NHS Risk Register - 22 February 2012
John Pugh: Would the hon. Gentleman be surprised to know that I have here a national risk register that was published by a Department in 2012?
Gareth Johnson: Yes, I would be surprised if that had happened.
It would be wrong for there to be routine publication of risk registers without any kind of control. The beauty of risk registers is that they enable civil servants to think the unthinkable.
The hon. Member for St Ives (Andrew George), who is no longer in his place, made the point that there is a difference between the approaches of the Government and the Opposition. If we are honest with ourselves, we must recognise that every Opposition in this place has been guilty of some scaremongering. There is no doubt about that, so let us be mature about it. Whether it has been my party, the Labour party or the Liberal Democrats, we have all been guilty of a certain amount of scaremongering. Presenting a pessimistic view as a real likelihood is part of the game of political football. However, there is a huge danger that information from the risk register could end up misleading the public and giving them inaccurate information.
Andy Burnham: May I remind the hon. Gentleman that the words of mine that he referred to related to the strategic risk register? We are debating a different document today. He seems to misunderstand risk registers, because he described them as presenting a worst-case scenario. They do not, and I can provide him with the material showing that right now if he would like to see it. The examples that I read in my speech were given a likelihood rating. They were said to be likely to happen and not mitigated by the steps that had been taken. I am afraid he has not grasped that point, and he needs to.
Gareth Johnson: Risk registers play devil’s advocate and ensure that there are contingency plans for every eventuality. The shadow Secretary of State has mentioned the transitional document, but nothing in the motion mentions a transitional or strategic document. Those words are not used in the motion.
When information on doomsday scenarios is released in an uncontrolled manner, it is easy to see how it can be viewed as being what is expected to happen. If a best-case scenario is released in an uncontrolled manner, that can raise unwarranted optimism. Ministers need to be able to plan for the best and worst-case scenarios without being seen as either overly complacent or doom merchants. Good government is about examining theoretical risks and assessing potential problems and hypothetical scenarios.
The last thing we want is for a Government to tone down their risk planning through fear of propagating alarm or panic. We want civil servants to feel that they can fully paint the picture of the extremes that need to be prepared for, without tempering their advice. We do not want them to have to keep one eye on risk management and the other on how the information will be perceived by the public when it is divulged.
Governments need to consider the commercial ramifications of publishing risk registers. Will the sales of certain products collapse unjustifiably? Are there potential unforeseen consequences? We literally need a risk assessment of the publication of risk registers.
Darent Valley hospital, only the second private finance initiative hospital to be built, is in my constituency. The disabling effect of the agreement is only now being dealt with, thanks to the decisions of Ministers. I do not recall the previous Government rushing to disclose the risk register that was drafted in connection with that commercial decision. Perhaps they were wise not to do so.
Although we all instinctively want transparency to prevail in what we do, we need to think through the repercussions carefully. If the Government lose their appeal against the decision, they will have to disclose the information required, and I believe that there could be serious consequences. Disclosure of the risk register would herald not a new era of open government but rather an end to proper, full risk management. Proper transparency is about the Government publishing what they believe will happen, not what they do not believe will happen but are making contingency plans for. Open government will always be desirable to a point, but as with all previous Governments we should not be in the business of publishing every scenario for which every Department is preparing.
Frank Dobson (Holborn and St Pancras) (Lab): I think the Government will conclude that it is foolish of them not to publish the register, because everybody assumes that they must have something to hide—something to do with policy development.
In the absence of publication, we can only speculate on what the register contains. I should like to know, for instance, whether there is any reference to the risk that is being taken by inviting American health corporations to bid for services in this country. After all, all the leading American health corporations have, at one time or another, been indicted for defrauding either patients, doctors or taxpayers. I asked the Secretary of State whether he would ensure that no contracts are given to any American corporation that has been indicted for fraud. He refused to ban them, so we can expect them to come in.
There is also the question of marketisation and of putting things out to tender. We have an example in my constituency. The Camden road practice was put out to tender in 2008 and the existing practice doctors put in a bid that met all the requirements. According even to the stuff that was published, they did better than the private sector bidder in respect of the requirements, but the private sector firm bid to provide the services at a lower cost to the NHS and got the contract.
When I asked for details of all the bids and considerations, I was told that they could not be disclosed because they were commercial and confidential. I warn all hon. Members who think they will get the details of what happens in their areas—we can safely bet that the words, “No you can’t have the information. It is commercial and confidential”, will come up time and again.
As it happens, a US company, UnitedHealth primary care, got the contract. I admit to having a touch of cynicism in my make-up and rather assumed it would do a rattling good job to demonstrate what a wonderful outfit it is, but it was not so. It did not even bother to act as a loss leader. It reduced the amount of time patients had with doctors and at one time suggested that patients could raise only one topic with their GP. Opening hours were changed. It closed a baby clinic, but because there was a great row, it reopened it. The PCT contemplated taking legal action to enforce compliance with the contract but was advised by its lawyers that the contract was not enforceable.
Last year, that triumphant outfit suddenly sold all its GP contracts, including the one at the Camden road practice, and said it would concentrate on offering support to GP commissioning boards because that is easier and more profitable than supplying a GP service. It sold the Camden road surgery contract to an outfit called The Practice plc. The contract was not put out to tender and nobody was consulted about the transaction—not the NHS or the staff, or least of all patients.
Patients—my constituents—were chattels in that transaction, but they might have been reassured when they saw the publicity for The Practice plc, which states:
“At The Practice we offer clinical services to NHS patients who need to be sure of the very highest standards. But it’s how we do what we do that makes the difference. We aim to deliver genuinely caring and thoughtful patient centered services, minimise waiting times and make the whole experience one to remember with satisfaction. From first referral through diagnosis to effective treatment we promise true professionalism…At The Practice, patients come first.”
Not any more they don’t. It has been announced that the practice in both centres is closing down because the lease has run out. The patients have been left bereft and bewildered. It is not a question of integrated care between primary care and social services. There will be no integrated care at the practice because people will be spread around half a dozen neighbouring practices. And why? It is because this commercial organisation, dedicated to profit and lining the pockets and handbags of its shareholders—the sacred shareholders, whose interests must always come first—has decided that it cannot find alternative premises. What is the risk of that happening when the Government spread this practice right across the country? Is the risk of that happening mentioned in this famous risk assessment? I doubt it very much.
A constituent of mine wrote to me:
“Before United Health took over…we had an excellent surgery with excellent…doctors. They knew their patients’ medical histories and the patients trusted them…. What are we left with? A Surgery which started to deteriorate almost as soon as the original doctors left/were forced to leave, one which continued to deteriorate… So much unnecessary disruption and upset… Totally ridiculous and unprofessional and with no sensitive consideration or understanding being afforded to patients.”
We hear a lot about patients from Government Members. They need to consider what will happen to their patients when this is all marketised.
Rehman Chishti (Gillingham and Rainham) (Con): It is a pleasure to follow the right hon. Member for Holborn and St Pancras (Frank Dobson), although given that the Order Paper reads,
“this House calls on the Government to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill”,
I wondered whether he was in the right debate. He spent most of his time not mentioning the Information Commissioner, although he mentioned risk in the last minute.
I want to focus on the argument over the risk register. I support the Secretary of State’s decision to challenge the Information Commissioner’s decision ordering the release of the Department of Health risk register. It is important to consider the procedure followed by the commissioner in determining whether it was the right decision to make. The Secretary of State’s decision to challenge the commissioner’s ruling is, procedurally, absolutely correct. The procedures set out in the Freedom of Information Act, as amended—[Interruption.] It is important to set the tone and background.
Andy Burnham: It’s not a court.
Rehman Chishti: The shadow Secretary of State does not understand the legislation. That is why he is making these assumptions. Section 35(1) makes it clear that:
“Information held by a government department…is exempt information if it relates to…the formulation or development of government policy”.
[Interruption.] Opposition Members do not like what they are hearing, but I hope that they will show the same common courtesy that I have shown them in the past. Section 35(1) makes it clear that the procedures applied by the Secretary of State were in line with the Freedom of Information Act, which was enacted by the previous Labour Government. Under that procedure and statute, he is entirely within his rights, using the correct procedure, to apply section 57 to appeal the ruling to the tribunal. That is absolutely right and proper.
It is important to say that we have the right—[ Interruption. ] I will come to the point on which the shadow Secretary of State keeps interrupting me—I am sure that he is not doing so to put me off making the point that he does not want to hear. Under the procedure in section 57, the Secretary of State can challenge a decision. It is important in our system—whether the criminal justice or the civil system—to have checks and balances on decisions that are made, whether by the Information Commissioner or by judges. If the shadow Secretary of State is now saying that the Information Commissioner’s ruling should be final, with no right of appeal, he should have said that when the Freedom of Information Act was being passed. However, he did not do so, and there is a right of appeal, where cases go to the tribunal. Even beyond that though, he asked earlier whether the Secretary of State could give us an assurance that he would not challenge the decision of the tribunal. Being realistic, how can the Secretary of State give that guarantee? The right hon. Gentleman knows, and I know, that the Secretary of State does not know what the judgment of the tribunal will be. He also knows that the rules that his Government passed, in section 59 of the Act, enable a referral to the High Court where there might be a wrong point of law.
Andy Burnham: Briefly, does the hon. Gentleman not accept that there is a big difference between the Secretary of State being within his rights and his being right not to publish? We accept that he is within his rights, but is he right? The precedent was set by the previous Government. We published a risk register after receiving a ruling from the Information Commissioner. That is the precedent.
Rehman Chishti: I am grateful to the shadow Secretary of State for that point, to which I shall return. In my view, the Secretary of State is absolutely right to use that discretion. The shadow Secretary of State knows the Department of Health well because he has been there, but I should point out to him that a spokesman for the Department of Health said:
“We have never previously published our risk registers as we consider them to be internal management documents. We believe that their publication would risk seriously damaging the quality of advice given to Ministers and any subsequent decision-making”.
I would say to the shadow Secretary of State—[ Interruption. ] He asked the question; I would be grateful if he listened to the answer. The reason why I say that the Secretary of State is within his powers and is right to do what he did is that never before have any Government or Secretary of State released that information. Being a sensible, considerate and fair man—which the Secretary of State is—he is right to challenge the decision, because that information has never been released before, as stated by the spokesmen for the Department of Health and made clear on page 2 of the information pack provided by the Library.
I also want to refer the shadow Secretary of State to another point. He has previously used the exemptions in section 36. Either we have exemptions or we do not, but the current exemptions, whether in section 36 or section 35, were put in place by the previous Government. If they did not want those exemptions—if they had said that everything should be in the public domain—they should have made that clear. I remind the Opposition of the saying “What’s good for the goose is good for the gander”. The fact is that you applied similar provisions, whether in section 35 or section 36, to withhold information. If you were able to do that in the public interest, then this Government, applying the same procedures and the same rules, can do so too. There is simply no point having legislation, in the form of the Freedom of Information Act, and now suddenly, when you are in opposition, you move the goalposts. In my view, that is totally and utterly unacceptable. It is also important to note that the Department of Health—
Mr Deputy Speaker (Mr Lindsay Hoyle): Order. May I gently remind the hon. Gentleman that I am not responsible? He keeps saying “you”, and I assure him that I will not and do not want to take responsibility for the NHS.
Rehman Chishti: I am grateful, Mr Deputy Speaker, and I am sorry to put the previous Government’s legacy on you.
Moving on, it is important to bear in mind the previous Secretary of State’s decisions in 2008, to which I referred earlier. However, it was not just him who acted in that way; the Secretary of State for Health before him, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), made similar decisions, under section 36 of the Act. In view of the procedure provided under the Freedom of Information Act and the similar decision taken by previous Labour Health Secretaries on public interest grounds, I feel that the Secretary of State is absolutely right to challenge the current Information Commissioner’s ruling.
On such an important issue, it is absolutely right to say that in the interest of fairness and transparency, the matter should be looked at by a higher authority. If a point of law is at stake, I would say that section 59 should be used to refer the matter to the High Court. The debate has touched on the excellent work going on—whether in respect of the cancer drugs fund or the reduction of viruses in hospitals—so I endorse the view of my constituent, Mr Thomas, sitting in the Public Gallery, who says that the Government are doing an excellent job.
Barbara Keeley (Worsley and Eccles South) (Lab): I support the motion calling on the Government to publish the transition risk register because I think it is vital to ensure informed public and parliamentary debate on the Health and Social Care Bill. As other Members have experienced, 40 of my constituents have written to me about this issue in the last two days. They rightly worry that the Government’s reforms will damage the NHS. They want to see the risk register released to inform them and to let them make up their own minds about the issues. My constituents also believe that Members here and in the other place should have all the available facts and information when debating and voting on legislation.
The proposed top-down reorganisation of the NHS is unnecessary, costly and a threat to our current health and social care services. As we have to consider these costly and unnecessary proposals, we at least need to know the threats and concerns that exist, about which the risk register might inform us.
Risk registers—like other local registers we have heard about—are routinely published by the North West Strategic Health Authority and other regions to communicate risks about the transition to new NHS structures and to ensure that those risks are understood and managed. Let me point out some of the risks mentioned in a recent risk register report for the North West Strategic Health Authority. The transition might mean a loss of grip on current performance or that organisational and system instability during transition could adversely affect corporate performance. Furthermore, corporate and individual capacity and capability might be diminished by uncertainties arising from transition. Those are all rated as high risk.
I believe that we are already starting to see some of those issues arising in the north-west and nationally. The Health Select Committee recently dealt with some of those issues in its report on public expenditure. The Foundation Trust Network had told the Committee that
“in the short to medium term there is significant disruption in relationships as experienced people leave the NHS or are redeployed.”
“With the financial pressures on commissioners, combined with the changes in personnel and disruption of historic relationships, there is growing evidence that commissioners are making unsophisticated attempts to reduce costs.”
Based on all the evidence we heard, the Select Committee concluded:
“The reorganisation process continues to complicate the push for efficiency gains…we heard that it more often creates disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings.”
I can provide a local example. Salford primary care trust was running an effective service of active case management for people with long-term conditions, but it ended that a few months ago. That is a counter-productive change—the sort of change being made by NHS bodies as they rush to meet the pressures of making savings and reorganisation. I know that ending that service was to the detriment of my constituents and other Salford people living with long-term conditions. I have raised the issue in debates with the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is in his place on the Front Bench.
The Bill brings competition into the NHS at a level that I believe is unhealthy and unwanted. What are the potential risks to patients of a massive increase in the use of private clinics, private surgery and other private treatments? Much is said about choice, but what about the risks? We know that tens of thousands of women with PIP breast implants are sick with anxiety; they understand the risks of using private surgeons who then refuse to follow their duty of care to their patients. These are women who fear that they might have industrial-grade silicon leaking into their bodies, giving them immune system problems. They are finding that their surgeons are either untraceable or do not want to know about their problems with the implants.
Dr Sarah Wollaston (Totnes) (Con): Does the hon. Lady accept that GPs will not be commissioning private breast surgery?
Barbara Keeley: In fact, there is a link, or a crossover, with the NHS. I have received letters from women who have had breast cancer and whose breast augmentation has been carried out in the private sector. I think that the hon. Lady attended the Select Committee meeting at which the issue was discussed, so she should understand the risks.
Many private clinics that were keen enough to sell surgery now want to charge their past patients just for a scan to check an implant. Women who have undergone surgery in those clinics have told me that the videos and brochures selling the surgery made no mention of the risks, or even of the fact that implants last only up to 10 years and that they would have to repeat the surgery every 10 years of their lives in order to keep replacing them. That was never mentioned.
Some clinics have gone into administration. My right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) described what happens in such instances. The new owners—if there are new owners—tend not to want to know anything about the problems of past patients. Questions of capacity are involved. The largest private medical company undertaking implants dealt with some 14,000 of the 40,000 patients who were given PIP breast implants, and thus could be seen immediately to be liable for 14,000 removal and replacement operations. However, it now says that it has the capacity to deal with only 4,000 operations of this type per year. Having created a problem, that group of private clinics is now saying that it does not have the capacity to solve it. The Committee was worried about the capacity of the NHS to deal with it, but the capacity of the private clinics who sold all those operations is much smaller.
The problem of PIP implants is on a huge scale, and I still believe that far too little is being done to help the women who are sick with anxiety about their implants. As I have said, the private clinics and surgeons do not want to deal with the problems, cannot deal with them because they do not have the necessary capacity, or deal with them only if the patient pays again, often when she cannot afford to do so. As we have seen, the Secretary of State has no power to compel private clinics or private surgeons to meet what we say are the moral obligations and their duty of care to former patients.
We also, sadly, have a regulator for devices such as implants—the Medicines and Healthcare products Regulatory Agency—which seemed to be incapable of conveying to the 40,000 patients with PIP implants the message that the product was faulty and could be toxic, thus causing 21 months of delay before the patients even knew about the new risk to them. Much surgery, including much private surgery, involves various medical devices and implants, and that situation is not acceptable. Given that we have seen such regulatory failure in the case of one sort of implant, I want to know what risk is posed by private surgery involving other devices. It is possible that in future we will see further scandals involving replacement knees and hips.
We need to know what risks, at national level, are inherent in the proposals in the Health and Social Care Bill, particularly the competition proposals. We need to know that in the House, as the Bill progresses, and we need to know it more widely. I support the motion.
George Hollingbery (Meon Valley) (Con): I want to begin by challenging something that was said by the shadow Secretary of State, the right hon. Member for Leigh (Andy Burnham), when he opened the debate. He has also shouted it several times from a sedentary position, and indeed he intervened on my hon. Friend the Member for Dartford (Gareth Johnson) a moment ago to make the same point. He keeps saying “It is a different register”.
Let me quote, at some length, what the right hon. Gentleman said earlier: “This led my predecessor”—the right hon. Member for Wentworth and Dearne (John Healey)—“to initiate a freedom of information request for the transition risk register. I wish to point out that my right hon. Friend did not request the full departmental risk register, which was subject to a similar request in 2009”, which was, indeed, released by the right hon. Gentleman. The right hon. Member for Leigh went on: “There are three crucial differences between the situation and the subject of today's debate. They would do well to listen because the Prime Minister got his facts wrong at Prime Minister's Question Time. The first important difference is that this relates to a different document. This debate is about the transition risk register, not the strategic risk register”.
I may have misinterpreted this, because it is not my key area, but let me refer briefly to the decision notice issued by the Information Commissioner. Paragraph 16 about the “Scope of the request” states:
“At the internal review stage the public authority referred to two separate risk registers which it said were relevant to the request and held by the department – the 'risk register centred on the Health and Care Bill' and the 'strategic risk register'… For the avoidance of doubt, the Commissioner wishes to state that he agrees with the public authority…and that it is the strategic risk register which should properly be seen as falling within the scope of the request.”
In short, the document that is requested now, and the one that the right hon. Member for Leigh refused to release in 2009 are, as adjudged by the Information Commissioner, exactly the same document. The right hon. Gentleman may wish to refer to that later, and I am entirely happy for him to do so. If I have got it wrong, I am happy to be corrected.
John Healey: I am grateful to the hon. Gentleman for giving way because, uncharacteristically, I think that he has got it wrong. The Information Commissioner’s notice considered two different freedom of information requests: one for the transition risk register from me, and one for the strategic departmental register from a journalist from the E vening Standard. The decision notice was a decision on both those registers. My right hon. Friend the Member for Leigh (Andy Burnham) is absolutely right: in our motion and the debate, we are talking about a different document—different in nature—from the one to which he referred and the one which was relevant in 2009.
George Hollingbery: I am grateful to the right hon. Gentleman for clearing up part of this, but I think that the decision that was made by the Information Commissioner was on the strategic risk register and its release. No doubt we can discuss that later, but I am grateful to him for his intervention and for clearing that up.
More generally, we must consider whether the Bill has been properly assessed both in the House and outside by many people. There are 443 pages of closely worded analysis on the impact of the Bill, and the impact assessments cover every possible aspect imaginable, including risk management and the risks associated with the new Bill. That information has been in the public domain for many months, and I do not honestly believe that there is anything to be gained by issuing further risk registers that may scare a number of people about the things that they have to consider. The risk register would add very little. The answer, basically, is that it is an expedient hook on which to hang a debate: to raise again in the House a topic that has been raised a great many times—quite rightly, in many ways, as many amendments have been made to the Bill. However, the quality of speeches from the Opposition demonstrates to me at least that the point of the debate was not to discuss the risk register but to use it as a hook on which to hang a particular viewpoint.
It is well known that when the right hon. Member for Leigh was Secretary of State he refused to release the risk register. I have examined that, and I was going to quote him further at length, but the House has heard that quote several times today, so I will not trouble hon. Members with it again. The argument that he made then was a sensible one, and it remains sensible now. Do we really believe that it is good for the Government to make public all their plans for the management of every conceivable risk that they might encounter? Some of those risks will scare people rigid, and I do not honestly believe that that is the right use for the strategic risk register.
Charlotte Leslie: Does my hon. Friend agree that the Opposition should be careful about what they wish for in setting a precedent of publishing every single risk register? It may seem unlikely at the moment, but one day, they might be in government.
George Hollingbery: That is a fair point. As we have heard again today, Tony Blair says that he very much regrets parts of the Freedom of Information Act. We have all come to regret parts of the Act, and setting such a precedent could be awkward for the Opposition. When, inevitably, they return to power, they will find that equally difficult to manage.
If officials are inhibited in any way from having full and frank discussions with Ministers on challenging issues for the Government, that is a retrograde step, and we cannot afford to take it. I have no argument with the Information Commissioner, as it is his job to make assessments based on rational arguments made to him in the light of documents under review and, as he explained in his judgment, on the timing of the initial request. It is germane, however, to point out that in paragraph 29, the judgment discusses exactly the issues to which I have referred, and cites
“the ‘safe space’ and ‘chilling effect’ arguments which are well understood and have been considered in a number of cases before the Information Tribunal.”
In paragraph 35 the commissioner makes his judgment and states:
“The Commissioner finds that the factors are finely balanced in this case”.
It was not an open and shut case; he had to make a fine judgment. The Information Commissioner himself clearly found that a difficult decision to make.
As I have said, it is entirely right and proper that the Information Commissioner should make his judgment as he sees fit. That is what he is there for, but for my part, I believe that that is a dangerous precedent to set. We have to wait for the result of the Government’s appeal and any further iterations of the statutory process before we receive the final answer. I recognise the shadow Secretary of State’s challenge, asking why the Secretary of State would not simply acquiesce and open up the information to all. The simple answer is that there are very good reasons for not doing so, and I have just talked about those.
What of the Opposition’s plans for the national health service? Will the shadow Secretary of State publish the likely contents of the NHS risk register for and the relevant impact assessments of his own plans for the service? That might be tricky because, other than the fact that they want to cut the NHS budget, we have absolutely no idea of the Opposition’s plans, and, as far as I can tell, neither do they. I trawled the party’s website today and I could find literally nothing about Labour’s plans for the future of the NHS; as is the case in a great many policy areas for the Labour party, confusion seems to reign on the Labour Benches. At a time when there is an exponential increase in demand on NHS services and a huge increase in available treatments, and when money is in very short supply for the Government, the Opposition’s response, judging by today’s debate, is nothing, except what seems to me to be naked opportunism.
I shall offer a final thought. Perhaps political parties should also be forced to publish impact assessments and maintain risk registers on their internal musings at election time, in the interests of transparency. Had Labour had to do that in 1997, it would have been extraordinarily unlikely that the party would ever have been elected.
John Healey (Wentworth and Dearne) (Lab): It is good to follow the hon. Member for Meon Valley (George Hollingbery), although he is wrong to say that this debate is simply a device for having a bigger debate. The motion is very simple and I had hoped that it would command wide support across this House, because this is not about being for or against the NHS Bill, or about being for or against the NHS reorganisation. The matter before us is whether we are for or against good government and the proper accountability of government to the public and to Parliament. A more open Government—a Government required to be more accountable—must raise their game and are more likely to be a better Government.
The Prime Minister said as much in the first month after the last election. He said that
“we’re going to rip off that cloak of”—
“secrecy and extend transparency as far and as wide as possible. By bringing information out into the open, you’ll be able to hold government and public services to account.”
Not for the first time, people are looking to the Prime Minister now to honour the promises he made, especially on the NHS. I have to say that 15 months after I made the original freedom of information request and 13 months after the Government introduced the NHS Bill, they are now dragging out the refusal to comply with the Information Commissioner in a way that prevents the public from getting a better understanding of the plans and prevents Parliament from doing our proper job of legislating well and legislating wisely.
John Healey: I will give way to the hon. Gentleman, as I have followed his speech.
George Hollingbery: I wonder whether the right hon. Gentleman could provide the House with a single example of where, in the transition of a Bill, a risk register of this sort has been used to inform the House’s debate. He may well be able to do so, and I would be grateful if he could.
John Healey: There is the precedent of releasing a programme risk register connected with the third runway at Heathrow, but the principle of the Freedom of Information Act is that each case is different—every risk register is different. The reason why this case is important and exceptional and why the Information Commissioner has, on balance, required the Government to disclose rather than withhold the risk register is that the Government’s health reforms are the biggest ever reorganisation in NHS history; that the legislation is the longest in NHS history; and that it has been introduced at a time of unprecedented financial pressure.
Mr Simon Burns: Will the right hon. Gentleman confirm for the House that, on behalf of Lord Boateng, he refused to release a risk register when he was a junior Treasury Minister?
John Healey: I do not think that the Minister was listening to the point that I just made: on the Freedom of Information Act, the decisions that Ministers make—I hope—as we did, and the decisions that the Information Commissioner would make on a challenge, depend on the specific information and, in this case, the risk register at stake. This case is unprecedented and exceptional and the Information Commissioner has come to this view because we are faced with such huge upheaval. It involves the biggest reorganisation and the longest legislation, at a time of the tightest financial squeeze for 50 years. Furthermore, this reorganisation was explicitly ruled out in the Conservative manifesto and in the coalition agreement. That is why, less than two months later, the huge upheaval of the White Paper was so unexpected, and why the NHS and the civil service were so unprepared for what they are now being forced to implement.
John Healey: I will not give way again; I have given way twice. The hon. Gentleman has spoken and has not been here for the whole debate.
Risk has been at the heart of the concern about the NHS reforms right from the outset. When I led an Opposition day debate from the Dispatch Box in November 2010, I described the reorganisation as
“high cost and high risk; it is untested and unnecessary.”—[Official Report, 17 November 2010; Vol. 518, c. 908.]
The lack of evidence and lack of confidence in how well the Government were prepared to manage the risks was the major cause of the growing concern among the public and professionals and in Parliament in the late autumn of 2010 and the winter of 2011. That alarm has only grown. It was first expressed by the all-party Select Committee report of December 2010, and reiterated in its January 2011 report, which concluded:
“The Nicholson challenge was already a high-risk strategy and the White Paper increased the level of risk considerably without setting out a credible plan for mitigating that risk.”
Not only is this reorganisation unprecedented and therefore exceptional; the NHS as an institution is exceptional. We all need the NHS. We trust it when we are most fearful, and we utterly depend on it when we are most vulnerable. That is why it matters so much to people, and why there is an unprecedented and exceptional level of public interest in any changes to the NHS and especially any risks to the NHS. The plans are unprecedented in their nature, their scale, their pace and their timing. That means that there is exceptional concern over the risks associated with their implementation. That is why there is an exceptional case for releasing this transition risk register. The Information Commissioner has had the benefit of assessing the risk register, and he has stated:
“There is a very strong public interest in disclosure of the information, given the significant change to the structure of the health service”.
There are two other factors that reinforce the case for, and the public interest in, the publication of the transition risk register. First, the story of this reform is a masterclass in poor policy making. It has been misjudged and mishandled from the outset. Good policy making normally involves policy consultation, followed by legislation and implementation. The Government have turned that on its head. First, we had implementation ahead of any legislation, followed by a forced pause to consult on the policies when they encountered so much resistance. That all adds to the risks and to the public interest in and the case for the disclosure of the risk register.
The Department of Health has a poor track record on risk assessment, on the use of evidence in policy making and on policy delivery. When the Cabinet Secretary did his first capability review of the Department, he concluded:
“Management of risk across the delivery chain is weak. There is no formal linkage between risk registers and mitigation strategies held by the Department and those in the delivery chain.”
Two years later, when the capability review was repeated, many of the same problems still applied, and the Department was again flagged in the review as at an amber state of concern—[ Interruption. ] Yes, that was under the previous Government. My point is that the Department of Health has a poor track record on planning and dealing with management risk, which is why it is so important to publish the risk register.
Clearly, in a short debate such as this, we cannot nail all the arguments that the Government are trying to put up. Suffice it to say that the Information Commissioner has heard them and has judged that the register should be released. The arguments will be tested in court on 5 and 6 March at the Information Tribunal and I shall give evidence to that tribunal. All I am asking for—and all the motion is asking for—is what the Government have promised. Today, on the Treasury website, one can see the Government’s principles for risk management:
“Government will make available its assessments of risks that affect the public, how it has reached its decisions, and how it will handle the risk.”
That is what we are asking for.
John Pugh (Southport) (LD): Another day, another health Bill debate: it is a groundhog day, déjà vu experience for many of us. On these occasions, I often find myself sounding like that irritating little man with the flat cap and glasses who was in Harry Enfield’s programmes and went around all the time saying, “You don’t want to do that.” It is a matter of record that I have described the Health and Social Care Bill as a huge strategic mistake and that I have from the start publicly and privately—but, I hope, politely—tried to discourage the Government from progressing with it. Even thought it is Ash Wednesday today, I do not intend to repent of my ways, although I do agree with the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) that the onus is now on critics to come up with a viable alternative to what the Government propose to implement.
Regardless of the merits of the Bill, the politics of it have turned into an absolute nightmare, to the extent that there are now two clearly defined schools of thought in Parliament. There are two opposed camps: those who think that the Bill is very problematic and that we should drop it, and those who think that it is a problematic but that we are stuck with it. All that is despite the good intentions of Ministers, the constructive amendments of both Houses and the work of the NHS Future Forum. I essentially agree with Tim Montgomerie, who publicly acknowledged what some Cabinet Members privately acknowledge: it is toxifying for the Tories and detrimental to the Liberal Democrats, which is sad.
Over the past 20 months, I have tried—possibly ineptly—to get that message across. I even e-mailed the Prime Minister’s advisor on strategy, Andrew Cooper, a man for whom I have appreciable respect. On 14 April last year I wrote to him saying that over the previous 10 months I had
“watched the coalition in terms of health policy cheerfully prepare to be driven over the cliff by the”
Department of Health. On 4 May of the same year I told him that the Government risked ending up in a no-win situation, and on 6 September that the Bill was unnecessary and would create uncertainty, divide the coalition, lower morale and harm Government ratings—which it has. There are no happy endings, I said.
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