NHS Risk Register - 22 February 2012
This unstable market in health care could have a very real effect on the viability and critical mass of essential hospital services, resulting in full or partial hospital closures. I have never heard of any plans from the Government to mitigate these risks other than the simple statement, “The market will decide.”
Joan Walley (Stoke-on-Trent North) (Lab): In view of what was said about Stafford hospital and the implications for patient care in North Staffordshire, may I say to my right hon. Friend and to the House that it is vital that we get the full information and full risk assessments that are required in order to be able to plan for the NHS that we need, and that this important debate is part of that?
Andy Burnham: What happened at Stafford gives us very important lessons about the dangers of autonomy, and this Bill is all about extolling the benefits of autonomy. As Health Secretary, I had to deal with that situation. In some ways, it was a legacy of problems with our own policy; I accept and acknowledge that before the House. Because of that situation, I proposed the power to de-authorise a foundation trust and brought it forward in the Health Act 2009. If a hospital gets into trouble, it cannot carry on being autonomous and unable to improve, but should be brought back and helped to improve. I proposed the duty of autonomy.
In fact, that duty was recommended by Robert Francis QC in the first stage inquiry that he delivered to me. I accepted his recommendation. The Health and Social Care Bill abolishes the power to de-authorise a foundation trust. A recommendation from Robert Francis is being abolished by the Bill before the Government even give him the courtesy of allowing him to report. I say again that I do not have a good answer to why they are legislating before hearing from his inquiry. As was said a moment ago, there are plans in Stafford for GPs to do more in the community. That might be a good idea, I do not know, but it might further destabilise that hospital. That should be a cause for concern.
Julian Smith: Will the right hon. Gentleman give way?
Andy Burnham: I will give way one last time to a Government Member, then I will close.
Julian Smith: Last week, I met Airedale NHS Foundation Trust, to which the right hon. Gentleman referred earlier. To clarify, neither the chief executive nor the chairman raised any of the points that he has raised. Not only that, but the local GP commissioning consortia are perfectly happy and are asking me and other local MPs to push ahead with the Bill. Why is the right hon. Gentleman such a scaremongering buffoon?
Mr Deputy Speaker (Mr Nigel Evans): Order. I ask the hon. Gentleman to withdraw that description.
Julian Smith: I withdraw it fully.
Andy Burnham: I do not know why the hon. Gentleman thinks that such an intervention is appropriate. Why did he not ask the chairman and chief executive about this matter? Why does it take me to go and research the risk register—[ Interruption. ] Listen to the answer. Why does it take me to research the risk register in his constituency and to tell him about the risks to the NHS in his constituency, which he clearly does not know about? I suggest that he goes away from this Chamber right now and searches online, where he will find that risk register. Perhaps he will learn something about his constituency.
We are told that the market will decide. Last week, the Government received a specific warning from more than 150 members of the Royal College of Paediatrics and Child Health that the market-based approach envisaged in the Bill will have
“an extremely damaging effect on the health care of children”.
“Care will become more fragmented, and families and clinicians will struggle to organise services for these children. Children with chronic disease and disability will particularly suffer, since most have more than one condition and need a range of different clinicians.”
“The Bill is misrepresented by the UK Government as being necessary”
“harm those who are most vulnerable.”
Those are not my words, but those of clinicians. [ Interruption. ] If the hon. Member for Suffolk Coastal (Dr Coffey) wants to dismiss them, that is up to her, but she would do well to listen to them.
Warnings do not come any more serious than the one that I have just read out. It shows why the Government will not publish the risk register: they know that the case for their Bill would be demolished in an instant. People watching this debate will ask how it is possible to proceed when experts make such warnings and when NHS bodies warn of fatalities. To press on regardless would be utterly irresponsible and unforgivable. That is what the Prime Minister said today that he plans to do.
The truth is that the Government are not listening, as we have seen throughout this debate. The Prime Minister is surrounding himself with people who say what he wants to hear, while closing the door of No.10 Downing street in the faces of those who do not. He will not listen to the doctors and nurses with whom he was once so keen to have his photograph taken. It could not be clearer: he is putting his political pride and the need for the Government to save face before the best interests of the national health service. He is gambling with patients, with public safety and with this country’s best-loved institution. The Prime Minister asked people to trust him with the NHS, but we have learned today that he is running unforgivable risks with it. What his Government are doing is wrong and they need to be stopped.
I call on Members across the House to put the NHS first tonight. Vote with us for the publication of the risk register so that the public can see what this reorganisation will do to their NHS. They deserve the full truth and tonight this House can give it to them and correct the Government who have got things so badly wrong. I say to people outside who are watching this debate, join this fight to save the NHS for future generations. The NHS matters too much to too many people for it to be treated in this way. People have not voted for what is happening. [ Interruption. ] Not a single Government Member who is shouting at me now can look their constituents in the eye and say, “I told you that I was going to bring forward the biggest ever top-down reorganisation.” The more people who join this fight, the stronger our voice will become.
We promised this Government the fight of their life for betraying that trust and that is what we will give them. Tonight, this House has an opportunity to speak for the millions of people who care about the NHS and are worried about what is happening to it. I implore this House to take that opportunity and I commend the motion to the House.
Mr Deputy Speaker (Mr Nigel Evans): Before I call the Secretary of State for Health, I say to the House that in my time as Deputy Speaker, this is easily and by some margin the worst-tempered debate that I have chaired. I ask Members on both sides of the House to lower the temperature so that we can have a decent and full debate.
The Secretary of State for Health (Mr Andrew Lansley): Let me put a quotation to the shadow Secretary of State again:
“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]
I asked in an intervention on the shadow Secretary of State whether he recalled that quotation. It is what he said in an answer to this House in Hansard on 23 March 2007.
Karl Turner (Kingston upon Hull East) (Lab): Will the Secretary of State give way?
Mr Lansley: I will in a moment.
Frankly, this is a broken-bat debate in the first place, because the shadow Secretary of State is trying to suggest that this Government should do something that he as a Minister and then as a Secretary of State steadfastly refused to do, using exactly the same arguments that the present Government have used.
I am afraid that the shadow Secretary of State’s bat was broken before he came to the crease, because at Prime Minister’s questions the Prime Minister put it to the Leader of the Opposition that, as he was devoting a whole Opposition day to this debate, he might want to make some argument or put some question to him on this subject, but such a point from the Leader of the Opposition came there none. The shadow Secretary of State is standing at the Dispatch Box without the support of his own leader.
Karl Turner: Does the Secretary of State think that his job is at risk and that it should perhaps be on a risk register?
Mr Lansley: I do not know about the debate being bad-tempered, Mr Deputy Speaker, but we at least have jokers in the House.
The shadow Secretary of State is out on his own. I will be kind to him and say that at least opposition is coming naturally to him. Whatever we propose, he opposes it, even to the extent of directly contradicting what he and his colleagues said in government. His contribution today was another shameless example. We have seen this before. The last Opposition day debate on this subject was a travesty of his previous views about the role of the private sector, the need for the private finance initiative and the role of competition in the NHS that he espoused in government. He has done a U-turn on those matters and now holds the polar opposite views from those that he held before. That may be a luxury of opposition and he may enjoy it for the moment—actually, I am not sure that he did enjoy it that much—but that kind of inconsistency will keep him in opposition for a very long time.
The shadow Secretary of State spoke for about 50 minutes and I heard not a word of appreciation for the staff of the NHS. We are asking the staff of the NHS to live in financially challenging times, but it is not mission impossible. He said that saving money in the NHS was mission impossible. That is certainly how the Labour party treated it in government. Spending money was about the only thing that it seemed to be capable of doing, but it never spent it well. We are asking the staff of the NHS to save and to reinvest, and to improve performance at the same time.
Did I hear one scintilla of appreciation from the shadow Secretary of State for what NHS staff are doing, or for the fact that we have the lowest number of hospital-acquired infections on record and the lowest ever numbers of patients waiting more than six months and more than one year for treatment? I did not. I put it on record again that whether we compare May 2010 with December 2011, during which time the number of patients waiting more than a year for treatment more than halved, or December 2010 with December 2011, in which time it went down from more than 14,000 to nearly 9,000, the number has gone down. For the shadow Secretary of State to stand at the Dispatch Box and say that it has doubled, which is transparently wrong, is a misrepresentation to the House and a travesty to the staff of the service. He ought to come to the Dispatch Box and withdraw it.
Mr Edward Leigh (Gainsborough) (Con): Of course the views of staff are desperately important, but this is our NHS, and what is really important is the outcome for patients. It is because of the catastrophic decline in productivity that I say to my right hon. Friend that we urge him to keep going, with no more watering down of the Bill. His parliamentary party is 120% behind him.
Mr Lansley: My hon. Friend is absolutely right, and when he was Chair of the Public Accounts Committee he constantly told the last Government that they should do something to ensure rising productivity in the NHS. He was not alone in that.
Emma Reynolds (Wolverhampton North East) (Lab): Will the Secretary of State give way?
Mr Lansley: I will in a moment. Perhaps the hon. Lady would like to explain the views of not only my hon. Friend the Member for Gainsborough (Mr Leigh) but his successor as Chair of the Public Accounts Committee, the right hon. Member for Barking (Margaret Hodge), who said:
“Over the last ten years, the productivity of NHS hospitals has been in almost continuous decline.”
[Interruption.] I hear Labour Front Benchers ask, “What about the risk register?” I will tell them what the risk to the NHS was before we came into government. It was that a Labour Government would carry on failing to increase productivity in the NHS. Productivity would have declined, and the NHS would have been unable to provide patients with the service and care that it should provide, because Labour wasted money on bureaucracy instead of spending it on patient care.
Emma Reynolds: I am proud of our record on the NHS, given that patient satisfaction with the NHS is at an all-time high. Does the Health Secretary agree with the analysis of Professor Black in his report in The Lancet that Tory Ministers’ claims that productivity declined between 2000 and 2009 is based on a myth?
Mr Lansley: I have just quoted what the Labour Chair of the Public Accounts Committee said on the basis of advice from the National Audit Office, which is precisely in line with data published by the Office for National Statistics. I think I will rest on that.
I want to make it absolutely clear that I appreciate what NHS staff do and the fact that they are delivering improving outcomes. We published 30 indicators of NHS outcomes just two months ago, and 25 of them showed that performance had been maintained or improved. They had not all gone up, but that is why we are focusing on those outcomes, and not just waiting times. However, the average time for which in-patients waited for treatment was 7.7 weeks in December 2011, down from 8.4 weeks at the last election. For out-patient treatment, the average is down from 4.3 weeks at the election to 3.8 weeks now.
Andrew George (St Ives) (LD) rose —
Mr Lansley: I know that my hon. Friend will join me in appreciating the success of the NHS in improving waiting times.
Andrew George: I do indeed welcome that news, and I do not question what the Secretary of State says about it. However, I am curious about the fact that on one hand the shadow Secretary of State says that it is all going terribly badly but opposes reform of the NHS,
and on the other the Secretary of State says that outcomes have never been better but is pressing on with the Bill. Why is he doing so?
Mr Lansley: The curious thing, as I know my hon. Friend will appreciate, is that even the Leader of the Opposition says that reform is needed in the NHS because of the challenges that it faces. Of course we can debate what the nature of the reform should be, but the idea that we can simply stand still and that nothing in the NHS needs to change is not the view of NHS staff, patients, the Labour party or the Government. We therefore have to consider what the nature of that reform needs to be, and I believe in patient choice and empowering doctors and nurses on the front line to deliver care. I believe in cutting bureaucracy and removing whole tiers of management to enable that to happen, and in common with my Liberal Democrat friends and colleagues I believe in strengthening democratic local accountability in the NHS and strengthening public health services through local government operations.
The worst possible thing for me to do would be to say, “We need to reform the NHS because it is doing so badly.” I do not believe that, but I do believe we have to root out poor performance. I was shocked to hear the shadow Secretary of State and the right hon. Member for Exeter (Mr Bradshaw), who has disappeared, talking about Stafford hospital. They were the ones who never appreciated the risk of what was happening there. They know that they went through reorganisations without ever addressing the risk. The dreadful things there happened on their watch, so they might at the very least have come here and apologised. The right hon. Member for Exeter came to the Dispatch Box when he was a Minister and said, “Oh, it’s nothing to do with me, it’s all to do with the management of the hospital.”
I believe in foundation trust hospitals, which apparently the Labour party now does not. [Interruption.] The shadow Secretary of State is trying to have it both ways. He is trying to say that he is in favour of foundation trust hospitals, but that if they get into difficulties the best thing is for them to be run by the Secretary of State. He might talk to the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who was the Secretary of State when, in the Maidstone and Tunbridge Wells NHS Trust, dozens, perhaps hundreds of patients died of clostridium difficile infection at the Kent and Sussex hospital. That was an NHS trust, not a foundation trust. The Department of Health and the Secretary of State have no God-given ability to run hospitals directly and do so better than they can be run by the doctors, nurses and managers in charge. The point is that there must be proper accountability, and through HealthWatch, local government and the responsibilities of Monitor we will have a proper accountability structure in the Bill.
Andy Burnham: I said that we would learn the lessons of what happened in the Mid Staffordshire trust, and I apologised at the time on behalf of the Government.
The first-stage Francis inquiry recommended the de-authorisation of foundation trusts. Why is the Secretary of State removing that power in the Bill before Robert Francis has reported again?
Mr Lansley: It is because we are clear that the reason he said that was that there was no mechanism available to Monitor in legislation for the maintenance of services and interventions. The Bill will mean that there is.
I sometimes think that the shadow Secretary of State has not actually read the Health and Social Care Bill. He keeps saying that this or that is in it, or that it does or does not do this or that, but for the first time since 2003, when his predecessor’s legislation stated that there should be a mechanism for dealing with hospitals that are failing, we are setting out a proper structure for the continuity of services. He says that it is just about de-authorisation, but it is not.
Clive Efford (Eltham) (Lab) rose —
Grahame M. Morris (Easington) (Lab) rose —
Mr Lansley: I am sorry, but unlike the shadow Secretary of State I have taken a lot of interventions. I will take more before I finish, but I need to say one or two things without trespassing too much on Back Benchers’ time.
The shadow Secretary of State does not really have anything of substance to talk about, so he wants to talk about the risk register. Let me tell him about our approach to transparency. We are international leaders in openness and transparency in government. Across government, we publish business plans, departmental staffing and salaries, full details of departmental contracts and summaries of departmental board meetings. We are legislating for foundation trust boards to meet in public, which the Labour Government never did; they resisted it. We are opening up the workings of government in ways that Labour rejected outright.
We have set our sights higher than that. In the NHS, we have opened up more information about services than was ever done under the last Government, shining a light on poor performance and promoting better performance. The NHS atlas of variation has been published for the first time, exposing the variation in outcomes for patients in different parts of the country. That was covered up by Labour, which would have said, “Oh, no, that’s the postcode lottery, we mustn’t publish that information.” We have set it out, because that is the route to improving performance.
I remember the shadow Secretary of State’s predecessors as Health Secretary going on the “Today” programme and saying, “Oh, no, nobody’s in mixed-sex accommodation any more. We’ve eliminated all that.” Well, we have published data on that for the first time, showing that 12,000 patients a month were being put into mixed-sex accommodation. Now, because we published those data and acted, that figure has come down by 95% since December 2010. The previous Government covered that information up; we are publishing and dealing with it.
Mr Lansley: I will give way in a moment.
We have published situation reports and real-time information on winter pressures, but the previous Government never did so. We are investing more in new information collections on A and E performance and new clinical quality indicators for A and E. We are collecting more data on ambulance performance and increasing the number of clinical audits. We are publishing the data on the things that matter to patients, all of which is helping the NHS understand the actual quality of care. We are open and transparent because we believe, as the previous Labour Government did not, that putting information out is in the public interest.
Mr Lansley: I will give way to the right hon. Member for Wentworth and Dearne (John Healey).
John Healey (Wentworth and Dearne) (Lab): In January 2011, the Secretary of State's Department set up the audit and risk committee with a commitment to publish minutes of its meetings within three months. The last note of any meeting of that committee published on its website is from February 2011. Is that international leadership or the same cloak of secrecy that prevents him from publishing the transition risk register?
Mr Lansley: When the right hon. Gentleman was a Minister he and his colleagues never published such information, so I will not take any lessons on that. As a Treasury Minister, he refused to disclose a Treasury risk register.
Let me explain what risk registers are for, because an hon. Lady on the Opposition Benches keeps chuntering about them. A high-level risk register, such as those being considered by the tribunal on 5 and 6 March, is a continuously reviewed and updated document that enables officials, advisers and Ministers to identify and analyse the risks of, and to, particular policies. Risk registers present a snapshot of the possible risks involved at any one time. Their purpose is to record all risks, however outlandish or unlikely, both real and potential, and to record the mitigating actions that can ensure that such risks do not become reality.
For such a register to be effective and for it to serve the public interest, those charged with compiling it must be as forthright as possible in their views. The language of risk registers must be forceful and direct. That is essential for their operation, to enable Ministers and officials fully to appreciate those risks and to take the steps to mitigate them, or to redesign policy to avoid them.
It is important to note that such high-level risk registers are different to the risk registers of the organisations from which the shadow Secretary of State quoted, such as the risk registers of strategic health authorities. The latter concern operational matters and not matters of developing and designing policy, and they are written with publication in mind—they are intended to be published. By contrast, there are very clear reasons why Departments—under not just this Government, but previous ones—do not publish their high-level risk registers while they are still active and while policy development is ongoing.
Sir Alan Beith (Berwick-upon-Tweed) (LD): The Justice Committee is currently inquiring into the workings of the Freedom of Information Act. It must identify where the proper boundary lines should fall to protect the ability of civil servants to advise Ministers, but that must be set in the context of legislation that the Government have committed themselves to supporting, and which the previous Prime Minister, Tony Blair, has now publicly disowned.
Mr Lansley: I entirely understand my right hon. Friend. My colleagues and I very much look forward to the conclusions of the Justice Committee’s post-legislative scrutiny of the Freedom of Information Act.
Simon Hughes (Bermondsey and Old Southwark) (LD) rose —
Mr Lansley: Further advice from my right hon. Friend, not only to me but to the Prime Minister, is always welcome.
Simon Hughes: I defend the Government’s record on the openness of information, and I am a clear believer that the Freedom of Information Act, which I and many Liberal Democrats supported, is the right way forward. Will the Secretary of State therefore confirm that the Government are doing nothing other than following the policy provided for in the Act, which is that when there is a dispute, including when the Government and the Information Commissioner have a different view, the matter properly goes to the tribunal, and the Government respond positively to the tribunal’s decision?
Mr Lansley: I am grateful to my right hon. Friend, because I had not intended to quote the Information Commissioner, who wrote an article in The Observer in which he rightly states that he is not infallible. The Government have the right to appeal to the tribunal and we have exercised that right. The tribunal is a proper place in which the public interest test can be applied.
Let me return to the reasons why we do not publish high-level risk registers, the first of which is candour. To be effective, a risk register requires all involved—not necessarily the officials responsible for the policy, but others—to be frank and open about the potential risks involved. It is their job to think the unthinkable and to look at worst-case scenarios. It is vital that nothing is done to inhibit the process of identifying risk. If people are in doubt about the confidentiality of their views, they will inevitably think twice before committing themselves to such direct and candid language in future. Without full candour, risk registers across the Government would be bland and anodyne. In effect, they would cease to be of practical value. Inevitably as a consequence, that would lead to a reduction in the quality of advice given to Ministers.
The second reason is that disclosure can increase the likelihood of some risks happening—it is like a self-fulfilling prophesy. When some risks are made public, those potentially affected are likely to act in a way that could increase the likelihood of the risk actually happening. Let us imagine publishing the risk registers of banks—no doubt the shadow Secretary of State would tell us that the risk registers of banks owned by the Government should be published. The consequence of publishing such risks would be to precipitate financial events.
Lord Turnbull, former head of the civil service, and not under this Government, said in another place:
“Managers might be reluctant to be frank in public about operational difficulties if that would undermine their ability to make contingency plans or could trigger an event before their plans are ready.”—[Official Report, House of Lords, 7 December 2011; Vol. 733, c. 729.]
The purpose of a risk register is to secure mitigation of those risks, not to precipitate them.
Jack Dromey (Birmingham, Erdington) (Lab): To see a sick baby survive in a specialist neo-natal unit is a joy; to lose a sick baby is a tragedy. Does the Secretary of State understand the concern expressed by Bliss, which represents the parents concerned, at more than 140 specialist nurses going, and at the risk and uncertainty inherent in the Government’s proposals? Will he agree to meet Bliss and me so that he can hear first hand the concerns of the parents?
Mr Lansley: I hope the hon. Gentleman knows that I attended Bliss receptions under the previous Government, at which it raised exactly the same issue.
Jack Dromey: So you have never met Bliss.
Mr Lansley: I have met Bliss—I just said so—and we discussed exactly those kind of issues. I would happily do so again.
The objective of the NHS—this is precisely what we have set out in our focus on outcomes—is to ensure that we seek a continuously improving quality of service for patients. I have many times been on specialist neo-natal intensive care units precisely to understand that. I remember having a long discussion just last year with the staff, including the neo-natal staff, at my local hospital, Addenbrooke’s, and hearing of the importance to them of recruiting an additional neo-natal nursing complement to ensure that they provide the right service. That is nothing to do with the Bill. It is about focusing in the service on delivering quality. That is why we are getting resources into the front line.
The third reason is that the publication of a risk register could take away directly or distract from policy development—the process that it is intended to support. Departmental officials and Ministers should work directly to deliver the policy rather than react to the risks associated with the development of policy before the policy has been agreed.
John Pugh (Southport) (LD): Will the Secretary of State give way?
Mr Lansley: I will give way in a moment.
Fourthly, the publication of the risk register would distort rather than enhance public debate. We should remember that a risk register does not express the risks of not pursuing the policy—[ Interruption. ] Hon. Members should think about it. A risk register does not include the risks of not pursuing a policy and ignores the benefits of a policy—it presents only one side of the cost-benefit equation and is deliberately negative. Effectively, it is a “devil’s advocate” document, not a balanced one.
What is the balanced document associated the Bill? The impact assessment. I have with me a summary of the impact assessment, but there are hundreds more pages. We incorporate all relevant information in the impact assessment because it not only captures the same risks, but puts them alongside the benefits, costs and impacts, including the impact of not taking action.
The impact assessment is the proper evidential and informative basis for parliamentary and public debate. If any hon. Member is in any doubt about the public interest served by not releasing the risk register, I remind them of the advice received by the House nearly five years ago from the shadow Secretary of State. The argument that he put was precisely the argument that we are now putting.
Duncan Hames (Chippenham) (LD): When pressed earlier, the shadow Secretary of State seemed to recognise some of the issues. He said that the publication of any document should be considered on its merits. May I invite the Secretary of State to stand by a simple principle and ensure that his Department always honours the full terms of the Freedom of Information Act?
Mr Lansley: We will, of course, fully abide by the terms of the Act. As my hon. Friend knows, and as the Information Commissioner himself said, we are proceeding precisely in line with the provisions of the Act.
Andy Burnham: Will the Secretary of State give way?
Mr Lansley: Let me make one additional point, and then I will give way to the right hon. Gentleman—again.
All the information was in the original impact assessment. Information was put into the revised impact assessment in September, as is customary on the introduction of a Bill to another place, but in recognition of the Information Commissioner’s decision on 2 November, the Minister in another place, my noble Friend Lord Howe, described—[Interruption.] I will if I need to, but I do not intend to read it all out. He set out the issues covered by the transition risk register to make Members in the other place aware of precisely what those risks were.
Andy Burnham: As I mentioned, there is a precedent here under the terms of the Freedom of Information Act. I refer to the request for the risk register on the Heathrow runway. The Information Commissioner having ruled on it, the previous Government published the register. The Government are not following that precedent but instead fighting it in a tribunal. If, on 5 and 6 March, the tribunal does not find in the Government’s favour, will he publish the risk register, or will he carry on fighting?
Mr Lansley: I heard the right hon. Gentleman mention his precedent, but it was not a precedent, because that was a risk register relating to an operational matter. I explained to him that the risk registers published by strategic health authorities relate to operational matters.
Andy Burnham: This is operational.
Mr Lansley: No, the risk register that the right hon. Gentleman is talking about relates to policy development, not an operational matter. It is a high-level risk register akin to others across Government that, if published, would be prejudicial to frank advice in policy development. [Interruption.] I am only repeating the position that he took when Secretary of State. Let me quote him:
“We have determined that the balance of public interest strongly favours withholding the information”.
I will take his advice and stick to my view: the release of the risk register does not serve the public interest, even if it might serve his political interest to make a song and dance about it. I have been clear about it, as has my noble Friend. The information on which any debate about the Bill should be conducted is already in the public domain.
Rehman Chishti: Will the Secretary of State clarify something? The point made by the shadow Secretary of State is complete nonsense. For him to give a commitment on something that might happen at a tribunal is bizarre, because the Secretary of State can use the rules under section 59 of the Freedom of Information Act to appeal to the High Court on a point of law. So he cannot give that commitment.
Mr Lansley: I bow to my hon. Friend on the procedures under the Freedom of Information Act. We have made it very clear that we are proceeding as the Act provides, as the Information Commissioner himself set out. I want to make it clear to the House that there is no information that it would be proper for the other place to have access to when considering the legislation, that it does not already have access to. The tribunal will be an opportunity not for politicians but for the likes of Lord O’Donnell, the former head of the home civil service, to set out clearly the process by which the free and frank expression of advice to Ministers in policy development needs to be protected under the Act.
I will tell the House about some of the risks that the NHS faced. It faced risks relating to the £67 billion private finance initiative repayment bill left to us by the right hon. Gentleman. He talks about hospitals being under threat, but we have had to offer exceptional financial support to seven hospitals to help them to back up their PFIs. Members might be interested to know that when I announced that decision on 3 February—just a fortnight or so ago—the shadow Secretary of State, who puts his view of these things on Twitter, wrote:
He did not even use 140 characters. He managed it in even fewer. He said he didn’t sign them off—but oh yes, he did. What about Whiston hospital in St Helens and Knowsley? He signed that off. It is a pathetic attempt to escape responsibility for leaving the NHS in debt. [Interruption.] Oh, he is blaming his junior Minister now. It had nothing to do with him! When he refused to release the departmental risk register back in 2009, did he do that, or is he going to blame one of his junior Ministers? I have such excellent Ministers that I will never have to blame them for anything, but frankly I would never attempt to do so, and I hope they know that.
Grahame M. Morris: Will the Secretary of State give way?
The NHS faced the serious risk under Labour of declining productivity, as has been so powerfully illustrated. Labour turned a blind eye to inefficiency. The reason why we have to plug a £20 billion productivity black hole in the NHS is that Labour let productivity fall year on year before the election. We are pushing productivity up, and already efficiency gains of £7 billion have been delivered.
Mr Marcus Jones (Nuneaton) (Con): My right hon. Friend cited the large PFI contracts that the Labour party landed us with. Does he agree that those contracts have put under threat not only the PFI hospitals themselves but wider health economies and smaller district general hospitals, such as the George Eliot in my constituency? They have been affected too.
Mr Lansley: My hon. Friend makes an important point that I understand precisely. He has been a strong advocate on behalf of not only George Eliot hospital but the whole health service in his constituency. I appreciate that.
I shall give a practical example. When I was at the Stobart centre meeting hundreds of general practitioners from across the north-west, those from St Helens said, “We’re really worried about Whiston hospital”—a PFI approved by the previous Secretary of State—“and we can’t deliver the service that we want to for our patients, because all the money will be eaten up by the PFI project at Whiston.” That is precisely why we are tackling the risks that we inherited from Labour.
The NHS also faces risks from Labour’s failed approach to public health. Under Labour, public health budgets were raided and alcohol-related admissions to accident and emergency departments, and levels of obesity and sexually transmitted infections, all rose sharply. I was staggered to hear the Leader of the Opposition talking about fragmentation of sexual health services at the last election. The last Conservative Government—I hope that my coalition colleagues will forgive me for a moment, because I am talking about the Conservative Government before the Labour Government—acted on sexual health, not least in relation to HIV. As a consequence, not only were HIV rates among the lowest anywhere in Europe but sexual infection rates fell for a decade. After the 1997 election the Labour party failed on sexual health, and sexual infection rates rose for a decade. Labour’s position has no basis. We had some of the highest HIV rates at the end of the previous Government’s term. It is outrageous. The Opposition have completely wiped out their recognition of what went wrong under the Labour Government, including on sexual health matters. That is why we are dealing with those risks.
Henry Smith (Crawley) (Con) rose —
Mr Lansley: I will mention one more risk, and then give way to my hon. Friend.
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