NHS Risk Register - 22 February 2012

Of course, the main show, rather than the sideshow, is the Bill itself. I am concerned that if the risk register were to be published soon, and we were to have information that would perhaps help to change people’s minds and enable a more informed debate, it would not be possible to come to a considered conclusion that it would be best to withdraw the Bill because of the nature of the prism of the Westminster village. Given the virility context in which such decisions are taken, the climbdown needed for a Secretary of State to withdraw a Bill such as this would be catastrophic both for himself and for the Government. So we end up continuing on with something that I believe could be catastrophic for the NHS—I have put my views in the public domain on many occasions on this issue.

The right hon. Member for Leigh (Andy Burnham) may want to win over Liberal Democrats, but describing us as “spineless” will not necessarily get many of us into the Lobby with him. If he does not want to contaminate his party with people he believes are so infected with such a disabling condition, I am not sure that it will help.

Valerie Vaz (Walsall South) (Lab): It is always a pleasure to follow my hon. Friend the Member for St Ives (Andrew George), a fellow member of the Select Committee on Health.

Mr Simon Burns: Friend?

Valerie Vaz: I thank the Minister for making his sedentary intervention.

Obviously, I rise to speak in favour of the motion and I humbly request the Secretary of State for Health to publish the risk register, as recommended by the Information Commissioner. I thank my right hon. Friends the Members for Wentworth and Dearne (John Healey) and for Leigh (Andy Burnham) for taking up this issue. As most people will know from their e-mail inbox and their postbag, and from letters that have gone into various newspapers, the professionals are behind us, as are the public.

I have an image of the Cabinet sitting round the table singing the classic Irving Berlin song, “Anything you can do, I can do better”, as each Secretary of State tries to please the Prime Minister by showing how far they can go beyond what was agreed in the manifesto and the coalition agreement. The Secretary of State for Health, who obviously does not want to hear a good argument, is not so much nudging the NHS—to use his favourite phrase—but giving the NHS a great big shove off the end of the cliff; this is more about the chaos theory than the nudging theory. There is a fundamental flaw at the heart of his reasons not to publish the risk register, which is that it contains the information that the public need to see whether the decision that he has reached in the Bill is without risk to the NHS. The Information Commissioner has deemed this to be in the public interest but the Secretary of State chooses to hide it from the public. The public have a right to know that when a decision is taken in their name the relevant considerations have been taken into account. If this reorganisation goes wrong, as it is doing—the good people in the NHS who are working hard are leaving now—could that possibly amount to misfeasance in public office?

In the Health Committee, we have seen what can be done with co-operation. We visited Torbay and saw public sector leadership at its best. I have absolutely no idea who the staff there voted for—nor do I particularly care—but I know that they saw a system for elderly people that was not working, and they worked hard, not thinking about their pensions or asking for overtime, to devise a system in which there was one point of contact for elderly people. Under the system, the risk is shared, 50% with the NHS and 50% with the local authority. They devised a system with consistency of leadership and long-standing good relations across the system. A care package that might take eight months to deliver elsewhere can now be delivered in two hours. By spending £l million on community care, they saved the hospital £3 million. A seven-step referral is now down to two steps. All of that is at risk, however. The NHS and local authorities could learn from that good practice and evolve in that way.

Some people say that, as a result of the Bill, the people around the table will be the same; they will just have different titles. People need to know that the risk is not just about getting rid of managers. The Secretary of State might say that he is reducing the number of managers by making them redundant, but the NHS still needs some managers—so step forward McKinsey and KPMG to help the GPs who do not have, or might not want, management skills. Members of the public need to know the risk associated with the loss of expertise that has stayed in the public sector for the common good, but which will now be lost by the dismantling of structures.

Steve McCabe (Birmingham, Selly Oak) (Lab): My hon. Friend says that there is a danger that we will end up with the same people sitting around the table. Does she agree that the Government should publish the number of people who have been made redundant and received redundancy payments from PCTs, only to be re-engaged to work for clinical commissioning groups? What has that cost the NHS so far?

Valerie Vaz: I absolutely agree with my hon. Friend. I have asked about this in a written question, and I have not had an answer. This is fiscal incompetence.

The public need to know that this is not GP fundholding revisited. They also need to know that, when they visit their GP, as my constituent Inayat did, the decision whether to prescribe antibiotics will be made on the basis of clinical need, not as a result of financial pressures. When Mrs Bennett needs to go to the Manor hospital, she needs to know that she will be next on the list, and that she will not be giving her place to someone who is able to pay, as a result of the cap being raised to 49%.

People need to know that when Nick Black wrote in The Lancet that productivity in the NHS had risen in the past 10 years, he ended his article by saying that he had no conflicts of interest. He was right, and the Secretary of State is wrong. The Secretary of State might not have taken into account relevant considerations when he declared that productivity had fallen. The public need to know of the risk that the Bill will be taking in replacing lines of management. At the moment, we have the Secretary of State, the Department of Health, strategic health authorities and PCTs. We are going to have the Department of Health, the National Commissioning Board, clustered SHAs, 50 commissioning support groups, 300-ish clinical commissioning groups, clinical senates, Health Watch—and, I could add, a partridge in a pear tree.

Thanks to the House of Commons Library and the Public Bill Office, I can tell the House that the Bill has had 1,736 amendments: 474 in Committee, 184 on recommittal and 1,078 on Report. The Bill Committee divided 100 times—the first time that that has ever happened. This is a bad piece of legislation. The public need to know the risks to the taxpayer. They need to know that costs have been saved, and not just shifted to another level or outsourced.

We are in this place to serve the people of this country. History does not judge kindly those who do not act in the public interest, and people will not forgive those who save face by continuing with the Bill only for reasons of vanity. The risk register associated with the Health and Social Care Bill should be published. The Information Commissioner has decided that that is in the public interest. The people want it and should have it. I support the motion.

Chris Skidmore (Kingswood) (Con): It is a pleasure to follow two of my fellow Health Committee members. The Chairman of the Committee wrote to the Secretary of State on 16 November 2011 to ask for the Government’s reasons for not publishing the risk register. In response, the Secretary of State wrote:

“It is important to understand that the risk register sets out all of the potential risks identified by the Department of Health for the entire range of areas for which it is responsible. These include financial risks, policy risks and sensitive contractual risks. It is a means by which the Department focuses on risks and acts to mitigate them. If the Department were to release risk registers in the future, there is a genuine possibility that the most significant risks will no longer be recorded, and no solution or mitigating action will therefore be identified. Any action that could deter staff from articulating and addressing business risk to their senior management and ministers carries with it the potential for highly damaging consequences.”

That is remarkably similarly to an answer given in Hansard on 23 March 2007 by the right hon. Member for Leigh (Andy Burnham) in response to a parliamentary question tabled by my hon. Friend the Member for South Holland and The Deepings (Mr Hayes). The right hon. Gentleman stated that the Department’s risk register dealt with

“emerging risks to the Department’s programme and the national health service, and what can be done to control and mitigate these risks. It also informs discussions between the Department and top management in the NHS about addressing key issues in policy, resourcing and service management. 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. We therefore cannot agree to place a copy of the current version of the register in the Library.”—[Official Report, 23 March 2007; Vol. 458, c. 1191W.]

We had a similar example on 31 July 2008, when the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) responded to a freedom of information request by stating:

“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.”

The Department of Health also refused a freedom of information request for copies of any presentations given by the director of public health concerned with the risk of not delivering on targets to reduce health inequalities, so it is not only risk registers that the Department has previously refused to reveal.

Members have talked today about the risk register in apocalyptic terms, as though it were a document that should remain within the confines of MI5 or MI6. The Health Minister, Earl Howe, has revealed details of the broad issues that are covered by this risk register. I should like to read them out, so as to set the debate properly in context. They include:

“how best to manage the parliamentary passage of the Bill and the potential impact of Royal Assent being delayed on the transition in the NHS; how to co-ordinate planning so that changes happen in a co-ordinated fashion while maintaining financial control; how to ensure that the NHS takes appropriate steps during organisational change to maintain and improve quality; how to ensure that lines of accountability are clear in the new system and that different bodies work together effectively, including the risk of replicating what we already have; how to minimise disruption for staff and maintain morale during transition; how best to ensure financial control during transition, to minimise the costs of moving to a new system, and to ensure that the new system delivers future efficiencies; how to ensure that future commissioning plans are robust, and to maximise the capability of the future NHS Commissioning Board; how stakeholders should be engaged in developing and implementing the reforms; and finally, how to properly resource the teams responsible for implementing the changes”.—[Official Report, House of Lords, 28 November 2011; Vol. 733, c. 16.]

John Healey: The hon. Gentleman is right to draw the House’s attention to that fact, but does he accept that that is information that has not been published elsewhere and that the Secretary of State’s argument that the impact assessments that have been published are sufficient therefore simply will not wash?

Chris Skidmore: It is interesting that the right hon. Gentleman raises that point, because Earl Howe was mentioning the transition risk register, which is continually updated. That is an important point, because the appeal to the Information Commissioner to release the risk register was made on 29 November 2010, in the autumn when the register was live. The Information Commissioner made his ruling based on the fact that there was an issue of public interest at the time of the request. If the risk register is released today, it will be the risk register from autumn 2010 rather than that from February 2012. That is the moment when the wheels come off the bandwagon. The Opposition are asking the Information Commissioner to release the risk register from autumn 2010, not the risk register from February 2012. The risk register that would be released is that from the time of the White Paper, before the changes were made and before the listening exercise. It is complete nonsense. If the document was released, it would be out of date, inaccurate and would scaremonger among the population.

John Healey: So the hon. Gentleman agrees with Lord Henley, the Minister in the House of Lords, who told that House in January that if the Government lose the appeal next month they will publish not only the risk register from November 2010 but the updated risk registers, too?

Chris Skidmore: The Government do not have to publish the updated registers on the basis of the Information Commissioner’s verdict, which was on the autumn 2010 register. That is the Information Commissioner’s advice that is referred to in the motion. The Opposition are asking for an out-of-date document—we might as well give up and go home.

Rosie Cooper (West Lancashire) (Lab): Is the hon. Gentleman aware of the comments made by David Nicholson, the chief executive of the NHS Commissioning Board, who said:

“I’ll not sit here and tell you that the risks have not gone up. They have”?

Chris Skidmore: I am, as I have the parliamentary Labour party brief—I can see that that is on the back of it.

Mr Robert Buckland (South Swindon) (Con): My hon. Friend’s point about the Information Commissioner’s decision is vital, because the public interest test is the test applied at the time of the request. That makes the decision interesting but, frankly, historical rather than relevant to the issues raised by Members today.

Chris Skidmore: Absolutely. We are debating whether we should release a register that is no longer relevant and that was written in autumn 2010, at the time of the request on 29 November. The topic is completely irrelevant, as the debate has moved on. We ought to be talking about reform and why we need it. We have wasted six hours of parliamentary time today discussing an out-of-date risk register.

Margot James (Stourbridge) (Con): Does my hon. Friend envisage that some of the amendments and changes to the Bill that the Government have introduced since that time would deliberately have taken account of some of those risks and that the situation would therefore have moved on?

Chris Skidmore: Yes, the situation has moved on. We have had the listening exercise under Steve Field and various Select Committee on Health reports. The name of the commissioning bodies, which were called consortia, has changed. Nurses have been added and we have opened things up so it is not just about GP commissioning.

Yasmin Qureshi (Bolton South East) (Lab): If the register is as irrelevant as the hon. Gentleman says, why not publish it?

Chris Skidmore: The Opposition are asking—[ Interruption. ]The shadow Secretary of State has already said that risk registers should not be published because they are confidential documents that must be used by policy makers. The Opposition are asking for a risk register that is out of date when what we should have been discussing today was reform of the NHS and how we can deal with an ageing population at the same time as dealing with a rise in chronic diseases.

I thought that it was striking that the shadow Secretary of State said at the end of his remarks that he would put the NHS first, without any mention of the patients. That is what these reforms are here for. They are allowing patients to be put in the driving seat and to sit down with their doctor, to understand what treatments they need and to have a choice of treatment through the opening up of providers. We could have had that debate—we could have spent six hours discussing that instead of this irrelevant document that you want to have a look at, which is out of date and from November 2010 when it is now February 2012. You are two years out of date, you are out of time and you are out of touch. I urge everyone to vote down the motion, simply because it falls outside the point.

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. I remind the hon. Gentleman that I am not out of touch, and I am sure that he was not suggesting that I was. Others might think so, but I want to reassure him that I am not.

Grahame M. Morris (Easington) (Lab): May I start by placing on the record my appreciation for all the staff who work in the national health service? I also want to make a declaration, unashamedly, that I love the NHS and will campaign tooth and nail to prevent any fragmentation, privatisation or postcode lottery or any diminution in the service to patients.

I tabled early-day motion 2659 calling on the Health Secretary

“to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill reforms in advance of Report Stage in the House of Lords”

so as to inform that debate. The motion we are debating in today’s important debate echoes the wording in my early-day motion, which almost 100 people have signed, including 15 Lib Dem MPs at the last count. I hope they will back up their signature with their vote in the Lobby today. Many Members on both sides of the House have received letters about this issue and there has been an e-petition from 38 Degrees, which has had tremendous support in very few days. In case Government Members need any encouragement, let me refer to a poll from this week showing that 70% of Lib Dem supporters trust NHS professionals more than the Prime Minister and the Health Secretary on the Health and Social Care Bill.

Mr Marcus Jones: The health professionals will be in charge.

Grahame M. Morris: Most of the health care professionals—indeed 90%; the ones who were not invited to the summit—oppose the changes in one form or other. Also, 80% of Lib Dem voters want the risk register published—an even bigger percentage than that of Labour voters.

Ian Lavery (Wansbeck) (Lab): Does my hon. Friend agree with the Secretary of State about the huge support for the Government from GPs over these reforms?

Grahame M. Morris: A number of Members on the Government Benches have referred, in Health questions and at other times, to the huge support among clinicians and GPs in their area, but Clare Gerada, the chair of the Royal College of General Practitioners, has said that just because GPs are compelled to man the lifeboats does not mean they agree with the sinking of the ship. That sums things up.

Hon. Members on the Government Benches should be particularly concerned by some recent polling figures. According to a poll by ICM, the over-65s—the category of people who are most likely to use the NHS and most likely to vote—want to drop the Bill by a margin of 56% to 29%, or two to one, which is the largest such margin. Sadly, not one Conservative Member, as far as I am aware, has had the courage to sign the early-day motion or to call publicly on the Health Secretary to publish the risk assessment. I know that, privately at least, some of the more thoughtful Conservative Members have been advising the Secretary of State to publish, but he seems to be flatly ignoring them. The risk register contains an objective list of the Department’s view of the risks, an estimation of the likelihood of each specific risk occurring and an estimation of its severity if it did occur. To be clear, what the Health Secretary is determined to conceal are the severe and likely risks of his own reckless attack on the NHS.

The Prime Minister must also be held to account for his broken promises on the NHS, for allowing his Health Secretary to put the NHS at risk and for standing by him while he tries to cover up the mess that is the Health and Social Care Bill. I remind the House that the coalition agreement that was signed by the Government parties stated:

“The Government believes that we need to throw open the doors of public bodies, to enable the public to hold politicians and public bodies to account.”

How does that statement square with this decision? Where is the accountability now? No one in the country voted for these health reforms, the Health and Social Care Bill has no mandate and we in the House will be asked to vote on reforms in the knowledge that the Department of Health and the Health Secretary are complicit in hiding the associated risks.

Charlotte Leslie (Bristol North West) (Con): Will the hon. Gentleman give way?

Yasmin Qureshi: Will my hon. Friend give way?

Grahame M. Morris: I am only going to give way twice, so I shall give way to the hon. Lady.

Charlotte Leslie: That is very kind; I thank the hon. Gentleman. Does he agree that if we want to debate the health reforms, this is not the place to do it because we are talking about the risk register? Also, does he agree that all this is slightly disingenuous because Governments do not publish risk registers for good reasons, in that it would be far more risky for patients, whom we should all be considering, if Government Departments could not have frank and open discussions? The risks we should really be looking at are those to patients.

Grahame M. Morris: I thank the hon. Lady for her intervention, but if she had been present for the whole debate, she would know that we have covered much of that in discussing the nature of a fundamental change—the biggest ever shake-up—in the national health service since it was established. We are not calling for the nationalisation of the railways or the abolition of the House of Lords. We are simply calling for the risk register to be published, in the interests of openness and transparency, to identify the risks associated with the changes proposed by the Government.

The changes are a matter of the most serious consequence. If the Health Secretary is suppressing a report that shows that the reforms could put patients at risk and worsen the functioning of the NHS—if that is in the report, which I do not know, as I have not seen the strategic risk register, at least the national one—he would be guilty of the biggest political cover-up in a generation.

As my right hon. Friend the Member for Leigh (Andy Burnham) mentioned, in his ruling back in November the Information Commissioner, Christopher Graham, said of the Secretary of State’s reasoning:

“Disclosure would significantly aid public understanding of risks related to the proposed reforms and it would also inform participation in the debate about the reforms.”

But almost three months on, we as parliamentarians are still being kept in the dark. We were told that releasing the risk register would jeopardise the success of the policy, but the Information Commissioner refuted that and said it would only enhance the quality of the debate and allow for greater scrutiny of the policy.

We were then told by Ministers that they had published the relevant risks associated with the reforms in the impact assessment. If that was the case, why would the Information Commissioner rule that they should be published to inform debate and why would the Health Secretary fight tooth and nail to prevent that?

Finally, we were told that publication would risk the frankness of future risk registers, another point that the Information Commissioner specifically ruled out. Before the general election, the Conservatives promised to “unleash an information revolution” in the NHS, yet in government they are giving us the biggest cover-up in the history of the NHS. The Prime Minister once described his priorities in three letters: NHS. So we should not be shocked by the professional and public outcry of "OMG!” since he has broken his promise of

“no more top-down reorganisation”

and deployed WMD—weapons of mass deception—to conceal the true nature of his reforms.

Opposition Members know the dangers for the future of the NHS with up to 49% of work carried out in NHS hospitals being done by the private sector, and every service provided by the NHS, whether it be radiotherapy or speech therapy, put out for competitive tender, making it vulnerable to private sector takeover. It is no wonder we are debating the threat to the NHS when so many pre-election promises have been broken.

I conclude by offering some advice to the Health Secretary. I leave him with this thought: history is littered with examples of people who have fallen from grace, not for their crimes, but for the cover-up. He should end his terrible attack on the NHS and have the courage to be open about his plans to fragment and privatise our beloved national health service.

Mark Simmonds (Boston and Skegness) (Con): I draw the attention of the House to the Register of Members’ Financial Interests. The only thing on which I agreed with the hon. Member for Easington (Grahame M. Morris) was the commitment that he has, I have and all Members on the Government Benches have to the national health service and its future as a taxpayer-funded service, with access based on need, not on ability to pay.

I think I speak for everybody on the Government Benches when I say that I would not vote for any Bill that privatised the national health service. The Health and Social Care Bill is not about that.

I can also confirm that my personal experience of using the national health service recently, both at Pilgrim hospital in my constituency in Boston and at Peterborough hospital—which, as the Secretary of State said, is highly indebted because of the previous Government’s PFI scheme—was first class and excellent.

Mel Stride (Central Devon) (Con): Does my hon. Friend agree that the Labour party’s suggestion that we are privatising the health service is not only utterly disingenuous, but extremely cruel and frightening for elderly and vulnerable individuals, of whom there are many in my constituency, who are perturbed by what is being said, which is untrue?

Mark Simmonds: I am grateful to my hon. Friend for that intervention. He is absolutely right. Certainly, some of the communicating that both Government parties need to do will be myth-busting on what is being portrayed as the future of the NHS and its services. They will be improved and enhanced, as will patient outcomes and services, as a direct result of the reforms that we hope to implement though the Health and Social Care Bill. They will not go backwards, as Opposition Members suggest.

Two distinctions can be drawn between the Government and Opposition sides of the House on this matter. First, we on the Government side are committed to increasing resources and investment in the NHS—in contrast to the Labour party. We can see that distinction in the enhancement of services in England and the deceleration and paucity of services in Wales. Secondly, Government Members understand the necessity of reform, whereas Labour Members do not. I accept that there are some exceptions, such as the previous Health Secretary, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who I think understands the importance of reform. Maintaining the status quo in the NHS is the greatest risk; it is not an option.

I think that today’s debate is a red herring and a cloak. My hon. Friend the Member for Kingswood (Chris Skidmore) completely destroyed the argument about the necessity of publishing the risk register, because it is no longer relevant. I am sure that the ministerial team would have been looking at that risk register and changing policies in order to mitigate and negate the initial impact of the risks recorded in it. Every former Government Minister who has spoken from the Labour Benches today, whether in a speech or an intervention, has form in refusing to put risk registers in the public domain when they had a chance to do so in office, and they know very well that risk registers can be misleading. Even the Information Commissioner, in his judgment, said that safe space was required.

Hugh Bayley: The hon. Gentleman said a few moments ago that he believed that increased competition, with private providers competing against NHS providers within the NHS, would improve outcomes. Does he therefore agree that there should be a common standard by which all care providers paid for with NHS money report on the cost and outcome of procedures? If so, why is that not in the Health and Social Care Bill?

Mark Simmonds: I am grateful to the hon. Gentleman for his intervention. That is not exactly what I said, but I will get to the nub of what he is talking about. I do think that comparable information is needed to inform patient choice, and not just on cost, but on outcomes and patient satisfaction and experience, so that it is on a comparable level—

Hugh Bayley: Why is it not in the Bill?

Mark Simmonds: I am sure that the information centre in Leeds is working on that as we speak, because I know that it is important to the ministerial team.

Charlotte Leslie: Will my hon. Friend give way?

Mark Simmonds: I will not give way, because I have done so twice already.

Finally, it was made clear in an earlier intervention that the shadow Secretary of State, were he ever to be Health Secretary again, would not by necessity publish all risk registers, so it is nonsensical to suggest that this out-of-date risk register either informs debate or is necessary for discussing the future reforms of the NHS. Of course, that is not really what this debate is about. It is a cloak to try to put obstacles in the way of what I believe is necessary reform. We know why reform is necessary: a growing and ageing population; increasing levels of co-morbidities and long-term conditions; rising health care costs; and the impact of lifestyle choices. However, listening to the shadow Secretary of State, one would think that the NHS was falling apart. It absolutely is not. It is performing very well at the moment. We are reducing in-patient and out-patient waiting times. The backlog of patients waiting more than 18 weeks is going down, and the number of patients waiting more than a year is half what it was in May 2010.

Gloria De Piero (Ashfield) (Lab): Will the hon. Gentleman give way?

Mark Simmonds: I will not, because I have done so twice already.

I could go on with the achievements that the national health service has delivered since the election, but while progress is being made we need to put in place the policy architecture that will enable the national health service to deliver improved patient outcomes, satisfaction and experience and to continue as a free taxpayer-funded service.

So what are these reforms that get Opposition Members so excited? First:

“Patients…will have the right…to choose from any provider.”

Interestingly enough, that was in the 2010 Labour party manifesto. Secondly:

“All hospitals will become Foundation Trusts”.

Interestingly enough, that was in the 2010 Labour party manifesto. Thirdly, there is the plan to

“support an active role for the independent sector”

in providing services. That too was in the 2010 Labour party manifesto. Fourthly,

“Foundation Trusts…given the freedom to expand…their private services”.

That was in the Labour party 2010 manifesto, as was the proposal to ensure that family doctors have more power over their budgets.

Who was the man in charge of putting that in the Labour party manifesto? It was the current shadow Secretary of State, which just shows how far the Labour party has moved to the left since the May 2010 election. If there is one thing that he and his supporters behind him need to understand, it is that general elections are won from the centre ground, not from the extremes of either left or right.

In the time remaining to me, I shall mention two key areas and bust some myths. The first area is competition and choice, which have always been part of the national health service. The original 1948 NHS leaflet stated that patients must choose their own GP. We should be discussing the benefits that choice can bring to patients, and how we can facilitate innovation and better patient outcomes. The evidence is clear: competition based on choice and quality, not on price for elective care, drives and improves not just efficiency and shorter hospital stays, but better management and, most importantly, patient care and outcomes.

The second area, which both the shadow Secretary of State and the Secretary of State mentioned, is integration, and it is absolutely key if we are to improve patient pathways and outcomes. Care is currently fragmented, and the state monopoly is under little pressure to deliver integrated care or new models of care. The national health service to date has been poor at integrating services, and the Secretary of State and his team need to be careful to ensure that the health service understands that the merger of organisations is not the same as integration, which is about integrating care pathways, and must not be used as an excuse to protect poor providers and weak management, or to block clinically led reconfiguration.

The successful integration of patient care, and in particular of chronic disease management, will, however, dramatically improve quality and outcomes. The Secretary of State also needs to address the issue of funding flows, moving them away from episodic care to year-of-care funding to enable integration to take place properly.

In conclusion, the national health service deserves our wholehearted support, but if it is to survive as a taxpayer-funded service free at the point of use, it must evolve and reform.

Rosie Cooper (West Lancashire) (Lab): I congratulate my right hon. Friend the Member for Leigh (Andy Burnham) on his persistence with these Opposition day health debates. I am sure that he shares with me a deep-seated hope that the Secretary of State will soon see the light, publish the risk register and drop the Bill.

“The public can be forgiven for being bewildered by the latest round of plans to reform the National Health Service in England. The set of proposals is large, many are highly technical, why they are needed is not clear and the protests from key respected groups are loud.”

Those are the words of Jennifer Dixon of the Nuffield Trust in her most recent paper for “The Political Quarterly”, and I am sure that many in the Chamber will agree wholeheartedly with them; I certainly do. They are an incisive analysis of the state of play with regard to the Health and Social Care Bill and the planned NHS reforms. The short opening paragraph of the paper begins to explain why it is essential that the Department of Health publish the transition risk register, as ordered by the Information Commissioner.

As each day passes, there are ever more reasons why the British people need to be able to see for themselves the risks associated with the Bill and how the Department of Health proposes to mitigate them. This is about a broader, more fundamental and more important issue than publication in itself. Many people are fearful about what the Secretary of State’s plans really mean for them and their families, and for the health service that so many people rely on. I cannot understand what is in the risk register that the Government are so frightened of revealing to the people who are actually paying for this.

The message of what the public think is loud and clear: they simply do not believe and do not trust the Government, the Prime Minister or the Health Secretary. A ComRes poll says that 69% of respondents do not trust the Government to get it right on health, while YouGov says that six out of 10 people think that the Prime Minister has failed to deliver.

Gloria De Piero: Perhaps one of the reasons why there is such a lack of trust is what is going on in our own constituencies. In my constituency of Ashfield, waiting times have gone up and the NHS walk-in centre has closed. That is the reality of what is happening on the ground.

Rosie Cooper: I am dreadfully sorry that my hon. Friend is able to say such a sad thing, and Government Members do not hear any of it.

People have listened to what the Secretary of State has said and they are telling the Government clearly that they think that their proposals are complex, muddled and expensive, and that they do not trust what they have been told. I wonder why they have such difficulty in accepting the Secretary of State’s words of reassurance, but perhaps there is a clue in the track record of the Government, the Prime Minister and the Secretary of State in making promises. They promised no top-down reorganisation and then did it anyway with no mandate, no mention of huge reform having been made by the coalition Government. We have a so-called Government of openness and transparency who will not publish the transition risk register despite being ordered to do so by the Information Commissioner. So much for “No decision about me without me”; these decisions seem to be about us without us—all of us. The Government say that there will be no cuts to front-line services, whereas we have just heard about cuts to front-line staff and the down-banding of members of staff. They say that waiting times will not increase, but they have increased. Yet the Government still press on.

This reminds me of a story about a man who is stranded as flood waters rise. The water is getting higher and higher, and he prays to God to save him. He refuses help from a neighbour in a rowing boat, from someone in a speedboat, and even from someone in a helicopter, saying, “No, thank you—I have faith that God will save me.” Of course, he is washed away.

Standing before his maker, he says, “I had faith that you would rescue me,” and is told, “I sent you two boats and a helicopter. What more did you want?” In this case, the Secretary of State has been sent the Royal College of General Practitioners, the Royal College of Midwives, the Royal College of Nursing, the British Medical Association, the physiotherapists and other professions allied to medicine—need I go on? Those are just a few of the signals to the Secretary of State that he has got it wrong.

If the Secretary of State continues with the Bill, before long he will be meeting the Prime Minister on the day of a reshuffle, but by that time the people in the NHS will have suffered hugely for these silly mistakes. The risk register is so potentially damaging that the Department of Health refuses to publish it, thereby spending taxpayers’ money on preventing taxpayers from knowing what it is doing with their money. That is absolutely ridiculous. It is imperative that the transition risk register be published.

The Government have been the architect of their own problems by breaking their promises, failing to demonstrate the need for such extensive reform of the NHS, and not listening to the people who use the service and the people on the front line who deliver the service—the very patients and staff whom the Government keep telling us that we forget about, and who are at the core of this matter.

When the Secretary of State assumed responsibility for the NHS there had been a sustained period of increased funding, lower waiting times had been achieved, the quality of care had improved significantly, and there were some of the highest levels of public satisfaction in the history of the NHS. In a little under two years, that situation is being reversed. I would put it to the Secretary of State, if he were here, that surely even he can see that now is the time to be honest and up front with the people of this country. It is time for the Government to take another deep breath, publish the risk register and put their trust in the people.

Gareth Johnson (Dartford) (Con): It is a pleasure to follow the hon. Member for West Lancashire (Rosie Cooper), although I disagreed with much of what she said. If we had listened to organisations such as the British Medical Association in the past, we would not even have a national health service. The BMA opposed the very creation of the national health service, so we should take no lessons from such organisations. What we have heard from Opposition Members today shows their culture of saying, “Do as we say, not as we have done.”

Although I disagreed with much of what the hon. Member for West Lancashire said, I did agree with something that the shadow Secretary of State said when he was in charge of the Department of Health in September 2009. He said that Ministers and their officials need space in which to develop their thinking and explore options, and that the disclosure of the risk report may deter them from being as candid in the future, which would lead to poorer quality advice and poorer decision making. The right hon. Gentleman was absolutely right then and that ethos has run through Governments across the ages.

Like most Members in this House, I support the principle of open government. I support the fact that the Department of Health has divulged far more information since the general election. We all want open and free government, but that will inevitably always be up to a point. No Government since the dawn of time have felt it prudent to publish a risk register and divulge it in the public domain, whether it be a transitional register, a strategic register or any other kind of register.

Bob Stewart (Beckenham) (Con): I have used risk assessments or risk registers in a different way. The military used them as a management tool to look at the worst-case situation and the best-case situation. We did not publish them or make them public for the simple reason that they would have worried people too much. They set out “what if” scenarios. That is why the previous Government did not publish them and why we do not want to publish them.

Gareth Johnson: My hon. Friend makes a valid and correct point. Governments need such registers to function efficiently and to cover every eventuality. As he pointed out, a risk register is a mechanism by which civil servants can candidly present a worst-case scenario to Ministers. It is not about what is expected to happen, but about what is the worst that can happen. Risk registers are therefore not Government policy, but preparatory documents.