Vascular Sector Reform

Zubir Ahmed Excerpts

Thursday 10th September 2026 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the potential merits of reform of the vascular sector.

It is a real pleasure to serve under your chairship, Dr Huq. Last night, you were in the Adjournment debate, and today you are chairing a Westminster Hall debate. Your talents are incredible—well done to you. We appreciate all the efforts that you make for us in this House in all ways.

It is, too, a pleasure to introduce this debate on something I am particularly interested in. A number of people in the Public Gallery have much more medical talent than I have—I am interested in the subject, but in the Gallery are some of those who carry out some of the operations and so have a deep interest. I pay a special thanks to Roger Greer, who is the administrator for the all-party parliamentary group for vascular and venous disease, which I chair—I declare that interest. That gentleman and others with him make the effort on this subject matter, which I am interested in.

Back home, I have had the opportunity to visit the Royal Victoria hospital. On vascular health, unfortunately some of the statistics for Northern Ireland, which I will mention, are worrying. I suspect that they will illustrate where we are in Northern Ireland, and that what is happening there will be mirrored here on the mainland.

It is a real pleasure to see the Minister in his place. We had a wee chat beforehand, and I think—although I am not a prophet or the son of a prophet—we will all agree on the subject matter of this debate. I very much look forward to the Minister’s response, and to his encouragement in some of the responses that we need as we move forward.

I am speaking on an issue vital to thousands of families across our great nation, the United Kingdom of Great Britain and Northern Ireland, and yet one that too often remains hidden in the shadows of our health service. I just said that to the Minister before—this is one of the issues that is slightly hidden. We might not always know everything about it, unless we have a particular interest. I know that other Members present—I thank them for coming—will have a particular interest in the pressing need for comprehensive reform of lower limb vascular care.

This debate gives this Westminster Hall Chamber the opportunity to highlight an often forgotten health issue. Vascular disease affects the very network of life within us, the arteries and veins that carry blood around our bodies, and encompasses peripheral arterial disease, chronic limb-threatening ischaemia, venous disease and devastating diabetes-related foot complications. I declare an interest as a type 2 diabetic, although I Richard in the Gallery might say, “Well, after that cake you had the other day, perhaps you’re not as careful as you should be with your diabetes”—but I do try to be careful and look after it.

Those are not mere clinical terms; they represent real human suffering, unbearable pain, non-healing wounds, severe loss of mobility and, in far too many cases, major limb amputation and premature death. I will put a bit of focus on that for us in Northern Ireland, because some of the figures for amputations in Northern Ireland are scary. I think they are probably scary here on the mainland as well. We have seen inspiring progress in cardiac and stroke care, which is very much welcome, but outcomes for vascular patients have simply failed to keep pace. That is the issue I want to highlight, if I can.

The risk of developing PAD is four times higher among smokers than non-smokers, and two to four times higher among people with diabetes than people without diabetes. That is another reason for this debate and the importance of where we are. One in five people over the age of 60 is affected by PAD, and more than 80% of amputations among people with diabetes are preceded by a foot ulcer. People might say, “A foot ulcer? That is not too bad”, but it can well be. Often, it is the precipitation of a disorder in your blood, which ultimately could lead to amputation. That statistic clearly demonstrates the enormous opportunity we have in prevention and early intervention.

One of the main thrusts of my comments today will be about early intervention and how we do that. We have experts in the Chamber who will speak, and I thank all hon. Members for coming along to make their contributions.

Approximately 4,200 major lower-limb amputations are performed every single year due to PAD, each representing, I believe, a personal tragedy, and an average cost of £28,000 to the NHS. We have to consider the costs, because they are part of what the NHS has to look at. Managing CLTI alone costs our health service an estimated £244 million annually, while the overall bill for NHS wound care reached a staggering £8.3 billion in 2017-18. That included some £5.6 billion spent on wounds that failed to heal. That perhaps gives a clinical look at where we are.

The human toll, of course, is tragic. Patients suffering from CLTI with rest pain or tissue loss face a 60% risk of death within five years, a prognosis that is worse than for many end-stage cancers. Following an above-knee amputation, a quarter of patients die within 90 days, and median survival among diabetic patients is just 1.68 years. Those stats illustrate the extent of the problem and, I believe, confirm the importance of where we are.

[Dr Zubir Ahmed (Glasgow South West) (Lab)]

The statistics that the hon. Gentleman highlights should shock us all. If those were the statistics for dealing with any cancer, we would simply find them unacceptable. Does he agree that vascular disease, because it is not treated in the same way as cancer, in some cases ends up being treated as a “second-class” disease, and that we should be mindful of that?

[Jim Shannon]

I thank the hon. Gentleman for that intervention. He has rightly said that, when it comes to vascular disease, while it is equal with cancer in its severity and in the numbers who lose their lives, it is not treated the same. Today’s debate perhaps gives us a chance to illustrate that, and I am hopeful that the Minister responsible for answering can give us some encouragement in relation to it.

Furthermore, this crisis starkly reinforces health inequalities. Just as an example, among individuals aged 45 to 54, those in our most deprived communities face above-knee amputation rates nearly five times higher than those in the least deprived areas.

I thank the Library, as always, for the information that it made available to us. It said that

“gaps in vascular care are resulting in avoidable harm for patients. In particular, the report highlighted ‘delayed diagnosis, inconsistent referral pathways and variable access to specialist care’ for people with PAD, venous disease and diabetes-related foot complications. It said these problems are resulting in ‘thousands of avoidable lower-limb amputations each year.’”

If we were to achieve something from today’s debate, it would be first to ensure an improvement in vascular health, but secondly for the issue of amputations to be addressed through early diagnosis and looked at much more significantly and strongly than it has been.

As the Member for Strangford in Northern Ireland, I feel a particular responsibility to shine a light on how this national crisis presents itself in Northern Ireland. I do that because I think it will help add to the debate; I am ever mindful that the Minister here today has responsibility for the United Kingdom but not directly for Northern Ireland—I understand that—but I use the figures, stats and information from Northern Ireland as an illustration of the issue. What I want to see, and what I think the Minister will want to see as well, is an improvement in this across the United Kingdom and elsewhere.

My job is to shine a light on how the national crisis presents itself in Northern Ireland. While the briefing outlines the systemic challenges across the UK, the reality on the ground in our region underscores an even more acute urgency. Across Northern Ireland, hundreds of patients undergo limb amputations each year due to vascular complications and diabetes-related foot ulcers. In fact, diabetes prevalence in Northern Ireland continues to rise steadily, with local health trusts treating thousands of individuals at high risk of developing severe foot complications.

People sometimes think that diabetes is not that serious. I used to be almost 17 stone. I realised, when the doctor confirmed that I had diabetes some 18 years ago, that I had to lose weight. I lost 4 stone and I have kept it off, but I have to work hard to ensure I do not develop any other complications, which can quite often happen.

The stats in Northern Ireland reflect stark and unacceptable regional inequalities, and they are mirrored by the stats and figures from the mainland. On healthcare inequality, patients from the most socio-economically deprived communities in Northern Ireland face significantly higher amputation rates, nearing the alarming national trend here on the mainland, where deprivation increases the likelihood of a major amputation nearly fivefold.

Hopefully, when the Minister responds, he will tell us how the issue of higher levels of deprivation can be addressed, because it must be done. The lack of hospital bed capacity, dedicated wrapping access and community foot protection services forces vascular patients into prolonged, acute hospital stays. Managing severe vascular conditions and non-healing wounds accounts for millions of pounds annually across our health and social care costs. Those resources could be saved through early preventative community intervention. Again, that means early diagnosis, early community intervention and savings to the NHS, which can then be used in other parts of the health service.

Turning to survival rates, a patient in Northern Ireland who undergoes a major lower limb amputation faces a staggering mortality risk within their first year post surgery. It is the same across the UK. Preventative care is quite literally a matter of life and death. I could not express that any better than the hon. Member for Glasgow South West (Dr Ahmed), who underlined that in his intervention.

If we are to relieve pressure on local hospitals in the United Kingdom of Great Britain and, ultimately, in Northern Ireland and protect our most vulnerable citizens, we must ensure that any national reform framework, including the national foot attack pathway, and standardised waiting times are fully integrated across all HSC trusts, and we cannot allow postcode lotteries to dictate whether a patient keeps or loses her limb depending on where she lives.

I hope the Minister can address the issue of postcode lotteries, which seem to happen with unfortunate regularity. I know he will be keen to change that, and this House is keen to hear what he says. The cardiovascular disease modern service framework rightly focuses on shared risk factors and acknowledges PAD, but its immediate priorities lack the explicit, detailed pathways, treatment standards and outcome measures urgently required for lower limb vascular care.

To close that gap—because that is what we are trying to do—clinicians, patient representatives, professional bodies and NHS leaders across the vascular sector are coming together to publish a definitive best-practice document this autumn. I am sure that document will be made available to the Minister, hopefully in advance. I think that will be helpful for the Minister and others in this debate who want to make changes.

The APPG on vascular and venous disease has highlighted a practical programme for reform, which I endorse. Obviously, I would endorse it because I am its chairman, but it is a positive, focused vision for the future that, if delivered, could make a difference. It includes the national foot attack pathway, backed by public awareness; same day or next day triage for urgent foot issues; and a multidisciplinary foot protection service in every integrated care system linked directly to specialist arterial centres.

When I go for my diabetes test once or twice a year—I have one next Wednesday—they make me close my eyes and do that wee prick of my foot to see if I react and if I can feel it. I am glad to say that I always do. The point is that if someone cannot, that is a serious problem. That is an issue for diabetics, in particular, and it is really important that they are checked regularly, especially their feet.

Thirdly, there should be national maximum waiting times enforcing urgent vascular assessment within five days for in-patients and two weeks for out-patients. Setting a standard to be achieved and having a clear focus on outcomes that reward early diagnosis, fast healing and reduced amputations, are ultimately about patients having a better quality of life—a more normal life—without their health deteriorating. There should also be faster adoption of innovation, including community diagnostics, compression therapies and digital wound monitoring.

When it comes to research and development, the Minister is always very keen to know about advancements in vascular health and how the Government are helping. One of the people involved from one of the hospitals back home in Northern Ireland is with us today in the Public Gallery. She is clearly very aware of these issues and I thank her for her work. There is some great work being done in our hospitals, particularly in the Royal Victoria hospital back home, and in the rest of the Northern Ireland health service.

Will the Government ensure that the cardiovascular disease modern service framework includes distinct pathways and outcome measures for vascular conditions? Will the Minister support a national foot attack pathway and clear waiting time standards? With respect, standard rhetoric and warm words will not heal a failing wound; nor will they save a limb. Thousands of our fellow citizens face devastating, life-altering amputations—tragedies that are, in so many cases, entirely preventable if they are caught early enough.

As a type 2 diabetic myself, I know the personal anxiety that comes with those risks. I also know about early intervention. For me, that was losing 4 stone, taking the medication and being careful about what I eat. Cake became a once-a-week treat—my doctor told me we are allowed to have a wee treat now and again—and I am allowed to have a fry on Saturday morning, but the rest of the week it is best to abstain and not have any of those things. I know that early intervention, proper community pathways and timely care can work. They have worked for me and I know that they have worked for many others.

The Government have rightly pledged to shift the focus of the NHS from sickness to prevention and from treatment to early intervention. Today, I am asking the Government and the Minister to produce a clear and actionable blueprint to do precisely that. The vascular sector is coming forward this autumn with clear solutions, and I am very impressed by the sector’s ideas and suggestions about how to improve the strategy, including a national foot attack pathway, dedicated foot protection services and enforceable maximum waiting times, because we need to make sure that waiting times reflect the needs of those seeking help. The real test for the Minister is whether the Department can step up, grab this opportunity with both hands and deliver the system-wide reform that our patients deserve.

I thank all hon. Members for coming along to participate in the debate. I also thank those in the Public Gallery for being part of this work and for their expertise and input into the strategy. I think that the Minister will see that it can bring about the change that he and we all want.

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[Dr Zubir Ahmed (Glasgow South West) (Lab)]

It is a pleasure to serve under your chairship, Dr Huq. I welcome the Minister, my hon. Friend the Member for Bury North (Mr Frith), to his place—he knows that I was in his place not too long ago, and I will be kind to him in my asks. I also welcome the Opposition spokesperson, the hon. Member for Solihull West and Shirley (Dr Shastri-Hurst), who is a former orthopaedic surgeon, so he knows a thing or two about the blood vessels that run around the bones of the body. It feels like a unique privilege for me to stand here today as the Member of Parliament for Glasgow South West—where we have one of the largest hospitals in the country—a trained vascular surgeon, and a former Minister who was partly involved in bringing forward the cardiovascular modern service framework when I was in post.

Vascular surgery was my bread and butter when I was a surgeon. There is no greater feeling for a surgeon and their team than returning blood flow to the limb—usually a lower limb—of a patient with critical limb ischemia, preventing them from undergoing a near-certain amputation, and watching them walk out of hospital. That is usually the culmination of many years of surgical training. I shall take this opportunity,  because I may never get it again as a parliamentarian, to thank those who trained me and many like me in the west of Scotland and enabled us to acquire and practise those skills: people like George Welch, Wesley Stuart, Keith Hussey, David Kingsmore, David Wallace and Steven Boom, and colleagues in the Public Gallery such as my good friend Tamim Siddiqui, a consultant vascular surgeon in the west of Scotland. I am biased, but I believe that the west of Scotland vascular surgery is a cut above the rest, although other vascular surgeons are available in the Public Gallery.

One of the reasons I think the west of Scotland vascular surgeons are a cut above the rest is that, unfortunately, our area suffers from some of the highest burdens of vascular disease in the country. That is reflected in the statistics more widely. In Scotland, life expectancy and healthy life expectancy are going down, having steadily increased from 1980 until about 2012. We now have some of the lowest life expectancy rates anywhere in western Europe. We have to reflect on why that is.

Scotland spends more on its NHS and has more staff and resource relative to the rest of the country, yet productivity is lower. Scottish hospitals are treating fewer patients now than before the pandemic, unlike English hospitals, which have surpassed pre-pandemic activity levels under the Labour Government. We have to reflect on where the political failure lies. On behalf of my constituents in Glasgow South West, it is only responsible to reference the fact that the SNP Government have proposed a massive restructuring of Scotland’s NHS, seemingly without any detailed consultation with anyone. It is not clear who that structural change serves, how much it will cost, or how we can judge its success or failure.

I urge the Minister, who also has responsibility for four-nation engagement, to ask the Scottish Government how we can help to reverse the trend by imparting our wisdom and what we have learned over the last couple of years about turning around waiting lists and optimising clinical pathways. We have become habituated to the idea that there is a physical border between Scotland and England that cannot be transcended, whereas I believe that we can co-operate and problem solve instead of point scoring. I urge the Minister to lend the weight of his office so that patients near the border can benefit from services each way and do not have to travel 80 or 100 miles to receive services simply for lack of political will. I shall be grateful if he does that and writes to me about the outcome.

Will the Minister consider the asks from the Circulation Foundation and the APPG, with which I have done some work in the recent past? As we all know, diabetes is unfortunately on the rise. Synonymous with diabetes is diabetic foot, which is now the primary cause of limb loss in this country. A concerted effort is required because early intervention on a diabetic foot can prevent major limb amputation. I ask the Minister that we think about the national foot attack pathway, with a same-day or next-day triage service for urgent cases that enables much quicker treatment of diabetic feet and diabetic foot sepsis.

The model of stroke care that we have established, particularly in England with thrombectomy services, which I understand will become near-universal in only a few months—it is far from universal in Scotland—is a good model to follow for diabetic foot care and the national foot attack pathway. We need community foot protection services in every single integrated care board, with multidisciplinary hubs linked to specialist centres, so that we can offer more care not in hospital, but in the community, which is a linchpin of our 10- year health plan in England; and the implementation of national waiting time standards of five days for in-patients and two weeks for out-patients with transparent reporting. If we do that, we will save not only money, but limbs and lives.

On commissioning, we have all become too habituated to paying for activity and inputs. It is time to shift the dial and pay for an outcome. In many ways, vascular disease and diabetic foot disease offer an early win—an early exemplar—of how we can shift the dial on commissioning services from input to output.

Alongside that, it is important to think about how we support innovation, which is in the Minister’s title. I know at first hand that there are so many innovative vascular scientists and specialist surgeons doing things very differently from what we were doing only five years ago. They need the Government’s support. The Government will be pushing at an open door if they come forward with new ideas for how to innovate so that patients benefit directly from effective technologies and digital technologies. We can even optimise the NHS app to produce end-to-end digital pathways for these patients. I know that the Minister takes these matters very seriously and will consider them in his response.

I end where I began, by thanking everyone who has attended today, particularly the colleagues from the vascular community in the Public Gallery. I reiterate that it has been an honour and a privilege to be part of this debate, as a parliamentarian serving a constituency with a diverse community that suffers from diabetes and vascular disease, but also as a proud member of the vascular surgical community.

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[The Parliamentary Under-Secretary of State for Health and Social Care (Mr James Frith)]

It is a genuine pleasure to serve under your chairship, Dr Huq, and to join you again in Parliament. We worked together before and it is an honour to be here today.

As is customary, I would like to thank the hon. Member for Strangford (Jim Shannon) for securing this important debate and for his insights. Some of us were wondering if he would write one of his famous letters of congratulations and courtesy to himself; we hope that somebody else will step up and show him the same courtesy that he affords us all by being so generous in his support of colleagues across the House.

I also thank my hon. Friend the Member for Glasgow South West (Dr Ahmed), who spoke so well and with such insight, for the leadership and expertise that he showed in pulling together the Government’s ambitions for not just the 10-year plan but, as has been mentioned, the cardiovascular framework. I am of course minded to listen to anything further that he says. On his point about Scotland, he is right that I also have responsibility for the devolved nations in a seemingly ever-growing brief—he will have sympathy with me over that. I am happy to have those conversations to ensure that we learn from the Scots and that the successes here can be transported north of the non-border to which he rightly referred.

The report published by the APPG earlier this year sets out suggested actions for improving vascular care. The Opposition spokesperson, the hon. Member for Solihull West and Shirley (Dr Shastri-Hurst), is right that there is much in this debate on which we agree. The calls to action include reducing waiting times, reforming commissioning, accelerating innovation, and establishing a national foot care pathway and community-based foot protection services in every local system. I commend the APPG for focusing their challenges on structural reforms and system changes, and not on simply making a new request for funding.

We can all agree with the improvements the actions intend to deliver, which are,

“earlier diagnosis, reduced travel and access barriers for patients, and relieving pressure on acute services by preventing deterioration and avoidable hospital admissions.”

That is crucial. At the election, I was pleased to stand for a party that wanted, when in government, to bring its power and might to bear on the biggest killers. The Government very much intend to deliver those improvements through the core shifts set out in the 10-year plan for the NHS.

For patients with vascular disease, that will mean fewer trips to hospital as we shift care closer to home and into the community. It will mean better use of digital technology—my hon. Friend the Member for Glasgow South West referred to the innovation part of my title, and there is more to come on that—to identify vascular disease, monitor its progression and, finally, stop it from developing or worsening.

In preparation for this debate, I have been encouraged—mercifully, I am pleased to say—to use my remarks reflect the call to action from the APPG.

[Dr Ahmed]

The Minister is making a powerful case that to govern is to make decisions. Does he agree that when it comes to the NHS, while we talk a lot about money, input and investment, today we are ultimately talking about reform, taking different decisions and showing leadership? Does he agree that, given the situation in Scotland and my constituency of Glasgow South West, where there is more money and more staff, it is quite obvious that it is political will that ultimately makes the difference?

[Mr Frith]

I concur fully with my hon. Friend’s point. I noted his earlier remark about the commissioning of outcomes, and I think that one of the developing themes adjoining my own thinking and my brief is the need to get better at commissioning outcomes, considering whole populations, communities and places, and determining how we spend our money based on outcomes, not just activity. My hon. Friend makes a very powerful point with his question.

The hon. Member for Strangford and other members of the APPG feel strongly about the establishment of a national foot attack pathway. The Government’s ambition for integrated care boards to act as strategic commissioners focused on the needs of local populations is very much determined to assist that. The prevalence of vascular disease is not evenly distributed, as the hon. Member for North Shropshire (Helen Morgan) mentioned. ICBs are expected to use their nationally supported local commissioning power and their local data and intelligence, which includes user feedback and outcomes data, to develop a deep understanding of local need as well as local plans to develop and deliver.

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[Mr Frith]

The hon. Member is absolutely right. We have to keep ICBs and their commissioning powers accountable to local jurisdictions. I will say a bit more on that in due course, but we are on the same page.

To facilitate faster assessments we also need to speed up and make earlier diagnoses, which is why the Government plan to open four new community diagnostic centres during ’26-27. That expanding capacity will help meet our March ’29 target that no more than 1% of patients should wait over six weeks for a diagnostic test.

On reforming commissioning to reward outcomes, as set out in the 10-year health plan, we want to develop new ways to pay healthcare providers based on clinical practice that maximises productivity and outcome, as my hon. Friend the Member for Glasgow South West mentioned. Under the best practice tariffs, providers receive payment when they follow agreed standards of care. On the adoption of proven innovation, the APPG report rightly identifies the importance of the NHS being able to quickly adopt new innovations.

As part of my responsibility to oversee further development and enhancement of the use and usability of the NHS app, one development coming through the House at the moment is the creation of the single patient record. The future exciting development of NHS online, or digital doctor, as I might yet call it, is about the digitisation of our NHS service—embracing innovation, personalising healthcare and responsive to individual need—as well as the innovator passport, delivered through a phased approach to accelerate access to and adoption of technologies.

The APPG’s report says that preventing vascular disease and its deterioration should be at the centre of the system, and I agree. Identifying people with vascular diseases and providing care centred on their needs is critical to ensuring vascular disease does not progress to the point where somebody needs incredibly serious interventions, such as a leg needing to be amputated. In this modern era, such amputations are wholly avoidable and should be prevented.

The distinction between the APPG’s report and the Government’s most recent announcement of the MSF has been mentioned. I was delighted to join the British Heart Foundation yesterday at the celebration event for the MSF ahead of the delivery plan later in the year. It is a reasonable challenge to ensure that we distinguish between conditions, a point made by the Opposition spokesperson, the hon. Member for Solihull West and Shirley. It was a point made to me—and a point I thought was likely to be raised with me—by stroke and diabetes charities at the event yesterday. We are on the same page on that. He made an excellent point and challenge on the distinction that is needed.

As hon. Members will know, prevention is at the heart of the Government’s health agenda—the prevention of health conditions and the prevention of them worsening. The cardiovascular disease modern service framework, which was published in July, sets a clear direction for how health and care systems should accelerate progress on the Government’s ambition to reduce premature mortality from heart disease and stroke by a quarter within a decade.

My hon. Friend the Member for Broxtowe (Juliet Campbell) talked about irregularity and different areas having different levels of heart failure, which she said was four times more likely in the area she represents. I would be very happy to have conversations about how we can embrace that insight and intervene. Prevention is fundamental to the Government’s efforts around an annual heart failure review, improving access to rapid diagnosis and embedding heart failure support in cardiac rehabilitation, as well as the wider Government goal to reduce premature mortality by a quarter within the next decade.

Central to the cardiovascular disease modern service framework is a holistic approach with a strong focus on reducing inequalities. The principles apply here, too: the missing millions; the need for healthy intervention and to understand the difference between the physiological, behavioural, environmental and social; an appreciation that living standards and the cost of living have as much impact as any knowledge of what to eat and when; and looking after each other. It is about commissioning for outputs, not just diktat, which means recognising that several conditions and risk factors share common causes and contribute to most heart attacks and strokes. Members have described them in their speeches: high blood pressure, smoking, diabetes, high cholesterol, unhealthy diet and lack of exercise.

At its core, the framework is about a fundamental shift towards proactive, whole-person, preventive care that is located in communities and neighbourhoods and makes better use of hybrid, traditional, in-person and digital models to increase uptake and treatment. Podiatry and related foot-health services align with the shift towards local community hub delivery. The framework’s approach is backed by wider Government, including the creation of the first smoke-free generation, which began under the Conservative Government.

[Dr Ahmed]

I will be quick, because I know the Minister wants to wind up and I am sure he has plenty of things to do. He is talking powerfully about the digital offering that the Labour Government are providing to patients today in England and, more importantly, our ambitions for the digital offer in the future. This will seem like science fiction to many of my constituents in Glasgow South West, where we have no NHS app and very little digital connectivity in the healthcare system. Will the Minister please take the learning and markers of quality—particularly the digital quality markers—that he is describing in the modern service framework to our friends and colleagues in the Scottish Government? My constituents cannot wait any longer.

[Mr Frith]

In the humblest of terms, I would be very happy to visit and speak to my Scottish counterparts to ensure that they take that opportunity, and that any development, whether on compatibility, operability, the learnings from the NHS app in how we then develop NHS Online—that sounds a bit too much like building a website; we have to be more ambitious and describe it as what it is, which is the digitalisation of our NHS—helps to ensure that our brothers and sisters in Scotland get the same level of digital access that we expect to deliver across the NHS in England.