NHS Risk Register - 22 February 2012
I get no satisfaction from being proved right. After all, nobody welcomes a know-all. However, nobody likes gigantic Government schemes that do not come off—especially not, as the right hon. Member for Wentworth and Dearne (John Healey) said, in the Department of Health. That is why it would have helped so much to have had a gateway review of Connecting for Health, the Government IT project. That was not published by the Blair Government, and blew £12 billion of taxpayers’ money. A review was demanded by my hon. Friend the Member for South Norfolk (Mr Bacon), but Blair decided to press on bravely through the signals of danger, aided and abetted by a report from McKinsey. I was relieved to find out that the Government do not rely on advisers to the extent mooted in the press, at any rate, because their advice has not always been solid or sensible.
Would not we all have really liked, however, to see a gateway review of Connecting for Health, and would it not have saved the country an appreciable amount of money? Why did we have to wait nine years—and spend £12 billion—before the NHS essentially settled on the position mapped out by my hon. Friend the Member for South Norfolk in a paper in 2006? Should we not have seen the review? Perhaps Labour should adopt an “I’ll show you mine if you show me yours” policy as the best way forward, for in truth there are not many good arguments against transparency in the case of this NHS risk register—and I have heard some pretty bad arguments, both today and in recent days.
One particularly poor argument has been that Members should not support this call because that would endorse the Labour party’s position. I think that is called political tribalism, which is not attractive and which poisons this place. It is always wiser to agree with people when they are right and to disagree with them if they are wrong, regardless of party. Another bad argument that has been made several times this afternoon is that the Labour Government did the same thing and refused to publish risk registers. That is a pretty weak argument in terms of its general logic. Just because the Labour Government fought an illegal war in Iraq, that would not justify the coalition’s fighting another war in a country of its choosing. Then there is the weak argument that publishing the register would create a precedent, but what is the precedent? Surely, it is that risk registers may be released when the Information Commissioner—a role that was set up by our legislation—so decrees when interpreting our legislation. It appears that most of the arguments that were presented quite cogently by the Secretary of State were attended to by the Information Commissioner at the time.
Some risk registers are voluntarily released, but it has been suggested, including in the other place, that the risk register might unduly alarm the unwitting public, who apparently cannot understand risk, or the difference between the unlikely and the probable. That rather patronising view is hard to square with the fact that risk registers are already published on many subjects, including on more alarming subjects than NHS reorganisation. I am talking not just about local risk registers such as that for NHS London. I have here the risk register on civil emergencies published by the Cabinet Office in 2012. It is not bland or anodyne, as has previously been suggested, and one can download it from the internet. It tells of the possibility of catastrophic terrorist incidents, major pandemics, volcanic eruptions, cyber attacks, floods, pestilence, and even the dangers of rabies and cosmic rays. I think it also gives the probability of all such events occurring. I cannot help thinking that if the public can already find out the chances of being blasted with cosmic rays, they can cope with knowing about the marginally disruptive effects of the abolition of strategic health authorities. I cannot help thinking that if the public have already grappled with the possibilities of being buried under volcanic ash or bitten by rabid dogs, they will not be too hysterical about the potential consequences of setting up health and wellbeing boards.
There is a virtue to transparency, which the Government accept. They have made substantial progress on this issue and it is unfortunate that this episode is going to blot the copybook. I am reminded of the futile attempts that were made by the previous Speaker to block the commissioner regarding our expenses. We risk a replay of that, and I urge all Members, before they troop into the Lobby tonight, to consider what they will say in 10 days’ time when the Government either win or, more probably, lose their appeal.
Mr Deputy Speaker (Mr Lindsay Hoyle): Order. A lot of Members still want to speak and time pressure is on. I shall have to reduce the limit to five minutes, and people will have to restrain themselves from making interventions. Those who continue to intervene must recognise that they might end up being dropped down the list accordingly.
Diana Johnson (Kingston upon Hull North) (Lab): I want to start by praising the tenacity of my right hon. Friend the Member for Wentworth and Dearne (John Healey) in pursuing this issue, which is another unfortunate aspect of the Health and Social Care Bill. From its start until today, this botched Bill has been an unmitigated disaster. The Secretary of State has said many times, “No decision about me without me,” but when we listen to the arguments being put forward by Government Members we see that that is not what is happening. They are saying that patients cannot be given information or told what is in the risk register. That is all very poor. Also, when Parliament has so little business to deal with on the Floor of the House we ought to have proper pre-legislative scrutiny of major Bills such as this one. There was no opportunity at the outset to look carefully at each clause, but that might have been a much better way of dealing with this and coming up with something that all Members of the House could get behind.
I am also concerned that the only voices to which the Government seem to be listening in this whole debate are the private health care providers. When we see that £8.3 million has gone into Tory coffers and £540,000 has gone into the Lib Dem coffers from private health care providers, we wonder why we are hurtling at such a breakneck speed towards a free-market NHS.
I agree with the Secretary of State when he said:
“Where the NHS embraces a culture of transparency, of learning from its mistakes and constantly striving for higher performance, it is a world-beater.”
I fail to understand the argument that he makes about why the risk register cannot be produced to allow Parliament to scrutinise properly the Bill that is before it. It is disappointing that we need to have this debate today.
I am struck by the tone that the Liberal Democrats are taking. I understand that 15 Members signed the early-day motion that mirrors the motion before the House, and I know the Liberal Democrats have always championed transparency and information being made available to the public, so I hope that those 15 Liberal Democrats will join the Opposition and vote for the motion. I know that at the general election in 2010 the Liberal Democrats were not arguing for a top-down reorganisation of the NHS. As I recall, what they wanted was elected representation on PCT boards. The person who stood against me in Hull argued that to save the NHS, the next Government must end the break-neck pace of NHS reforms. That was what he stood on in 2010, yet the party that he stood for is now arguing in the House of Commons for reforms of the NHS at break-neck speed. Just as we have seen with tuition fees, armed forces pay, VAT and police numbers, there is likely to be another Lib Dem betrayal on this subject as well.
I shall focus on my major concerns about what might be in the risk register. I am extremely concerned about poorly performing doctors and how that will be dealt with. I know that PCTs, especially my own PCT in Hull, were taking positive action to deal with such doctors, and I am worried that with the chaos that will be created by the new structure, we will not be able to tackle those GPs. I am also concerned about Haxby Group, which has GP practices in my constituency. We have heard from my right hon. Friend the Member for Leigh (Andy Burnham) about what was happening in York. At present the PCT can keep an eye on what is happening with Haxby in Hull, but as I understand it, in future there will be five different NHS regulators involved in controlling the position that Haxby takes on offering private health care to its patients.
I am concerned about medical education. Hull and York medical school is in my constituency. How will we get a planned approach to medical education for the future? How does fit with the NHS Bill? I am also concerned about social care. The acute trust in my constituency has the fourth highest number of bed-blockers. How will we deal with that under the new structure? Finally, on health inequalities, the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton), has said that northerners are “boozed-up smokers who are addicted to unprotected sex”. That is a paraphrase, but I am worried that the good work that the primary care trust has done through collaboration and co-operation on health inequalities will be lost because of the Bill.
Henry Smith (Crawley) (Con): I am grateful to have the opportunity to take part in the debate. As I have said in the House before, every right hon. and hon. Member feels passionately about the NHS. We have legitimate disagreements about the best way forward for the national health service, but we all know that it is something that each and every one of our constituents, almost without exception, and each and every member of our families, cares about. We have all relied on our health service at one time or another. It is therefore understandable that debates about the future direction of the NHS should arouse the sort of passion articulated earlier today.
It is important in the debate to reiterate what my right hon. Friend the Secretary of State said, which has been repeated by other hon. Members—that as a result of the Health and Social Care Bill, the national health service will remain free, regardless of the ability to pay, and universally available to all citizens of this country. When we discuss improvements to the health service, it is outcomes that we need to focus on.
I believe that the biggest risk to the NHS—which, as the shadow Secretary of State has said, is one of this country’s most respected institutions—is allowing it to continue with inertia and carry on as it has done in the past. At best that is a sentimental and quaint way of looking at the future of our health service. At worst it is dishonest and dangerous for the future health care of each and every one of our constituents.
Certainly, the experience in my constituency shows that the health service desperately needs change, and that without it we risk the quality of care. In 2001 maternity services were removed from Crawley hospital, and in 2005 we lost our accident and emergency department. The risks that have been experienced since those events have increased immeasurably, but since we have started to move towards the provisions of the Health and Social Care Bill we have seen considerable improvements. Waiting times have reduced for my constituents. Local GPs and clinicians very much support the provisions of the Bill and have already joined together in a GP commissioning consortium. The elected local authorities, which are a welcome addition to local health debates, are engaged, which is great for improving future health care provision and ensuring the involvement not only of patients and clinicians but of elected councillors. Only last week I was delighted to open a new digital mammography unit at Crawley hospital and a new day unit being expanded there, so already there are improvements.
In my concluding remarks I want to talk about the inconsistency we have heard from the Labour party on the release of the risk register. As we have heard, the right hon. Member for Leigh (Andy Burnham), the former Health Secretary, and his predecessor in that job, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), rejected making the risk register available on a total of three occasions. The argument that things are now different is just nonsense; the only thing that is different is that Labour are now in opposition. They are using precious time in this place to call for the release of a risk register that, as my hon. Friend the Member for Kingswood (Chris Skidmore) has said, is now over a year old and no longer relevant, because we have moved on with—
Madam Deputy Speaker (Dawn Primarolo): Order. I call Hugh Bayley.
Hugh Bayley (York Central) (Lab): I believe that the Government should publish the risk register relating to the Health and Social Care Bill, and I wrote to the Secretary of State last year to urge him to do so. I received a reply from a junior Minister in the Lords that gave the arguments that were advanced to the Information Commissioner about why it would be dangerous, including the suggestion that civil servants would pull their punches if their risk assessments were made public. The commissioner rejected those arguments, but even after he made his decision they were still being advanced by the Government, and we heard them advanced once again in the Chamber today.
The Government have got themselves into an utterly impossible position. Dozens of constituents have written to me, and I have been told by people with very high posts in the NHS, including senior clinicians, senior mangers and professors of health policy, that the Government ought to publish the register. Underneath this all is a growing belief that the only reason the Government can possibly have for not publishing the register is that it would be politically embarrassing for them to do so.[ Interruption. ] The Minister shakes his head, but the hon. Member for Southport (John Pugh) drew an interesting parallel. When the former
Speaker in the previous Parliament sought to overturn the Information Commissioner’s decision that the information on MPs’ expenses should be published, I tabled a motion stating that we should publish the figures for second-home allowances. This was before
The Daily Telegraph
exposed what it did, and, had the House published at that stage there would have been a public outcry, but there would not have been the loss of public trust in this House, which came when we were seen to be hiding the data and seeking to overturn a reasonable decision, made by the Information Commissioner, that it should be made public.
The Government have got themselves into precisely that position because if, after the tribunal, they are told that the information has to be published, the embarrassment that they know they will face, they will face, but they will face it against a background of public cynicism that would not have existed if they had published in the first place. If, however, they win their case and the information on the register is not published, the public will still believe that the Government have something to hide, so my advice to them is, “You’re in a hole, stop digging and publish.”
The Secretary of State said in his speech to the House that all the information that is relevant to the debate about the Bill is in the impact assessment so there is no need to publish the risk register. But if all that we—and the public—need to know about the Bill has already been published, the Government have nothing to lose by publishing the risk register.
If we look at the impact assessment, we see that from time to time the Government have redacted certain figures, so if one or two things, for some particular reason, had to be kept secret, they would still be able to publish 99.99% of the risk register, and they would satisfy this House and public opinion and build greater confidence.
There is public fear because there are inevitably risks to increasing competition in the provision of NHS services. Increasing competition is not in itself a bad thing. The Labour Government increased competition between acute London hospitals in coronary care and achieved better coronary care outcomes, but when we contract to private providers we inevitably create risk. I should not need to tell Government Members that risk is what private companies take, and that it is given as a justification for making profit and reward, but if risk applies to profit it can and does apply to the quality of patient care.
Several Government Members have said that they want to drive up the quality of patient care and to drive down the cost of care, but they will do so only if they publish comparable data on outcomes and cost for every supplier of service to the NHS. The Government need to commit to do that and to include it in the Bill; otherwise, members of the public will fear that the consequence of the reforms, forcing competition on the NHS, will mean that some care standards will fall, which is what happens when we have unregulated—
Madam Deputy Speaker (Dawn Primarolo): Order. I call Ben Gummer.
Ben Gummer (Ipswich) (Con): Your predecessor in the Chair, Madam Deputy Speaker, noted that this has been an intemperate debate, and so it has, reflecting a wider debate about the NHS that has become increasingly intemperate with every day that has passed. The reason is in large part the terrible myths, put about by the Opposition and their co-agitators in the health care unions, which we have heard again perpetuated in the leadership, and in the sponsor and proposer of the motion today.
As any demagogue will know, it is always difficult to present a travesty of the truth in a calm and reasonable voice, and that is precisely why the manner in which the Opposition have conducted this debate, and the entire debate about the NHS, belies the fact that they are interested not in a calm and reasonable debate, but merely in smearing the Government and in bringing into disrepute this long-needed reform of the NHS.
The inconsistency of the Opposition’s position is evident even in the motion, which asks for the Government to respect the decision of the Information Commissioner, yet that is based on an Act, the Freedom of Information Act, which the previous Government brought in, and on which I have to say the Conservative party was wrong. This is not just about the decision of the Information Commissioner; the Act describes a process that must be respected in its entirety. We are in the middle of a quasi-judicial tribunal, and it would have been right and respectful to the spirit of the Act if the Opposition had waited until the decision-making process was complete before making this point. Far from dragging it out, as the former shadow Health Secretary, the right hon. Member for Wentworth and Dearne (John Healey), claimed earlier, and as the current shadow Health Secretary says from a sedentary position, the Government have brought forward the tribunal date to expedite it. That is entirely consistent with the Government’s track record on transparency.
Yesterday, in the Justice Committee, we took evidence from Maurice Frankel, who is well known to Labour Members as a champion of freedom of information. He said that we as a Government are doing reasonably well, and that we are certainly ahead of Australia, Canada, the United States and Sweden. When the hon. Member for Kingston upon Hull East (Karl Turner), for whom I have great respect, asked how FOI in England and Wales compares with that in similar jurisdictions, Professor Hazell of the UCL constitution unit said that we compare very well and have a rather more generous regime than in Australia and Canada. We are now improving on that as a Government.
Karl Turner (Kingston upon Hull East) (Lab): Would the hon. Gentleman say that the question was put in relation to this particular issue? He is rather suggesting that it was, but it certainly was not.
Ben Gummer: The hon. Gentleman is entirely correct. I am trying to put in the round the position of this Government on freedom of information—that is, respecting the Act brought in by the previous Government in going through the necessary process, and in the meantime showing greater transparency in their dealings with the public than any previous Government. One need not look only at the transparency inherent in departmental
business plans and departmental spending above £5,000. The risk registers quoted by the shadow Secretary of State, which he revealed with a flourish as though he were some latter-day Carl Bernstein, came from the websites of local PCTs and were revealed as a result of transparency initiatives by this Government. In their motion and in their attack on the Government, the Opposition have shown inconsistency that reveals their true intent.
The shadow Secretary of State repeatedly called into question the Government’s motivation for not releasing the risk register. Their motivation is precisely the same as that which drove him to refuse to release a risk register in 2009. In turn, I question his motivation for calling this debate and picking a fight on this matter. It is not, as the motion might suggest, to inform the public debate, but to fuel the misinformation campaign that has been the basis of the Opposition’s attack on the NHS reforms; to take out of context statements from a document that, by its very nature, considers risks rather than benefits; and to use that in an effort to undermine a programme of reform that has the support of increasing numbers of health care professionals in my constituency to whom I have spoken, and is showing real results.
Jonathan Ashworth (Leicester South) (Lab): Will the hon. Gentleman give way?
Ben Gummer: I will not, if the hon. Gentleman does not mind.
That is not responsible opposition; it is dangerous opposition. The Leader of the Opposition goes around lecturing everyone about responsible capitalism, but he might like to start at home and have a look at responsible opposition. In undermining the ability of the machinery of government to operate correctly, the Opposition undermine not only this Government’s, but successive Governments’, ability to make decisions on our constituents’ behalf. Wiser colleagues of the shadow Secretary of State might rue the day that they wanted all risk analysis by Departments to be made public, thereby unbalancing our debates. That would have made impossible even the timorous reforms of Tony Blair in academies and in foundation trusts.
Let me inform the shadow Secretary of State of the effects that these health reforms are already having in my constituency. We have better care for the elderly that stops them going into hospital and allows them to be treated at home, and a drugs budget that is being kept under control for the very first time. He turned down a heart unit in my local hospital; we are now having it built at a cost of £5 million. The reforms will deliver real benefits to my constituents in Ipswich, and I wish that his constituents could have received them too.
Jim Shannon (Strangford) (DUP): As a Northern Ireland MP, I will give a Northern Irish perspective. The need for the publication of the risk register is clear in my mind and in the minds of my constituents. My constituents tell me that they have concerns over the reform of the NHS and how it will affect them. It is therefore important for the risk register to be made public.
When one inquires into what a risk register entails, one is pointed to the guidance in the NHS paper,
“Making it Happen: A Guide for Risk Managers on How to Populate a Risk Register”. A telling paragraph states:
“Managing risk effectively and embedding internal control into the processes by which objectives are pursued is extremely important for the NHS. The external driver in the form of a Statement on Internal Control, places a public disclosure obligation on individual boards of directors. That responsibility includes ensuring that the system of internal control is effective in managing risks. The production of a ‘live’ Risk Register is considered to be an integral element of good risk management practice by the Controls Assurance Team and NHS Litigation Authority and is a key feature of the Australian/New Zealand Risk Management Standard. It is hoped that this document will help NHS organisations progress this agenda.”
What has changed in that need to ensure that good risk management practice is carried out by the NHS for the benefit of the organisation? Why is this risk register not being published so that front-line NHS workers can understand the risks and give their input?
I want to give an ordinary perspective on this matter. One of the major hospitals in Northern Ireland, the Ulster hospital, is on the border of my constituency. Its catchment area includes some 200,000 potential patients. It is a fantastic hospital with friendly and helpful staff, from the porters up to the consultants. I have been in contact with a large number of its staff who have concerns over this matter. They are clamouring for openness and transparency. People from my constituency work in that hospital every day in their various roles. They want to ensure that they are part of any decision-making process, because they know that their experience and expertise should be considered in any debate. They are not being given such an opportunity at this time.
I and many Members on the Opposition Benches—and, I suspect, some Government Members—believe that there must be transparency so that people know whether the savings are worth the risk. Our health service is a priority. For many people it literally means the difference between life and death. It is essential that those on the front-line of the service are aware in advance of what the changes could bring so that they can prepare for them.
I have been contacted by the British Medical Association and many other bodies that have asked me to speak on their behalf and on the behalf of doctors, midwives and staff in the NHS. The letter from the BMA, which I am sure all Members have received, bears repeating:
“Health professionals are already seeing fairly chaotic and complex implementation of the reforms ‘on the ground’ which has already begun within the NHS. The challenges and potential risks identified with this process should be contained within the register. Furthermore, the staff currently trying to balance the implementation of the reforms with the drive to find £20 billion of efficiency would benefit greatly from the Government’s view of the risks associated with this difficult twin challenge.”
That must be put on the record in this House, as it has been by many Members today, to bring clarity on this matter. The opinions of those who are working on the ground must at least be considered, but they cannot give a full opinion without possessing the full facts.
I am not someone who believes that every aspect of public service should be disclosed. Defence matters clearly should not be disclosed, because it would put the lives of soldiers at risk. As a Northern Ireland MP, I know that from the time of the troubles up to the present day, there have been security matters that cannot
be disclosed and that should be kept secret. However, it is my opinion that the reverse could happen if we do not release the risk register. I believe that not releasing it could cause danger and harm. I therefore support the disclosure of the risk register.
The NHS, although far from perfect, is something that we can have pride in because of the dedication of those who work in our hospitals: the doctors who take on extra shifts to ensure that every patient has access to care, the nurses who stay for an extra 10 minutes or more to finish changing people’s dressings, the auxiliary workers who ensure that the elderly patients eat all of their dinner, the porters who transport patients slowly enough so that they are not hurt, and the cleaning staff who work later than necessary to ensure that the wards are clean. Those people are part of the NHS, have knowledge of the NHS and have an interest in the NHS. My constituents tell me that they want the publication of the NHS risk register. I urge Members to consider that very carefully. The publication of the risk register is a single issue. I ask Members to support it tonight.
5.24 pm
Mr Marcus Jones (Nuneaton) (Con): I rise as a Member who is completely and utterly committed to, and supportive of, our NHS, and completely committed to transparency and openness in government. In that vein, I applaud the Government’s recent moves to extend transparency in the Department of Health, with probably more information being provided than ever before. There is more information on IT projects and departmental spending, to name but two of the many examples of the progress that the Department is making. A similar exercise is going on across government, which I applaud.
Although it can be a ghastly system to administer, I also fully support how the Independent Parliamentary Standards Authority expenses regime is made public. I probably will not get too many cheers for saying that, but I am completely and utterly committed to transparency.
However, we have to recognise that there are often situations in which all risk scenarios are discussed, including doomsday scenarios. We need to consider carefully whether to put all that information directly into the public domain, for fear of the panic and problems that it may cause. For example, if Members saw a copy of the Treasury’s risk register and the wrong information were put out, suggesting an increase in interest rates, growth problems, problems with the banking system and the austerity measures that may be needed in a doomsday scenario, that information would be in the public domain within seconds. It would probably mean the markets going into freefall, and we would all be rushing to the nearest cash machine to take our money out, if we had any left. No Government have released such information in the past, for obvious reasons. The doomsday scenarios that we have to consider are real risks, but they rarely occur.
There is no doubt that the risk register covering the Health and Social Care Bill will include certain such scenarios, and the Government’s approach is critical to developing policy not just on health care but across the piece. That was certainly the Labour party’s view when it was in government and when the shadow Secretary of
State was in charge at the Department of Health. Under his stewardship, a very similar request to see the risk register was refused, and section 36 of the Freedom of Information Act was cited as the reason.
[Interruption.]
Madam Deputy Speaker (Dawn Primarolo): Order. Let us not have shouting across the Chamber. We need to hear the Member who is speaking. If other Members disagree with what is being said, that is what the debate is for.
Mr Jones: The same practice was followed by the shadow Secretary of State’s predecessor as Health Secretary, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson).
Glyn Davies (Montgomeryshire) (Con): Does my hon. Friend agree that the Opposition know perfectly well that what they are asking for is unreasonable, and that the case that he is making is absolutely sound? They are seeking to discredit the Government rather than support the NHS, and they are taking a completely irresponsible position.
Mr Jones: I absolutely agree. The points that they are making today are just as confused and incoherent as the rest of their policies. They seem to just cut and paste their policy with some frequency to suit the bandwagon that they wish to jump on at a particular point.
Karl Turner: Will the hon. Gentleman give way?
Mr Jones: I will continue, if I may.
The motion is something of a red herring, in that it does nothing to meet my constituents’ concerns about the delivery of health care. When I speak to them, it is quite obvious that they want choice about where they are treated and access to high-quality health services that can be provided locally. They want less management and bureaucracy in the NHS and more money to go to the front line.
My constituents certainly do not want to go back to the PCT-type commissioning that we had under the previous Government, because Nuneaton was completely disadvantaged under that system. Nuneaton is one of the most disadvantaged areas of Warwickshire and has one of the worst health inequalities. Despite that, NHS Warwickshire did not support Nuneaton and health funding dissipated elsewhere in the county. The huge PFI scheme in Coventry drained the life out of the Warwickshire health economy and caused a threat to constant service reorganisation, which could have caused the loss of A and E and maternity, and other women and children’s services, in the George Eliot hospital in Nuneaton.
We need to battle and fight against the problems that we encountered under the PCT, but at least under the new system, the local GP commissioning consortia are helping. They want to work with the George Eliot hospital and are making efforts to support and maintain those services in Nuneaton.
Siobhain McDonagh (Mitcham and Morden) (Lab): I wish to share with the House a cautionary tale and to suggest that the publication of the risk register might be in the best interests of all hon. Members and all parties, because it will allow us to stand back and look at the consequences of the changes.
The London experience—certainly the south London experience—is that the changes will lead to a wholesale closure of general hospitals in urban settings because they confuse the roles of providers and commissioners of services. I am in a fortunate position. After 13 years of argument, one of the last acts of the previous Labour Government was to agree to spend £219 million on the rebuilding of St Helier hospital. Thankfully, the current Government agreed those plans—it was one of only three capital programmes of its size in the country.
St George’s hospital in Tooting, which is known to many, was to merge with St Helier to make St Helier large enough to become a foundation hospital. After those years of argument, the programme was going well until St George’s hospital looked at the GP commissioning plans in my area, which suggested that they would reduce services at St Helier hospital by £40 million over the next five years. St George’s, the only hospital interested in merging with St Helier, backed away immediately, because it knew it could not make the figures stack up.
We now have a £219 million capital programme for a hospital that, as it stands, is completely unviable. I should not be admitting that to the Government because they might think that they do not want to spend that money. I want them to spend it, but I want them to spend it on a viable hospital, because the demand and the need are there.
I can understand why GPs, who are private practitioners, want to provide more services. My argument is in favour of the consumer—the patient. Patients might not want to get up every morning to try and make a GP appointment and not get in that day. They might not want or be able to take a day out of their working lives or sustain the consequences of doing so to get a GP appointment. They might not want to wait a fortnight for a blood test, as I am doing. They might choose to go their local hospital for that service. I believe it is the right of NHS patients to make those choices, but they are the choices that we will deny to people if the Health and Social Care Bill is passed, because it imposes a 19th century health model on the 21st century. Our experience in London is that walk-in clinics provide for many, but not for everybody, better services than GPs.
We have heard about the relationship between the patient and the GP. In south-west London, people are grateful to see any doctor when they go to the GP service. That relationship does not exist. I appreciate that the experience of people in market towns outside London might be entirely different, but from a London perspective, the changes will have an enormous impact on patients, including the most disadvantaged patients who live in our capital city. As a consequence, enormous numbers of hospitals in suburban areas will face reductions and closure. MPs of all parties must consider whether that is what they want. It is beginning to happen. On a BBC regional programme recently, the medical director of NHS North West London said, quite openly, “Yes, we will see the closure of many hospitals.” Is that what we want? Are we prepared to support that? Is it in the best interests of our constituents? I do not believe so.
Jeremy Lefroy (Stafford) (Con): The subject of this debate is risk within the NHS, specifically that associated with the Health and Social Care Bill. I want to address
the matter with specific reference to Stafford hospital. My constituents, whether patients, relatives, loved-ones or NHS members of staff, have been through a great deal over the past few years. There is tremendous support for a quality acute hospital and the services that it provides in Stafford, including full-time emergency care, which it currently does not provide. The existence of that support is evidenced by a petition signed by 20,000 people. Those people need to know that the Bill will not hinder but support their ambition. I would like to show why it will support it.
The other great legislative influence on the future provision of NHS care in the coming years will be the report from the Robert Francis public inquiry into all the aspects of the troubles that surrounded the hospital. I am glad that the Secretary of State ordered that inquiry. He deserves credit for doing so. Indeed, his predecessor as Secretary of State, the right hon. Member for Leigh (Andy Burnham), also deserves credit for ordering the previous inquiry, which drew many valuable conclusions. Since those came to light, they have had a great impact on the Health and Social Care Bill. I will give three examples.
First, the Bill places a duty on the Care Quality Commission—the successor to the Healthcare Commission—and Monitor to work together closely. As Francis said, the absence of that duty was one reason for the troubles at Stafford and why the trust got the authorisation that it should not have got. Secondly, clause 2 places a duty on the Secretary of State to improve and promote quality throughout the NHS, which is vital. Thirdly, the Bill will strengthen local accountability for health services.
Francis will report soon—possibly while we are still considering the Bill—and as the right hon. Member for Exeter (Mr Bradshaw) said, we have to ensure that as many of those recommendations as possible are addressed in the Bill or very soon afterwards, perhaps in other legislation. A senior member of the Royal College of Physicians described the report to me as undoubtedly the most important review of the NHS in the past two decades, so it is vital that its recommendations are carried through.
In Stafford, we have seen at first hand the risks within the NHS. These risks, and their consequences, predate the Bill. The greatest risks that any health care system has to address are the safety of patients, the quality of care and the financial sustainability of services. The three are inextricably linked.
Mr Marcus Jones: Does my hon. Friend agree that part of the problem with Stafford hospital is the same as the problem at the George Eliot hospital in Nuneaton, Warwickshire? A PFI hospital built in close proximity has been a huge drain on the local health economy and has starved smaller district general hospitals of resources.
Jeremy Lefroy: I want to come to that point, although I should point out that people are grateful for the new hospitals built under PFI. I would not take anything away from that. It is the financial arrangements around them that have caused problems in some cases.
Much more work needs to be done on tackling the risk of harm to patients and ensuring patient safety. Local accountability, which the Bill strengthens, is
important. Clinical commissioning groups will not commission services for their patients if they do not have confidence in them, but they have a responsibility to work with those providers so that confidence can be restored—they should not just ditch them. Transparency in the reporting on and reaction to adverse and serious incidents is improving, but under the Bill, with the health and wellbeing boards, HealthWatch and the CCGs, there will be groups taking a direct interest in what is happening in their local area.
Since the troubles at Mid-Staffordshire, all parties have focused on quality of care. I welcome the improvements at Stafford. There is still much more to do, but the staff have done a tremendous job moving things forward. However, there is a serious problem nationally, as was highlighted by the recent CQC report commissioned by the Secretary of State. We would all agree that it is not acceptable that elderly and vulnerable people are left unattended when they need help in hospital. We still get such cases, even today. That is why the Health and Social Care Bill’s requirement for the Secretary of State to improve the quality of services is so welcome. Making that a requirement will not in itself solve the problem, but it will ensure that the Secretary of State has a legal duty to deal with problems in the quality of care.
Then there is the question of financial risk. In Stafford, we face the problem at first hand, with a £20 million deficit this year. I am grateful to the Government for supporting us in that, and for their support in so many other places. However, we face great challenges, along with many other small acute trusts across the country, and we would under any Government. Let me make it clear: acute district general hospitals are an essential part of the health economy of this country, wherever they are. For the sake of towns and smaller cities across the country, we must, as a Parliament, find a model for them that works. Clause 25 of the Bill enhances local involvement in the commissioning of services. That will help the process, but it will need to be a robust process. When the consultations that are envisaged take place, they must be real, and they will be real: CCGs live in the communities for which they will be commissioning and they should know more than anybody about what their patients need.
The final risk cannot be legislated for, and no risk register will ever deal with it. If compassion for patients is lacking—if they are seen as numbers, not as people; if the elderly and vulnerable are considered a burden and somehow less important than the young and fit—we will have failed, however well funded our services are, however strong and shiny our new hospitals are, and however complete our risk register is. However, I am confident that we will not fail.
[back] |
[top] |
[next] |