Caroline Johnson MP: speeches

Speeches

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  Q I should perhaps reiterate that I am a member of the Royal College of Paediatrics and Child Health. Dr Dickson, NHS England has responsibility for workforce and workforce planning. How will the Bill affect that, and what effect is the delayed and delayed and delayed workforce plan having on the ability to plan the workforce now and for the future? Dr Dickson: I would go back to some of the comments that have been made before. It is the opportunity cost at the moment. We know that the workforce plan is being worked on in the background, but when you are unsure what the operating and delivery model will formally look like, there is a difficulty in seeing what the workforce for that will be. We are also talking about massive changes in the way we think about care delivery—movement into the community and a different way of working—so we need a different workforce. Therefore, we need to put in some work to look at how curricula drive a different type of workforce, how we train people to work in a different way and how we empower them to see the opportunities to work in that way, when they do not have actual role models. We need a culture shift anyway, whatever is happening, but the abolition of NHS England is in many ways increasing the time. Things need to move, and they are moving, but they are not necessarily moving as fast as they should.

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  Q Good morning, Sir Jeremy, and thank you for coming to the Committee this morning. You are our longest serving Health Secretary and you focused much of your tenure on patient safety. I understand you are still part of the all-party parliamentary group on patient safety, so that focus is continuing now. How does HSSIB improve patient safety and what are your thoughts on whether moving it into the CQC is a good idea? Sir Jeremy Hunt: As the Committee knows, the principle of HSSIB was modelled on the airline industry, where the air accidents investigation branch has a superb track record of identifying safety breaches. There is a very good rail accident investigation branch that does the same for the railway industry, to make sure lessons are learned. My concern was that the NHS and actually health systems across the world are not very good at learning lessons when there are tragedies. The heart of what the AAIB has is this concept of safe space, where people can talk to it completely without fear that what they say will get passed on or used against them in a court of law, and so they are very open about what may have gone wrong, allowing a rapid conclusion to be drawn. So that was the principle behind it. I am against the transfer of HSSIB to the CQC for two reasons. First, I am worried that it will undermine that safe space principle. I think the safe space principle is the bit of HSSIB that is working very well and I am worried this will undermine that. Secondly, the Bill does not do anything to address the bit that is not working well, and that bit is that the NHS is still very poor on acting on recommendations that are made, and by the way not just by HSSIB but by public inquiries, prevention of future death notices, by maternity and newborn safety investigations reports. We are the world champion at doing inquiries and reports. Unfortunately we are also the world champion at allowing those reports to gather dust without anything actually happening. What I would really like the Bill to do is something, whether through the National Quality Board or whatever, so that the public know that when HSSIB or MNSI or a Select Committee or a public inquiry makes a recommendation, the Government have to make a formal decision within a limited time period—“yes we are going to do this” or “no we are not”; no sitting on the fence about “this is under review and we will consider it, come back to it”, but a positive or a negative decision—and then if it is a positive decision, a timeline by when it will be implemented. That is not a party-political point, because this is a problem that was not fixed when I was Health Secretary and it has remained outstanding for many years. Families just put their heads in their hands in despair that they get these inquiries, get these recommendations, and nothing changes.

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  Q Sarah, the King’s Fund report said that the potential cost savings of abolishing NHS England “would be minimal in the context of the entire NHS budget”. Many MPs across the House have struggled to get numbers and costings in questions both oral and written, particularly in relation to staff redundancies. We have not received information on the full arrangements of where NHS England’s functions are going to go yet. How can we be sure that its abolition will save any money at all? Sarah Woolnough: I think, on the basis of the question, we do not know. Our worry has been about the opportunity cost. The Government, when in opposition, said that they would not launch wholescale reorganisation, because they understood the potential opportunity cost on time and other resources. As this has played out, taking longer than anticipated, we have had multiple examples of teams left in limbo about where they will end up in the target operating model. Our ongoing concern has been, “Is the benefit worth the cost?”

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  I am a member of the Royal College of Paediatrics and Child Health, a member of the British Medical Association and an NHS consultant paediatrician.

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  Q What about the risks of that—the conflict? Dr Dash: I do not see a conflict. I think they are complementary and this is all about improving the regulatory landscape in the healthcare system.

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  Q Earlier in this session we heard concerns that you keep some information secret. You have the safe space legislation in place. Does that improve or weaken safety? Dr Benneyworth: There is no doubt that it helps to improve safety. That is something we have learned from 100 years of the air accidents investigation branch, which has had an immense impact on aviation safety, the rail accident investigation branch, and many others. Safe space, or protected disclosures, means that people can talk freely to us about things that have gone wrong without fear of sanctions, being told off by their line manager or losing their jobs. We hear all the time about people who have ended up losing their jobs or getting into trouble because they have raised concerns. We see in our investigations that we are still working in a culture of fear. In an ideal world, that would not be the case and people would feel able to speak up openly about what has gone wrong, but we are working in a culture where people are not in that place. This enables staff working in the service and patients to talk to us freely about what they see on a daily basis that they think needs to change. Patients sometimes worry that they will be treated differently and not get the same care after they raise things. This enables patients to talk to us in the knowledge that they will not be named. The patients we work with who have been harmed from healthcare tell us, “We don’t want this happening to other families. We’ve been through this awful, terrible time, and we want to change the system.” This enables them to talk to us. We do not name individuals in our reports and do not name organisations. We are now in a stage where we are growing that trust. We are coming up to being three years old as an organisation, and we are growing that trust with the system. When we launch an investigation, organisations right across the country say, “Please come and see what’s happening here. Please come and talk to us.” I worry that that might be impacted by the changes ahead.

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  Q I have one small question. Dr Dickson, even in paediatrics I have looked after patients who have ring binder after ring binder of notes. Clearly, when seeing a patient for 20 or 30 minutes in clinic, there is not time to read ring binders and ring binders of notes. To what extent will the single patient record oblige clinicians to have read and understood everything for every appointment? Is that really practical? Dr Dickson: You need to believe that you have found out enough about a patient to deliver their healthcare. I would turn it around and say it is very difficult to deliver appropriate care to somebody on whom you do not have full information.

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  Q Good morning, Dr Dash. What effect is the abolition of NHS England having on its current day-to-day functioning? What sort of number of people are working solely or mostly on the transfer, and is that affecting your ability to deliver on your core business? Dr Dash: I do not believe it is affecting our ability to deliver. Much of the work to date has been led by a joint team of people from across NHS England and the Department of Health and Social Care, who are working together, have put together a process and have been going through all the things you would expect of any integration process. That has been a fairly confined team. As they are starting to look at what needs to happen in each of the different functional areas—the different directorates—that we have set out, they are working with the directors general or the executive directors leading each of those to understand what different functions we need to enact within each of those directorates, and what their teams could look like. They are putting time into that, which is good—that is what we want them to do, not least because they are also looking at ways of working, not just at numbers of people—but I would not say that it is a distraction. In fact, in some ways, I would say it is really helpful, because it is helping to define the core priorities and the key things that we need to focus on, and how we can continue on the journey of seeking to improve health and healthcare services. That is across those executive directors and directors general. The team who are putting a lot of time into this, not surprisingly, are the people working in the HR functions. That team are spending a lot of time going through the mechanics, and they have been managing things like the voluntary redundancy programme. I would hope, and I believe, that there is no negative impact on our focusing on what we need to focus on.

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  Q I want to move on to the single patient record. Do you feel that general practice has had enough information about its role in terms of who is responsible, who is accountable, who will be editing and who will be responsible for checking that the editors are right on this single patient record? Dr Dickson: The legislation is very much an enabler for a single patient record. The devil in the detail there is not entirely true. In my experience, if you ask most patients if they would like a single patient record, they feel that it is already there. They do not understand that we do not have the ability to share their data in a way that works for them. Therefore, the idea of a single patient record is very much a lodestone for medical practitioners and most patients. When you talk them through the detail of how you achieve that and who owns the data, it is a much trickier issue for many, including the professionals, but also the public. Kay Keane: I agree. The detail is not there at all. At the moment, we look after the data that is in the GP summary care record. That creates lots of questions for our patients. They will see information in there that they are not sure about or that they want help with. They will perhaps be able to read some of their hospital letters within that record. However, lots of patients have a variety of health inequalities that might mean they cannot access that data. In general practice, our non-clinical staff often help them to navigate their way around all that information. We also have patients who will read something in their record on which they want clarity—maybe something that happened a long time ago that they cannot remember and want explaining to them. All those things take time. Where will the responsibility for that go? It takes an awful lot of resources in general practice to educate and support patients and to help them navigate their appointments and the letters coming through. Where will that responsibility sit? At the moment, it is of course with the GPs, but practically it is practice managers, up and down the country, who take on the day-to-day responsibility.

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  Q We have the Hughes report that is two years from recommendation and we have not got an answer to that one yet. Our previous witness talked about a repository for recommendations—a sort of national hub to put them all into. Do you have any thoughts on that? Sir Jeremy Hunt: What HSSIB has done is positive but it is still trying to solve a bureaucratic problem with more bureaucracy. What there needs to be is a formal system with a legal obligation on the Government. I felt this when I was chair of the Select Committee as well—that Governments would kick recommendations that were awkward, usually things that cost money that they did not want to spend money on, into the long grass without actually saying whether they agreed or disagreed with them. There is a terrible phrase that is often used: “agree in principle”. I may have been the one who invented it, but it is really bad for accountability because it allows the Government to say, “Yes, we really understand where you are coming from, but we are not going to put any timeline or give you any commitment as to whether we are actually going to make the change”. I think we need a proper system—and if it is the National Quality Board, that would probably be a good place—for formally assessing all public inquiry recommendations, all Select Committee recommendations and HSSIB recommendations, and saying, “Yes, we’re going to do this” or “No, we’re not”, but if it is yes, it will happen by this date with this person being responsible.

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  Q So, in essence, the fact that NHS England is being abolished, whether that is the right or wrong thing to do, will have an effect on the delivery of new services? Dr Dickson: We are delivering services as normal, but that head space and the innovation to see what the future should be and to work towards that future actively are limited by not knowing what that future looks like. Kay Keane: We do not know what the left shift that we keep hearing about looks like; we do not know what that is for practices. In general practice, we are very practical—we get on with what is in front of us—so the big organisational changes do not have a huge effect on the day-to-day seeing of patients and organising that, but understanding what is around us does.

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  Q You wrote a report about the CQC that was not hugely flattering, and you have also written a report about the patient safety landscape. First, why did you choose to roll HSSIB into the CQC, given what you said about the CQC and the clear and obvious conflicts of interest that it creates? Secondly, you identified in your findings that a large number of clinical nursing staff were being moved into more managerial roles, with an effect on clinical capacity. Which of your recommendations would have dealt with that, or what would you recommend now? Dr Dash: On the first question, as you say, my first review looked at the CQC, and that there are a number of considerable challenges there. I would have hoped that, by now, many of those challenges had been addressed. Some of them have been, but some of them have struggled. It has already gone from the previous chief exec to a new chief exec, and it is now out looking for another chief exec, and the chair has changed too. That has definitely impeded progress. As I said, it has made considerable progress in some key areas, in particular the use of technology, but it still has a way to go, and we all need to acknowledge that. I note that the ministerial team in the Department of Health and Social care has suggested that the integration of HSSIB into the CQC should happen only when the CQC is in a more stable position, which sounds sensible and pragmatic to me. On the second review that I did, I was asked to look at the regulatory and quasi-regulatory landscape. I was referred to a report that had been done by Professor Carl Macrae and others that talked about 126 organisations. When I looked, I found more than 150, and I listed all of those in my report. I spoke to many people—well over 200 people who joined various roundtables and so on—and the very consistent theme was that this is so busy and confusing, and keeps leading to all sorts of different recommendations from different organisations, but also to people having continually to respond to all these different bodies asking for people to fill out a form, asking questions and doing reviews. As a result, our clinical staff—not just our nurses, but all our clinical staff—are having to spend considerable time filling out those forms and going through tick-box exercises. You will hear people talk about that a lot. The concern is that this very busy landscape is distracting from what it is there to do, which is to improve quality of care. I was asked by the Department of Health and Social Care to look at that landscape. I was asked to focus on six organisations, which are listed in my report, of which HSSIB was one. Across the six—of course, six is a small number out of that 150—I was asked to look at where there were opportunities for rationalisation and simplification. The observation was that colleagues in HSSIB have some great skills and capabilities in carrying out investigations into healthcare, highly complementary to the work of the CQC, which is equally there to understand how well different organisations are performing, to give the public confidence, to give ratings and to identify problems, and therefore putting those two organisations together would create significant synergies and opportunities for them both to work well.

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  The question is, how do you find it within the way it is structured?

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  Q The Bill requires that Healthwatch be abolished, to an extent, and that local authorities do their own inpatient engagement instead, but they do not seem to be mandated to do so in quite the same way. Local authorities are under financial pressure. Do you believe that such engagement will happen at all, or to the same extent that it does now? Jacob Lant: There are a few points on that. The narrative around the Bill is that Healthwatch is being abolished and its functions lifted and shifted across to local authorities and ICBs. That is not the case. We lose a number of important functions. For example, the signposting support that Healthwatch provides will disappear so patients and care users will not have that to help them to understand how to navigate local services. I mentioned the unsolicited feedback that is gathered; that function will disappear. The outreach into communities, particularly marginalised communities, will disappear. The voice for patients and communities on health and wellbeing boards disappears, so there is no feed into those local decision-making bodies. There are several places where there is not a direct lift and shift across. That is a concern, and the Committee should probe it further. On the resourcing point, at least local authorities will get part of the existing funding for Healthwatch to support their functions in that space. Under the Department’s impact assessment, ICBs will not get any funding from the current pot. That represents a 50% cut in the resourcing for listening to patients and communities, which is a concern.

• 16 Jun 2026 · Health Bill (First sitting) · Hansard source

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  Q Thank you, Sarah. That was also the view of the Darzi report. He said that it was “neither desirable nor necessary”. Jacob, what effect will the abolition of Healthwatch have on people’s confidence in the independence and reliability of views of patient experiences? Jacob Lant: First, it is important to note that we know that there are people who are reluctant to come forward and share their poor experiences of care with the NHS directly. They fear retribution if they complain or speak up. Research by Healthwatch has shown that about one in five people experience poor care, so a significant proportion of people are unwilling to come forward and speak to statutory agencies. That will be concentrated in communities who are particularly marginalised—those who already lack trust in institutions. There is a clear case already that there will be a group for whom the lack of independence will be a real concern. The second point is about the unsolicited feedback that is gathered by the Healthwatch network. Dr Dash and others have talked about how the system does lots of engagement itself, and how it could therefore surely take over those functions. But the system engages on its terms: it is about service reconfiguration that it wants to do, or about trying to gather experiences on a particular topic in which it is interested. Healthwatch allows an opportunity for continual listening and engagement with communities, where they can speak up about anything that is affecting them, from dentistry to patient transport and administration of care. Those issues are not necessarily on the system’s agenda. As I see it, under the changes that will disappear.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q You have talked a lot about adult social care in terms of the very elderly and frail and people with dementia, but it also affects younger people. For example, Swallow Lodge, which is a facility for working-age adults in my constituency, is under threat of closure. I and others have made the arguments about how it is a lifeline that allows the families to have a break and the individuals using the service to flourish and enjoy life, but there is an economic argument too. How well do you think that is understood? Closing such a place could lead to higher costs for the NHS in mental health or physical health support, further social care admissions and the like. Sir Andrew Dilnot: You are absolutely right to emphasise the importance of non-elderly adult social care, which is roughly half of all of the expenditure and growing. One reason that we see particular pressures in the elderly care sphere is that the less-elderly need has grown very dramatically, again because of the scope for increased human flourishing. On the whole, as far as I can see, there is very little understanding of the integrated nature of these costs between social care and the NHS, so I think there is very little thinking in budgetary terms about the consequences of the squeeze on social care leading to increased expenditure and needs elsewhere in the NHS. That is not easy to resolve. Moving to a system that properly integrates those trade-offs will be difficult, and it requires a different sort of funding regime, but while we do not, those costs exist. My sense is that they are second order at the national level, but where they are certainly not second order is for the individuals concerned and their families, for whom this kind of thing is an eruption of anxiety and grief, in the context that families are already under pressures that most of us would find hard to imagine.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  That would be moving it on to a new system. Dr Imam: That is in a separate shared care records system. Dr Byrne: As I understand it, the architecture is not yet decided, so how we solve those technical challenges will be determined by the choice of architecture. Dr Cocker: Similarly, I believe that the technical solution for how that will be delivered has not been finalised. When we did the maternity-based pilot in the north-west, the wireframe prototype that was developed pulled information from all the separate systems—the maternity system, the hospital central electronic patient record system, the GP system. The pilot was based on pulling it from each individual system into one place where it can be viewed, but that is a future aim. The focus is on phased implementation, so it would not all be immediately available like that, but that is the vision.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q Good afternoon, Mr Restell. When the NHS has been reorganised in the past, it has become more centralised or less centralised. Which do you think this Bill does? Jon Restell: There are lots of different ways to answer that. Obviously, some functions of NHS England moving into the Department, with powers going to the Secretary of State, feels like a centralising measure. I know that the ambition of Government is to give local NHS bodies more freedom and autonomy, but the Bill is very careful and goes into a lot of detail to leave powers with the Secretary of State to intervene in the running of those local bodies. On the whole, it is probably more of a centralising measure. Another way that some changes outside the Bill process are centralising is through the merger of ICBs and, arguably, quite a lot of providers. Whereas before you might have two or three ICBs covering an area, you now have half the staff covering much bigger geographies. I would argue that that centralises decision making to a higher level than formerly.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q The question was really about trust, and how people can be trusting of figures. For example, with Healthwatch, if you internalise patient experience into an organisation, do people then trust you when you say that it has got better? They will have only their own experience and the experience of their own family to work on; that will be the lens through which they look at things. We know that the waiting list numbers have come down, and there is not widespread trust in those numbers, for all sorts of reasons. If the numbers for patient experience are governed by the Department of Health, or the ICBs themselves marking their own homework, will the public trust them? Whether they should trust them is one question, but will they trust them? Karin Smyth: I will come back to the waiting lists, but you are absolutely right about trust. In saying that I expect this to be the board’s job, I think it is its job to get this right, and we need to support it to do that. We heard a bit from Penny Dash about the national quality board and the patient experience directorate inside the Department of Health and Social Care reporting directly to the chief executive and the permanent secretary. That has to be part of the wider architecture, which is of course outside the Bill, so we need to be able to tell that story to the wider public. We know from all the recommendations, reviews and the support that we give as Members of Parliament to our constituents that trust is really important. Getting that right and bringing people on that journey with us will be really important. Independence helps with that, and that it is why it is good to debate it as we consider the Bill—it is good to be able to air some of it—but I think people accept that things are not working and have not been working. I think your question about waiting lists is about the data and the information that says where we are at. It is really complex. To follow NHS England’s data, of which there is a lot—I commend the amount of data that is available—you need to be quite clever at spreadsheets, and at finding and articulating data, in order to bring it back to your own constituency and local place. These things are complex. It is complex to record, track and recognise how people move through a waiting list, for example. It is good that we are transparent about that. One thing that I am keen to push out is data on performance in trusts. Making so-called league tables is controversial, but the more information that we have out there, and the more we have honest debates about how complex and difficult it is—I am happy to take your questions around how that moves in order to for us to explain that—the more that helps to build trust.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  So you are losing a protection with the Bill. Sally Burlington: Exactly.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q Thank you. Maria, how do you think the Bill and all the changes around ICB funding will affect local services? To what extent does the process in itself cause disruption—or not? Maria Higson: Whenever we introduce these changes into the system we have to remember that we are talking about a group of professionals who are trying to deliver for the NHS, citizens and patients. This Bill was first announced back in March 2025. It would be fair to say that since then, for an awful lot of people, there have been organisational and personal unknowns. The best intentions to deliver against the agenda and the three shifts can be hindered by that uncertainty. As with everything, implementation is absolutely critical.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q Do you have any thoughts on the separation of elements of the record such as safeguarding records and sexual health records? We have heard about carers being able to see parts of the record. Surely there are circumstances where we may want people to see parts of the record but not others, or people may wish to share some parts and not others. Are you aware of any provision being made for that? Dr Byrne : At the moment, I think it is too early to say. Those are absolutely important questions that will have to be addressed in the design. At the moment, I am not sure how the programme intends to deal with those questions, but clinically, that needs to be thought about. There are complications that need to be thought about very carefully in terms of the record and the access. Sometimes that is clinically complicated, but I am not aware of what the plans are for that.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q My first question, which is about specialist commissioning, is for James. Your charity is involved with palliative care for children. What effect do you think the changes in the Bill will have on the commissioning of very specialist, low volume and high complexity services? James Cooper: I think that there are both opportunities and threats for families of seriously ill children and the professionals and services that provide them with palliative and end-of-life care. When we talk about seriously ill children, we mean children with life-threatening conditions, life-shortening conditions and severe medical complexity. They have a range of emotional, psychological, social and physical needs that need to be met across health, education and social care services. Part of that care involves specialist children’s palliative care, which is predominantly provided at a regional level by teams led by specialist paediatric palliative care consultants. They often have Grid training, and there are not many across the UK—there are only about 24 whole-time equivalents. They are often based at children’s hospitals or children’s hospices and are often co-located across both. These specialist teams also comprise senior nurses and other specialists involved in emotional, psychological and practical support for families. Our issue is that these services are often quite patchily commissioned at the moment; even though there has been a specialised children’s palliative care specification from NHS England since 2012, we think that money and commissioning has flowed to these services to only a very limited extent. For example, we have a successful service in the east of England, which provides 24/7 end-of-life care at home for seriously ill children, supported by nurses and these specialist consultants. But the provision is really patchy across England. The Bill presents some opportunities through the additional powers for the offices for pan-integrated care board commissioning—the OPICs—to mandate ICBs to work together to commission these services. We would like to see that. However, because of the small numbers but highly complex needs of these children, the services often need to be planned and funded at a regional level, although they often are not. We are concerned by the increased devolution to ICBs because of the extent to which other children’s palliative care services—the core services—are being commissioned at the moment. We have a range of evidence that shows that it is possible in some areas for that care to be commissioned well—for example, 19% of ICBs currently commission end-of-life care for children at home 24/7, provided by nurses and specialist consultants. However, at the moment ICBs are not taking on their full functions and implementing national guidance. I would like to see much more rigour and accountability from the centre, the Government, to make sure that such specialised commissioning works for this particular group of complex children and families.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Thank you. You are nodding, Dr Cocker. Dr Cocker: I was just going to say that we did do some exploratory work in relation to safeguarding, because that is quite a key part of safe maternity care, but because of the issues with confidentiality for other involved parties—say, a mother’s partner or someone else in the family—and the risk of that information being pulled through to someone else’s single patient record, it was felt that we could not include any information that contained information about anyone else. That aspect has been considered, but as Dr Byrne said, it would need careful consideration of all those different sources and whether there would be any option to change what feeds in. The only one I am aware of that we have looked at specifically was safeguarding, and it was primarily due to confidentiality issues for other involved parties.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q I have a question for Emily about digital exclusion and the app. What can be done to help people not to be digitally excluded? How do you see this working in areas of the country with poorer broadband connections, for example? Also, what about the record? Sharing your medical records is not an all-or-nothing thing, is it? It may be that someone is happy to share their current illness or current medical circumstance with their carer, but may perhaps want aspects of their history to remain a secret. Have you had any indications from the Government on how that might work? Emily Holzhausen: Yes. That is a lot of different questions. It has to be done with the right permissions, with the patient being in control of their data—that is a very strongly held principle within the NHS. There will be situations where people do not have capacity and their primary carer, who might be their partner, their son or daughter, might need access. We have lasting power of attorney in England, which could be used as a mechanism, or other assurance mechanisms. As for digital access, that is an issue that I am sure Paul will want to come on to. Especially when digital access costs money and we have people in poverty, we have called for that to be supported by Government to ensure that everybody has digital access. People have to feel confident about it. While we have seen a doubling in the number of carers using the NHS app to manage their own health and care in the past two years, there are key groups that are being excluded: older carers, people on lower incomes and people who feel less confident with technology, for a whole range of different reasons. Some of this stuff is delivered very well through voluntary and community services—I know that Age UK has helped my family locally, for example, but I will stop there, because I am sure Paul will want to come in on that.