Gregory Stafford
MP for Farnham and Bordon · Conservative · United Kingdom
“As I have mentioned before, the spanking new dental surgery in Haslemere hospital has sat entirely unused since it was built, and, as far as I am aware, there are no plans to use it.”
“My first point can be summarised as: “Don’t repeat a mistake to find out whether it was a mistake.” Thousands of children have already received puberty blockers through the former Tavistock pathway, and my view is that, before exposing a whole new cohort, the Government should complete the long-promised data linkage study to establish wha…”
“I declare that I am a member of the all-party parliamentary group on patient safety. Patient safety cannot be something that is discussed only after a tragedy has occurred. It requires a culture of accountability, transparency, and most importantly, action.”
“That is a complete contradiction of the ban. Thirdly, clinical equipoise does not exist in the evidence if the evidence already points to significant risk and uncertain benefit. The Cass review concluded that the evidence base for puberty blockers is weak and that concerns remain over bone health, fertility and neurodevelopment.”
“Such a process and principle are closely connected with new clause 98 and the Government response to the Hughes report on those harmed by sodium valproate and pelvic mesh. Those are deeply serious issues involving people who have suffered life-changing consequences and have spent years seeking recognition and redress.”
“When the Secretary of State appeared before the Health and Social Care Committee last week, I questioned him on that issue directly. While he confirmed that the Department remains committed to meeting that 2030 target, which was first established by the previous Conservative Government, no plan—or indication of when a plan would come—was…”
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“Member is trying to achieve, because as he said, Claire Murdoch, the national director for mental health, resigned in September over the fact that she did not feel that the Government were spending the right amount on mental health. New clause 27 would put the mental health investment standard on a statutory footing by requiring the Secretary of State to specify an increasing amount of expenditure by integrated care boards on mental health, and then requiring integrated care boards to incur that expenditure. It also differs from amendments 9 and 10, in that rather than increasing the amounts as a total of expenditure—an approach for which I have sympathy—it has the more realistic requirement that it must only go up every year.”
“Overall, although I accept that the Government have increased spending on mental health, the fact that it is going down as a proportion of the total bill is one of the many reasons why we on the Health and Social Care Committee were very concerned about the future of mental health funding. It is also why we supported our Chair, the hon. Member for Oxford West and Abingdon, in tabling new clause 27. The differences between new clause 27 and amendments 9 and 10, tabled by the hon. Member for Winchester, relate to the financial penalty. If we want people to spend more on mental health, it would seem perverse to punish them by taking money away from them, because there might be reasons why they could not meet this requirement. I totally accept what the hon.”
“The spend in that period is expected to be higher than in the previous year, 2024-25, but it will actually be a smaller proportion of total NHS spending, decreasing from 8.78% to 8.71%. That reduction also means that 2025-26 will be the first year since 2016-17 in which mental health spending will not rise as a proportion of total health spending, which is in contravention of the mental health investment standard that has been introduced. In fact, on 17 November last year, NHS England confirmed that the proportional increases will not take place over the next two years to 2028-29, and that there will instead be “flat real funding growth”.”
“I will start by addressing Liberal Democrat amendments 9 and 10; once again, I see the impetus and reason behind tabling them. As the hon. Member for Winchester said, new clause 27, tabled by the Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon, has a similar but subtly different—in my view, usefully different—impetus and emphasis. I am a member of the Health and Social Care Committee, and we published a report into community mental health in December last year, which laid bare the shocking state of mental health services in this country, especially community mental health services. Mental health accounts for over 20% of the demand for health services in this country, but in the period 2025-26, it is forecast to receive only 8.7% of NHS expenditure.”
“Member for Winchester comes back with a devastating argument in his wind up, I am not yet convinced that new clause 34 amendment meets that test.”
“As a result, I do not think it is clear what compliance with the duty in this new clause would look like in practice, how the success would be measured or how public bodies could demonstrate that they had fulfilled the obligations. Finally, although the requirement for an annual report may improve visibility, as with the provision in new clause 33, there is a risk that new clause 34 could create an additional reporting obligation without necessarily improving services or outcomes. Before Parliament imposes a new statutory duty, it should be satisfied that there is a clear objective, a measurable standard against which performance can be assessed and a distinct purpose that is not already served by existing legislation or rules. I am afraid that, unless the hon.”
“The question therefore arises as to what additional legal effect the new duty would have. Secondly, the concept of “mental health wellbeing”, while perhaps being a term we kind of understand, is inherently broad and rather difficult to define when we are talking about writing it into law. Unlike things such as waiting times, staffing levels, or access standards, “wellbeing” is not really a measurable outcome. I have some sympathy with my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt), who said in evidence that he wanted to see fewer targets, because they often have unintended consequences and skew the system towards the targets rather than what is actually required. Mental health wellbeing could encompass life satisfaction, emotional resilience, social connections, employment, housing security and many other factors.”
“I welcome the intention of the new clause to ensure that mental wellbeing is taken seriously across the health service. However, I have a few concerns about placing such a broad duty on a statutory footing, not least because, as my hon. Friend the Member for Sleaford and North Hykeham asked: is that not the job of the Secretary of State anyway? As far as I can tell, new clause 34 essentially duplicates many of the responsibilities that already exist. The Secretary of State and NHS England—as currently exists—along with integrated care boards and other public bodies, are already subject to duties relating to improving health, reducing inequalities, promoting public health and improving the quality of services. Many of the objectives listed in the new clause are already capable of being pursued under those existing powers and obligations.”
“My hon. Friend is absolutely right. We have talked about this issue while debating numerous clauses of the Bill. If someone were being ungenerous, they might say that there is an urban bias to this Bill. I think that it is less that than the fact that the Government have decided to use, as my hon. Friend rightly says, these mayoral structures to base health services on, when in fact, in so many areas, they either do not exist yet or, as far as we can tell, will never exist. Maybe Manchesterism will change that; we do not know. The Minister is smiling, so maybe she knows. Regarding new clause 34 and the promotion of positive mental health, the prevention of mental illness and the reduction of stigma are obviously vital and important goals.”
“The clause makes it even less certain which responsibilities will transfer to regional teams or providers, and how accountability will operate across the system. Introducing substantially enhanced ministerial powers before the future operating model is fully defined, as we have discussed with regional mayors and other bodies, will essentially risk creating uncertainty, duplication and potentially gaps in oversight.”
“Friend the Member for Sleaford and North Hykeham said, into bodies primarily responsible for implementing centrally determined priorities. Such centralisation risks diminishing the flexibility required to respond to local, demographic, clinical and population health challenges. The timing of these legislative changes also raises significant concerns, because they coincide with the abolition of NHS England, the redistribution of its functions and the requirement for ICBs to reduce their operating costs by at least 50%--and, in some cases, even more than that. Collectively, those reforms represent one of the most significant reorganisations of NHS governance. However, there remains little clarity regarding which responsibilities will remain with the ICBs.”
“While I agree with the points made by the hon. Member for Winchester, I note the irony that he is talking about how he wants more independence in this clause, whereas the amendments he tabled previously would have taken independence away from the ICBs—but hey, ‘twas ever thus with the Liberal Democrats. On the new powers in clause 43, we have previously discussed the power of the Secretary of State to direct how ICBs use and manage both financial and other resources, impose expenditure limits, require approval of local decisions and compel repayment of funds where directions are not followed. These provisions substantially weaken the operational independence of ICBs, transforming them from organisations that are intended to exercise local strategic leadership, as my hon.”
“It is not possible to take the clause forward without having some clarity on exactly how those powers are going to be used in future. As my hon. Friend the Member for Sleaford and North Hykeham said, clause 44 is shorter. She covered most of the points that I was going to make, but I think the Government should explain how effective oversight of the system-wide financial discipline that we have talked about will be maintained in the absence of the provisions omitted from the 2006 Act and the Health and Care Act 2022 by the clause.”
“My hon. Friend is right, and I have mentioned that in relation to other clauses. I am perhaps a cynic in my belief that if stuff is being written into legislation, that probably means that the Department has some idea of what it wants to use those powers for. It would be useful to hear from the Minister what her and the Department’s intentions are for these powers. How directing or otherwise will they be of ICBs? Specifically, proposed new section 223GB to the NHS Act 2006, relating to service integration, also exposes that inherent contradiction. It enables the Secretary of State to require ICBs to allocate designated funding into pooled budgets with local authorities, and at the same time to impose centrally approved spending plans and performance objectives.”
“My hon. Friend is right again: there is a lack of clarity in these two clauses, as I have highlighted. I am sure the Minister, having heard my hon. Friend’s question, will respond when she gets her moment.”
“I understand the purpose of clauses 45 and 46, as there is clear public interest in ensuring that providers that hold licences in our health and care system comply with the law. Patients, taxpayers and staff are entitled to expect high standards, proper governance and accountability. Where a provider delivers vital public services, it is reasonable for the licensing scheme to help to uphold those obligations. In that sense, the intention of the clauses is good. My hon. Friend the Member for Sleaford and North Hykeham outlined a number of questions for the Minister. Could the Minister explain in more detail how clause 46, which essentially provides for the enforcement of the provisions in clause 45, will operate in practice?”
“It is entirely right that a carer should see the patient record relating to whatever it is they are providing care for, but—I am not trying to be flip—should carers know that at 17, the person who they are caring for was treated for a sexually transmitted disease or something similar, which the patient might not want them to know?”
“I have a lot of sympathy with this amendment and what the hon. Gentleman is trying to achieve through it. Does he have any idea of how a patient would nominate a carer in such a circumstance? Indeed, would it be done by the patient themselves? If not—for example, the patient might have mental health issues or capacity issues—could the carer be nominated by a health professional or a statutory body? Although I absolutely agree with the intentions of the amendment, could he give some examples? For instance, would a carer be able to access all of the patient’s record, or just the part for the period in which they have been providing care?”
“As I expressed in my intervention on the hon. Member for Winchester, I have a lot of sympathy for what he is trying to achieve with amendment 8. Whether by accident or design, he has allowed us to have a real think about—”
“Is it simply a repository of treatments, illnesses, conditions and so on, or does it give a wider commentary on those conditions and treatments? In the example given by the shadow Minister, knowing that someone has hearing difficulties would be useful, but is the single patient record the appropriate place for that? I do not know the answer, but we need to discuss and decide that, because there is a danger of scope creep. If we try to make it all things to all men and women, it could lose the stated purpose, which is to ensure that a clinician has the full facts when dealing with a patient.”
“It is not as simple as saying, “Here is a wonderful record and everyone can access it,” because it will contain some of the most sensitive information an individual holds, including details of their physical and mental health. I entirely accept that carers often play a vital role in supporting patients, but unrestricted or poorly governed access could undermine patient confidentiality and therefore trust in the system. I am sympathetic to the concerns of the hon. Member for Winchester and think that, not just in relation to this amendment but as the record is pulled together, we really need to consider these vital issues. On amendment 65, like the shadow Minister, I have a lot of sympathy with the point about reasonable adjustments. We need to be careful when deciding as legislators the purpose of the single patient record.”
“However, I have some concerns about privacy and access, and amendment 8 potentially highlights those. The amendment provides for a nominated carer to access a patient’s record, but who nominates the carer? Is it always the patient, and how will that consent be verified and continually checked so that if the patient wishes to remove consent for the carer to see their record for whatever reason, there is a way of doing so? What protections exist for vulnerable patients who may feel pressured or even coerced into granting access? If circumstances change, how easily can that access be withdrawn, by whom and through what process? Although I am not being critical specifically of the amendment, the Government will need to think about those questions when they introduce the single patient record.”
“I will be charitable and take him at his word. We have opened a vital conversation about who will have access to this record, how it will be shared, which bits of it will be shared, and how we ensure that the laudable aim of a single patient record—to ensure that a clinician treating a patient has all the vital facts in front of them—is balanced with that patient’s privacy. As the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham said, we must make sure that the patient is put at the centre of this. We need to look at the amendment under that microscope of scrutiny. We must use our role as legislators to ensure that gaps in legislation are closed so that loopholes cannot be exploited. I am fully in favour of the Government’s intention on that.”
“As ever, my hon. Friend is entirely right. It would be helpful to have more clarity on what the single patient record will look like. I will not repeat my earlier questions, but I think they are prescient. I hope that the Minister—even if she cannot answer now, which I accept—has those in mind when she and her colleagues start to look at this. Even if the Minister cannot provide detail, all I ask is that she provides reassurance that access to the single patient record will be based on explicit consent, limited to what is necessary for either the caring role—as in the amendment of the hon. Member for Winchester—or the clinical role overall, subject to some kind of regular review and supported by some robust audit mechanism. If we are to create a system on this scale, we must ensure that the safeguards are just as strong as the benefits.”
“In essence, we debated the amendment in a Westminster Hall debate some months ago, when I had the dubious honour of being the shadow spokesman for the Conservative party despite not being a Home Office shadow Minister. It became clear in that debate that mandatory medical markers do not exist. It is still a voluntary system. How does the hon. Gentleman propose to make the system equitable? The hon. Gentleman and I support mandatory medical markers, and there seemed to be cross-party support for them in the Westminster Hall debate. If they are not mandatory, some people will potentially be put under a different system, because their sufficiency or ability to hold a shotgun licence could be taken away from them, while those who are not on the system, because it is not mandatory, would not lose theirs. How does the hon.”
“For example, there may be people out there who are not in favour of recreational shooting, and someone may hold a firearms license for recreational shooting. Of course, section 2 firearms licences, especially for shotguns, are often held by farmers and people involved in conservation, and for all sorts of other reasons, including the control of pest populations. But if someone has a licence for recreational use, there may be people who, for whatever reason, find that to be against their own beliefs and opinions. That might lead to a patient being subjected to a level of intrusion or bias, or perhaps not receiving the care they deserve, because someone has made an assumption about what they are like based on that information. We need to be careful about that.”
“If a patient who holds a firearms licence presents a serious medical risk because of a mental health crisis, suicidal ideation or behaviour that raises concerns about risks to themselves or others, an immediately visible marker would help clinicians to make informed decisions and take the appropriate safeguarding action. But a firearms licence is obviously not a medical condition, nor is it health information in any traditional sense. This goes back to the point I made in the debate on a previous amendment, about how broad the information that we keep on the single patient record will be. The inclusion of such a marker across the single patient record could lead to issues relating, as we talked about in previous debates, to who would want to see that information.”
“Member for Dover and Deal (Mike Tapp), responded to that debate, but he was unable to reassure us that provision would be made. I did not understand the arguments he made, because I think mandatory markers are probably the way forward. Given that they are supported by organisations such as the British Association for Shooting and Conservation and the Countryside Alliance—organisations that one might not have expected to be in favour of them—the Government should look into the idea. There would clearly be a benefit to the proposal in amendment 71.”
“It is a pleasure to serve under your chairmanship again, Ms Lewell. On amendment 71, I ought to declare that I am a supporter of the Countryside Alliance. Although I do not own a shotgun myself, I represent a large shooting community and I have been on a shoot relatively recently, but without a gun, so I did not shoot anything. As I alluded to in my intervention on the hon. Member for Winchester, I spoke on this issue in Westminster Hall some months ago, when it was clear to me that there was a significant level of cross-party support for the idea of mandatory markers for GPs. As mandatory markers for firearms licensing are technically a Home Office issue rather than a Department of Health and Social Care one, the Under-Secretary of State for the Home Department, the hon.”
“I thank my hon. Friend for that helpful intervention; I had not appreciated that. If that is true, the security and safety of the individual who holds the firearms licence, and indeed of anybody else in the vicinity, is paramount, and we generally would not want people to know precisely where guns are held, because that could be a security risk. I think the hon. Member for Winchester has the best of intentions, but the consequences have not been fully thought through.”
“I will, but first I want to be kind to the hon. Gentleman and say that, as with his previous amendment, he has opened up a conversation about the single patient record that we really need to have, to ensure that what is on it needs to be there for the treatment of patients. As legislators, we need to have a wide conversation to decide what it includes and how it is going to be used.”
“We need to make sure that we root out that kind of behaviour, but we also need to protect people from it. Amendment 72 is another that was tabled with the best of intentions. The improved identification of veterans is an interesting idea, because I do not think many veterans actively identify themselves when they access healthcare. A visible marker could help to ensure that healthcare professionals are aware of a patient’s service history without relying on self-disclosure. There may be direct benefits to a veteran, because they may be eligible for dedicated NHS services—including mental health, rehabilitation and other veterans’ healthcare pathways—through the armed forces covenant. A marker could, then, assist clinicians in directing patients to appropriate support more quickly.”
“I admire the hon. Gentleman’s optimism. I am not belittling his point—I, too, hope that no one would be treated, both in the traditional sense and in the medical sense, based on their background or anything else, including their recreational hobbies. Unfortunately, we have seen cases in the NHS in which someone’s religious background has led to antisemitism and other unfortunate issues. Unfortunately, sometimes the system itself has a problem. The Health and Social Care Committee published a report relatively recently on black maternal health. We could see the difference and the fact that, unfortunately, black women experience a worse level of care, often because of assumptions made about their backgrounds. I agree with the hon. Gentleman that I hope everyone is treated dispassionately, but I am afraid it does not always happen.”
“Disabled people may also face accessibility barriers that these systems do not always anticipate in their design. Modernisation should never mean creating a two-tier NHS—one for those who are digitally confident and another for those who are not. The people at risk of being left behind are often those with the most complex healthcare needs and the greatest reliance on the continuity of care. A proper assessment of digital exclusion is therefore not just a bureaucratic exercise, as some may describe it; it is an essential safeguard. We need to understand how the single patient record will affect elderly patients, disabled people, carers, those with learning disabilities and those who may struggle to engage with digital services.”
“As we move towards a single patient record, we have to ensure that technological progress does not come at the expense of those who are least digitally connected. As others have said, I am particularly concerned about older patients and many disabled people, who often rely most on NHS services but can face the greatest barriers when healthcare systems—and all systems—become increasingly digital. For some elderly patients in my Farnham and Bordon constituency, navigating online platforms is challenging, and others may not have regular access to the internet at all. Unfortunately, my constituency has one of the worst full-fibre broadband roll-outs in the country, and it has extraordinarily poor mobile phone reception in the central rural parts of the constituency, despite my best efforts with BT Openreach and others.”
“A public information campaign is not a bureaucratic hurdle; it is a democratic necessity. If Ministers are confident that the single patient record will improve care, strengthen efficiency and protect privacy, they should be eager to make that case to the public and should therefore welcome the scrutiny, transparency and informed debate that a three-month public information would bring.”
“A three-month campaign to give them that opportunity would be appropriate, because the things that I have outlined are not technical details that need to be buried in some Government website or hidden in the small print of a privacy notice; they are fundamental questions that deserve proper public engagement. I am especially supportive of amendment 49 because of the impact on older people, disabled people and those who are less digitally engaged. I do not think that most of my constituents spend their time reading NHS policy documents online—my notes say “most”, but I think none of them do, unless they are involved in the health world themselves—and they should not wake up one morning to discover that a major change to the management of their health information has already been implemented without their knowledge.”
“Friend the Member for Sleaford and North Hykeham, would prevent the Secretary of State from making regulations to establish the single patient record unless a public awareness plan had first been published and laid before Parliament, and a minimum three-month public information campaign had been conducted before the system went live. That seems eminently sensible, and I hope it is something that would be not just welcomed by Ministers, but on their agenda already. Patients clearly have a right to know what information is being held, who will have access to it, how it will be used, what safeguards are in place and what rights they have in relation to their own data before the system goes live.”
“To conclude on amendment 70, before we proceed any further, the Government should be able to demonstrate that no patient will receive a worse service, face greater barriers to care or lose access to information simply because they are older, disabled or less digitally connected than others—that goes to the heart of fairness and equity of access in our NHS. I am absolutely certain that the Minister does not wish that to happen, but it would be interesting to hear how she will ensure that it does not happen. Amendment 49, in the name of my hon.”
“For me, the key thing is that we must have equity of access to the single patient record. If somebody wishes to see their own medical record, they should be able to do so, whether they are digitally savvy or not. As far as I can tell, that is the intention behind the Liberal Democrat amendment. However, the hon. Gentleman raises an interesting point. We are seeing this already, but the more we go down the digital route—because it is more efficient and straightforward, and takes out the unnecessary bureaucracy of having a human interaction to book an appointment or whatever—the more likely it is that this will become the portal for all interactions. I am not saying that that is the Government’s intention, but he raises a point, perhaps inadvertently, that we need to think about.”
“As my right hon. Friend has just said, this is a unique system that will have unique benefits, but it will also have unique risks. Almost in answer to the point made by the hon. Member for Ashford, I do not think there is anything— [Interruption.]”
“I worry that every patient record will potentially be available to every single person, and I doubt that there will be an ability to check every single person proactively rather than reactively. That means patients need access themselves to look at their record and see who has been accessing it. If the name of the person who has accessed the record, or the organisation they belong to is available, patients can say, “Well, there is Mr Smith, my child’s paediatrician, and that is fine. However, who is this guy from elsewhere in the country who has looked at the record?” They can then raise that. That is absolutely vital.”
“It goes directly to proposed new section 250F(4B)(b) of the National Health Service Act 2006, which is the system of audit logging to be applied to each record, so that every time someone accesses a patient record or part of that patient record, the identity of the person obtaining that information should be recorded. I believe that the patient should be able to easily see, hopefully in real time, who has been accessing their record and at what time. We on this side have mentioned a number of big events: that poor boy with the crocodile, terrorist attacks in Southport and so on. I suspect that those data breaches have been identified because they were big events. People have gone out to check that nobody has been inappropriately accessing those records.”
“Cambridge University Hospitals trust is currently investigating 40 members of staff who appear to have accessed that boy’s medical records inappropriately. While we would always hope that that would not happen, unfortunately it clearly does. This single patient record means that someone will potentially be able to look at patients’ records regarding anything and from anywhere in the country. My hon. Friend the Member for Sleaford and North Hykeham slightly generously described some people as “nosey”. Along with those who have an actual ulterior motive, that presents a real challenge. I say to the hon. Member for Ashford that just because the current system is in place to protect patient records as they currently exist, that should not be a bar to making sure that we make the system even more robust given its potential risks.”
“As my hon. Friend the Member for Sleaford and North Hykeham pointed out, those people could be situated anywhere across the country. Patient records should be accessed only where there is a clear clinical, professional need. The public rightly expect robust safeguards, strong audit trails and meaningful consequences where the rules are breached. Amendment 48 raises that important issue. The Minister should explain how inappropriate access will be prevented, how misuse will be detected and what sanctions will apply when the standards are not met. My hon. Friends have already mentioned a number of cases and I pick another one: the unfortunate case of the three-year-old boy who was hospitalised after being attacked by a crocodile at a zoo.”
“Before I was rudely interrupted by the fire alarm—I am not taking it as a hint, much to the Minister’s disappointment—I was saying that this is a unique system and that with the unique benefits come unique risks. I was trying to answer the points made by the hon. Member for Ashford. As my hon. Friend the Member for Sleaford and North Hykeham and my right hon. Friend the Member for Melton and Syston have mentioned, we already know that despite the regulations, whether they are from professional regulators or the ICO, people will get round the system. One of the biggest concerns that patients will raise is not simply whether patient records will be accessed by nefarious people from outside, such as cyber-hackers, hostile states and so on, but whether they are secure from inappropriate access by people who have access to the system.”
“Again, the Government need to have a plan and system in place to ensure that there is not inadvertent, non-nefarious access to patient records as well. That is why I am very supportive of amendment 48. To make sure that this system is trusted by patients, we need to have the highest level of safeguarding possible, both from external attacks and from internal misuse. My hon. Friend’s amendment goes a long way to putting some of that trust in place.”
“My hon. Friend is right. I will not sit here and propose a solution to this problem, but what her amendment does is ensure that the Government look at this and present a plan before both Houses of Parliament, before we get to a single patient record. I have now touched on the nefarious and the nosey. I think there is also a case of inadvertent access. With this new system, despite what the professional regulators might think, and despite the best training from the Information Commissioner’s Office, there will be occasions in a new system where people do not understand the limits of what they are allowed to look at or the appropriateness of access. There could well be inadvertent access to these systems.”
“Or will it include both, so that the patient knows that they have had a heart attack, for example, but the medic can see the precise detail on what sort of transient ischaemic attack it was. We need to understand what the data is recording and at what level of detail.”
“There are major questions for public trust but those are left, I would say, entirely to future regulations. We need clarity about them now. My third concern is the scope of the information that may be included. The definition of “patient information” is extraordinarily broad. It covers information about physical health, mental health, diagnosis, treatment and care, including social care. The definition of “patient” includes people receiving social care or having their care needs assessed. What we do not know from the Bill is exactly how that data will be presented. Will it use language that a patient can understand? Will it talk about having a heart attack, or will it use medical information that a medical professional will need to assess?”