grasp the nettle on corridor care, overcrowded hospitals, ambulance delays and delayed discharge, we need to get the NHS and social care working together. All those issues seem to have their roots in social care—or the lack of it.”
“The hon. Member for Sleaford and North Hykeham covered most of the points I was going to make, so I will be very brief. The changes that are proposed to the better care fund seem like another example of decision making being taken away from local authorities and other organisations, which are often the ones that are best placed to understand the health and care needs of their local populations. This measure centralises power rather than devolving it. Ultimately, the Bill leaves the impression that social care is being pushed more and more on to local authorities.”
“I beg to move amendment 8, in clause 47, page 34, line 19, after “behalf” insert “, including nominated carers”. This amendment makes it explicit that nominated carers can access the single patient record on behalf of those they care for.”
“It could allow them to care more effectively for their loved ones, and it could allow it to be flagged on their own records that they are carers, so they receive the support that they need.”
“All the stakeholders have said that the single patient record is part of the Bill that could be genuinely transformative. I would also like to note the Bill’s many references to carers, including the Secretary of State’s duty to promote the involvement of carers alongside patients in decision making around care and commissioning. However, the Bill is currently quite vague as to whether carers will be able to access the single patient record, and we want that to be made explicit. We want to reiterate the lack of focus on social care, which is the biggest issue facing the NHS, and emphasise our call for carers in general. The benefits that the single patient record could bring to patients have been well-established, and it is well-supported, but we believe that the single patient record could also be of huge benefit to carers.”
“The hon. Gentleman makes some very good points. Obviously, the whole point of this amendment is to equip people who are providing what is often the daily care for someone else with the information they need to provide that care. My family cared for my father at home for many years when he had dementia; he was on medication for other physical health issues as well, and he was not capable of administering his own medicine, or even of understanding what he was on half the time.”
“For example, being able to quickly see what historical medication the patient has had, especially when it comes to antimicrobials, and the results of tests that were performed in other hospitals and healthcare settings, is absolutely vital to ensure that we do not allow antimicrobial resistance to increase at an unnecessary pace. Often, patients do not understand the type of antibiotic they are on, or remember the name of it, and that is a specific but big issue, because it can generate antimicrobial resistance. There are a few more issues that I could speak to, but I will sit down.”
“We understand that the Bill is not designed to set out all the specifics of what the single patient record will look like—that key point was made in the interventions by the hon. Members for Farnham and Bordon and for Ashford. However, although we do not know exactly what it will look like, as it is being created, drafted and thought through, we would love the Minister to confirm to us that carers will be able to see the appropriate parts of the single patient records of those they care for, so that they can oversee their medical care and flag any issues. There are some specific advantages to having a single patient record when travelling between hospital trusts.”
“I agree that there is no need for carers to see irrelevant or extremely historical information in the single patient record. Currently, however, there are a lot of carers who, for various reasons, such as not having legal power of attorney, cannot access the information that they need. We also sometimes find that the people who are carers, who are potentially the spouse of the patient and are themselves elderly—because a lot of people receiving care are elderly—do not understand the information that they are being given. There can be a situation where the person providing care does not fully understand why the patient is getting some medication, or the best way to treat them. We hear that quite a lot.”
“The hon. Lady is making very good points. The whole thrust of the argument is that there is little detail around how the single patient record will be created and implemented. This is a perfect opportunity to work out how we can empower carers while preserving patient confidentiality where necessary. If we do not focus on that in the early stages of the SPR’s implementation, before it has even been designed, we will miss the opportunity to ensure that carers have an easy way to get the right information. We should not miss that opportunity.”
“If the people providing the daily care are not empowered properly, it is—well, not a complete waste of time, but the efforts of the medical staff are in vain if the compliance day to day is not accurate. I thank everyone for the discussion. I will not press the amendment to a vote, and I beg to ask leave to withdraw it. Amendment, by leave, withdrawn . Ordered, That further consideration be now adjourned.— (Emma Foody.)”
“I thank everyone for that very useful discussion. I was pleased to see everyone broadly in agreement that we need to work out how we can provide the necessary information to provide better care, and to balance that with privacy. Everyone made really insightful points on that. I just emphasise that, as we all know, there is a difference between treatment/prescription and compliance, and compliance is where many medical treatments fall down. It is once the medical staff are not involved on a day-to-day basis, when the patient is not under their direct care or in the facility of the medical treatment, that most of the care takes place, and that is when successful or unsuccessful treatment for the medical condition occurs.”
“I beg to move amendment 71, in clause 47, page 34, line 29, at end insert— “(3A) The regulations must make provision for medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record. (3B) The regulations must include a requirement for the Secretary of State to prepare and publish a report on the potential merits of introducing a statutory requirement for mandatory medical markers for firearms licence holders to be used by those relevant in providing patient care.” This amendment would require medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record.”
“If their mental health status changed during that time, the amendment would enable them to be flagged to healthcare workers and GPs as a person who has a firearms licence, so that any necessary proactive measures could be taken to ensure that they are still safe to have that licence, or should have it removed, rather than waiting for them to apply for a new licence in a few years’ time. The British Medical Association supports the amendment and the Royal College of General Practitioners thinks it would be valuable. A survey carried out by the Association of Police and Crime Commissioners found that 87% of existing certificate holders believe that GPs should inform the police if they become aware of health issues that could have an impact on the certificate holder’s ability to own a gun safely.”
“The amendment was tabled in the name of my hon. Friend the Member for Epsom and Ewell (Helen Maguire), and would require medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record. I will not read through all my speaking notes but, in a nutshell, a person rightly undergoes mental health checks before they acquire a firearms licence, but that will not be reviewed until they are due to renew their firearms licence a few years later.”
“The amendment seeks to make prior armed forces membership visible to all relevant healthcare workers, and to make the Secretary of State consult on the merits of doing so, so that when a GP is treating a patient, they are aware of that person’s service history without having to ask about it specifically.”
“The transition from serving in the armed forces to civilian life can mean that many of those individuals struggle with mental health issues, such as post-traumatic stress disorder. The issues are often specific to the service the individuals have given. Some stats show that more than half of England’s Army veterans have some sort of health problem. I should point out that veterans do not only have mental health problems. Specific back and knee problems are much more common among infantry soldiers because of the type of training they have done over many years.”
“The hon. Gentleman makes an interesting point. I suppose this is another chance to use the developing single patient record to ensure that we close the gap. The record could be formed in such a way, and the process put in place, to ensure equity in the system, with mandatory markers. Amendment 72, also tabled by my hon. Friend the Member for Epsom and Ewell, would require prior membership of the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record. It would also require the Secretary of State to publish a report on making prior armed forces membership visible on the single patient record. There are just over 1.85 million armed forces veterans in the UK, 13.6% of them women and 86.4% men.”
“The hon. Gentleman makes some good points, especially given his experience as the Conservative spokesperson in the Westminster Hall debate on this subject, for which he did a lot of research. I do not think we need to worry about medical professionals seeing that someone has a firearms licence and potentially treating them differently because of assumptions they make about them. Medical professionals are trained to be dispassionate, and they try to show little bias. I would be very surprised if a doctor, seeing it flagged on a single patient record that someone was in possession of a firearms licence, changed their attitude towards or approach to the treatment of that individual. I think that particular point is probably not relevant.”
“I thank all hon. Members for their input, and the Minister for her insights. I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn.”
“Will the Minister expand a little on the detail and on how all this will be implemented? What precautions will be taken to ensure that patient data is protected? Will she consider the Lib Dem proposal for a health data charter that sets out principles and responsibilities for handling NHS data?”
“I have spoken to three different practices in Winchester, and the practice managers are quite concerned that GPs will be required to share data much more routinely than they do now, but they will still carry the legal and professional risk and will likely act as the channel to explain to patients how their data will be used. GPs will need to be brought on side for the SPR to work, and that will depend on who decides, what safeguards apply and how burdens on practices are managed. Recent experiences show the sensitivity of the issue. The British Medical Association has stated that it may consider collective action on GP data sharing. The 2022 roll-out of automated prospective GP record access through the NHS app was paused after concerns about safeguarding and the burden on practices.”
“Public involvement should be ongoing, visible and tied to real implementation decisions. Past NHS data reforms show that support depends on people feeling informed, heard and able to challenge decisions. Any red lines should also be clear. For example, there should be consented use for marketing or insurance purposes. We also need to discuss the role of GP practices in this debate, given that they work within the NHS but are also private businesses. GP records are among the NHS’s richest data assets, and GP practices are to remain independent data controllers.”
“The Bill should be more explicit on who is responsible for decisions about access, sharing, liability and redress. That is why we have tabled various amendments, which we will get to later, most notably on our health data charter, setting out the key principles of how health data should be handled and a duty to prioritise domestic suppliers in technology procurement. We welcome Opposition amendment 49, which we debated earlier—I believe it was echoed by the NHS Alliance—suggesting that a plan should be laid before Parliament for a minimum three-month public information campaign before the system goes live. The discussion on this needs to be constructive, not alarmist, to make sure that the SPR is rolled out in a safe fashion and so that we all get to feel the benefits.”
“There have been recent examples of NHS staff inappropriately accessing the private health records of the victims of the Southport and Nottingham terror attacks. The decision by the University Hospitals of Liverpool Group not to inform patients of the breaches understandably raised privacy concerns. The Government must therefore ensure that there are sufficient safeguards and guardrails, and that they are communicated clearly to the public to build trust. The single patient record needs to happen, but in the right way. The issues with the FDP’s uptake have shown that patient and staff mistrust can significantly undermine a system’s effectiveness. The most important safeguards should not be left entirely to later implementation. They should be laid out in primary legislation at the beginning of the process.”
“We would be really concerned if people were too worried to come forward for medical treatment because they thought that their immigration status might be passed on to another Department. There was a Westminster Hall debate recently on the concerns about Palantir and about the single patient record being abused. From an economic point of view, it seems a lost opportunity to have such a huge infrastructure project farmed out to foreign companies based abroad. First, this is a huge opportunity for companies in the UK to boost our economy, provide employment and drive innovation. Secondly, if we are reliant on foreign companies to deliver this service, we could lose our health sovereignty and their motivations might change depending on the political and economic situation of the country in which they are based.”
“Trust among medical staff, patients and the public is essential for this much-needed system to succeed, and we have only to look at the pushback on the federated data platform to see that. Sufficient guardrails are necessary to make sure that secondary uses of health data are allowed only when they deliver a clear public benefit. Rules need to be future-proofed so that they are not vulnerable to change depending on the political or economic situation. There should be meaningful checks, balances and transparency. We want to make sure this technology is focused on enabling and delivering healthcare. We know that, in the US, Palantir is providing health data to US Immigration and Customs Enforcement, which is then used to support deportations.”
“Although the public are rightly concerned about the use of their data, especially outside of direct care and for planning and research purposes, we wholly support the idea of a single patient record. The plan is for people to be able to see their primary, secondary and social care records all in one place, all in the NHS app. It will be transformational, but patients should be in control of their data. They should be able to see who is accessing their records and should be able to opt out of sharing data. It is essential that there is sufficient control and guarantees around the sharing of data, whether for research or other reasons. The Bill does not go far enough to provide reassurances that patients will ultimately be in charge of their own data and how it is used.”
“I will speak to clause 47 and to new clauses 7 and 8, which were tabled by my hon. Friend the Member for Newton Abbot (Martin Wrigley). The sector has been calling for a single patient record for decades, and it is the single most impactful part of the Bill. It could be transformational for patient experience, care, outcomes, consistency of treatment and reducing errors. Members have talked about the hassle of people having to tell their story repeatedly or recollect the history, which many people cannot do accurately, so the clause could be hugely impactful. Polling shows that nine out of 10 Britons want better access to medical records. Many assume that a single patient record already exists and are often quite surprised when they go to another hospital and find that it has no record of what has been done in the county next door.”
“This is an extension of that, so that dentists, pharmacy contractors and providers of ophthalmic services can all feed into integrated care boards’ healthcare plans. That is how most people come into contact with the NHS, which means that those providers have a close and deep understanding of the healthcare issues facing the demographics in their communities.”
“It is an honour to serve under your chairship, Sir Jeremy. I have been itching to speak on this new clause, tabled in the name of my hon. Friend the Member for Epsom and Ewell (Helen Maguire)—I am not sure how to pronounce that, but I am sure it is a very beautiful place; I have never been. It would ensure that a certain range of primary care providers were consulted by integrated care boards in the development of the healthcare plans. The recent King’s Fund report, as well as many others, showed that over 90% of NHS contact with patients is in primary care in all its forms. New clause 70 relates to new clause 60, also tabled by my hon. Friend, which is about having GP representation on integrated care boards.”
“If integrated care boards are not drawing on the experience, knowledge and data from primary care providers in all their forms, any healthcare plans they come up with will not be relevant to those demographics. We will not be keeping people out of hospital or treating them as effectively in the community, and the whole system will not be as efficient or as targeted as it could be. I would appreciate it if the Minister considered accepting the new clause.”
“The hon. Lady makes a good point. The purpose is to ensure that those who are deeply embedded in community care are consulted by the ICBs, so that they do not miss obvious localised issues in their demographics when developing care plans. Just to give a brief example from a surgery I held recently, Joanne Cook is an occupational therapist who is campaigning for occupational therapists who have received specific training to be able to prescribe, and crucially de-prescribe, medications, in the same way that trained paramedics can. Often, occupational therapists see patients on a daily basis. They give them intimate and regular care, and are even better placed than GPs to notice small changes and adjust medications to keep people out of hospital.”
“What we are desperately trying to do is ensure that we are drawing on the expertise of primary care providers. The hon. Member seems not to understand that talking about 40 new hospitals the whole time with no plan to deliver them is looking at the wrong end of the health service. We need to try to keep people healthy and in the community. The new clause is an attempt to refocus thoughts on keeping people healthy in the community, rather than talking about hospitals that never existed.”
“This Bill is a missed opportunity for the Government to reform or promote the use of section 75 arrangements, or to provide an alternative mechanism that they believe would be more effective in addressing the challenges that funding flows present to the integration of health and care services. That is why the Select Committee suggested this new clause to prompt a review of section 72 and the introduction of guidance to support pooled budgets and jointly commissioned health and social care services.”
“It also heard that the use of section 75 arrangements is inconsistent. In October 2023, the Government launched a call for evidence to explore how section 75 could be better utilised to support integration. A summary of responses published in December 2024 identified several areas for improvement, including the need for stronger inter-organisation relationships, clearer governance and financial structures, and better data sharing. The Health and Social Care Committee recommended that the Government expand the use of section 75, including the range of services that it will be used to support.”
“Melanie Williams, the then president of the Association of Directors of Adult Social Services, told the Health and Social Care Committee that the NHS and local authorities “spend a lot of time debating about who pays, rather than having a conversation about how, in the longer term, we can invest in people’s outcomes to enable better health and wellbeing.” She highlighted concerns about the funding of intermediate care and community health services through aftercare under section 117 of the Mental Health Act 1983 and NHS continuing healthcare. Section 75 of the 2006 Act provides a legal mechanism for NHS bodies and local authorities to pool budgets and jointly commission health and social care services. The Select Committee has heard evidence of positive examples of such arrangements being used to commission integrated services.”
“We all recognise that closer arrangements are needed to properly address discharge delays, which directly lead to corridor care or even unnecessary admissions to hospital. It seems that a consensus has been reached, yet the action to back that up is not there. We feel that, through this Bill, the Government are moving away from closer integration.”
“New clause 26, tabled by my hon. Friend the Member for Oxford West and Abingdon (Layla Moran) and the hon. Member for Worthing West (Dr Cooper), who both sit on the Health and Social Care Committee, would require the Secretary of State to review the arrangements under section 75 of the National Health Service Act 2006 and consider whether to require NHS bodies and local authorities to enter into new arrangements with one another if that is likely to lead to an improvement in how their functions are exercised. A recurring theme of Health and Social Care Committee inquiries is the impact of financial flows and how they frustrate attempts to deliver truly integrated care—an issue we discussed in earlier sittings.”
“If people deliberately inflict suffering on a defenceless animal, it is often a warning sign that that violence will extend beyond the animal and into the home. We do not know what goes on behind closed doors.”
“It is an honour to serve under your chairship, Dr Murrison. I thank the hon. Member for Burton and Uttoxeter (Jacob Collier) for introducing this hugely important debate; the petitioners and Bea Elton for getting so many signatures, which is why we are discussing this issue; and Holly’s family, who are turning an absolute tragedy into something that could have a positive legacy. That is very courageous. In my many years of working in veterinary practice, one observation always stuck with me: how people treat animals is often a reflection of how they treat the people closest to them. People who treat animals with unfailing kindness tend to be some of the kindest people you will ever meet.”
“Thirdly, anyone convicted of deliberately abusing an animal should be prohibited from owning animals in the future. The courts should have the powers to impose long-term or, where appropriate, lifetime disqualification orders. Holly’s killer had abused animals since the age of eight. He had admitted it and the RSPCA knew about it, but the legal and justice systems that are in place did not allow anyone to join those dots. We cannot allow that to happen again. By clamping down hard on deliberate animal abuse, we can protect women, spouses, children and animals from future harm.”
“The issue at the moment is that the abuse of an animal is often prosecuted under animal welfare laws and does not show up when people look for historical allegations of or convictions for domestic violence. Secondly, anyone convicted of sexually abusing an animal should be automatically placed on the sex offenders register. At present, such convictions under animal welfare legislation carry no referral to public protection mechanisms. That means that if someone has sexually abused an animal, they are prosecuted under animal welfare laws and there is no way of tracking them, although they have a higher likelihood of committing sexual violence against other people as well. That cannot be right; it is an anomaly that this House should fix.”
“Animal abuse is not always an isolated act of cruelty; sometimes it is the first symptom of something much more dangerous. That is why I take every opportunity to discuss the important work of the Links Group, which highlights the evidence linking animal abuse with domestic abuse and other forms of violence. I ask the Minister to consider three measures. First, when someone has been convicted of abusing an animal, that information should be disclosed under the domestic violence disclosure scheme, commonly known as Clare’s law, where it is relevant to protecting someone at risk. If animal abuse predicts domestic violence, that information must be available to all those who need it.”
“My concern in those situations, beyond treating the animal in front of me, extends to the people living in closest proximity to the person who has brought in the dog. We know that people sometimes even coerce their partner to stay with them instead of leaving by threatening to harm their pet. On that note, I pay tribute to organisations such as Trinity in Winchester, which has a refuge for people fleeing domestic abuse that allows them to take their pets with them, because that is a barrier to people escaping that situation. Cats Protection and Dogs Trust have very similar schemes, and they are hugely important. As vets, we are trained to recognise the early signs of diseases so that we can treat them before they become irreversible, and I believe we should take the same approach to violence.”
“I totally agree. We should be clear that, as other hon. Members have pointed out, there is a very big difference between someone who causes suffering to an animal for a variety of reasons, such as mental health issues or ignorance, or through neglect, and someone who deliberately causes harm to an animal because they have a sadistic personality or want to feel powerful. In this debate, it is important to consider the motivation behind causing the suffering: if someone causes deliberate suffering, it indicates that they may well cause harm to other people around them. As a vet, it is always unsettling to treat a dog with a broken rib that could have resulted from a kick when the owner says that it fell down the stairs, for example. That is a very unusual thing for a dog to do, and it would be very unusual to break a rib as a result.”
“I totally understand the need for safeguards so that disclosures are not used as an excuse for harassment or inappropriate release of data. Sexually abusing an animal does not mean that someone is on the sex offenders register, and the committing of deliberate acts of violence against an animal would not automatically be included in domestic violence disclosure; but, given the way that information is recorded and stored currently, even if the police wanted to and thought it appropriate, it is unlikely that they would be able to disclose it. Would the Minister meet me to discuss how we ensure that these offences are at least recorded in a way that means that they could be disclosed if deemed necessary and appropriate?”
“Just to reiterate what my hon. Friend is saying, in Winchester we are now putting an urgent treatment centre in front of the A&E, staffed by GPs to do the triage, because so many people who turn up are only there because they cannot get a GP appointment. So we now have hospital trusts paying for GPs to provide same-day GP appointments, and that is coming out of the secondary care budget instead of the primary care budget. That is obviously the most expensive place to treat patients for routine things.”
“If he wants to help with the details in order to get 8,000 GPs by the end of this Parliament, he can submit his suggestions to the Liberal Democrat website.”
“Even when the right hon. Gentleman criticises, he does so in a charming way. None of this is moving the discussion to how we keep people healthy and treat them early. He may criticise our funding models and challenge the detail for achieving this measure, but if we flip that round, the previous Government promised 40 new hospitals, which were not hospitals and did not materialise. The entire focus of healthcare has been on treating people once they are sick, while people cannot get GP appointments. I hope that the right hon. Gentleman would agree that the thrust of the argument is to try to keep people healthy and treat them early, before they end up needing hospital treatment, and that that is what we should all be focusing on.”