NHS Risk Register - 22 February 2012
Several hon. Members rose —
Madam Deputy Speaker (Dawn Primarolo): Order. There are still 17 speakers who wish to participate in this debate and we have under an hour to go. May I ask Members not necessarily to take the full five minutes if they can possibly avoid it? [ Interruption. ] You can all sit down while I am speaking. May I also ask those who have already spoken to observe a self-denying ordinance and not intervene? They have had their chance.
Catherine McKinnell (Newcastle upon Tyne North) (Lab): My inbox and postbag, like those of my colleagues, have been flooded with e-mails and letters calling for the publication of the risk register. Without it, MPs will be voting on changes to the NHS without knowing the full facts. I am overwhelmed, although not surprised, by the concerns of my constituents. I want to use today as an opportunity to express those concerns.
One key issue that I feel has not received enough attention to date is the level of risk posed to children by the proposed NHS reforms. Concerns about that have been expressed by more than 150 paediatricians, who have called on the Government to scrap the Health and Social Care Bill. First, they quite rightly question the Government’s assertion that this top-down reorganisation is even necessary. More importantly, however, they say:
“We believe that the bill will undermine choice, quality, safety, equity, and integration of care for children and their families.”
My colleagues have already described the shameful saga of the release of the risk register, so I will not go any further into that. However, we should be grateful for the interim insight given by NHS London’s assessment of the risks of reorganisation, which makes for grim reading. By virtue of the fact that the Government are refusing to publish the risk register, I can only be concerned about what the national picture must be. In addition to the risk of all patients receiving “sub-optimal care”, the London assessment refers to the risks to safeguarding children, the “dilution of expertise”, and
“weaknesses in information sharing systems and processes,”
“The consequences of this may be preventable harm to children”.
There is clearly a fundamental problem with the reforms when it comes to child protection. In order to safeguard children effectively from abuse and neglect, various agencies need to communicate and work together. However, the result of the NHS reforms will be to substitute co-operation for competition, to the detriment of good safeguarding and, ultimately, to the children whom it is supposed to protect. Each month we see a higher incidence of children being neglected by their parents and taken into care. In that context, and against the backdrop of significant cuts to children’s services, the Government should not be focusing their energies on unnecessary reorganisation that could increase risks to an already vulnerable group.
The Government’s policy is completely confused in this area. The Department for Education is aware of the need and expresses support for providing early help to vulnerable children and families. We should be focusing on training midwives to identify vulnerable families before a child is born, getting them the support they need if they are at risk. The NHS London risk report, however, has expressed grave concerns about the capacity of maternity services and the capability of the work force—as a direct result of the proposed reforms. Similarly, general practitioners—a first port of call for many families—have a key role to play in identifying and reporting risks of abuse. This is hampered where, as shown in the London risk report, the reforms will render their performance variable and, in some cases, poor.
In the words of the 154 paediatricians who wrote to The Lancetlast week, the safeguarding of children
“will become even more difficult when services are put out to competitive tender and organisations compete instead of co-operate. Children who are vulnerable, neglected or abused will inevitably slip through the net…The bill will be detrimental to the goal of integrating care for the most vulnerable children across health, education, social care and the criminal justice systems in order to deliver good outcomes”.
It defies belief that the Government are insisting on pursuing reforms that have been assessed as potentially and needlessly resulting in harm to children. How, faced with that, can the Government continue with this folly?
Even in the face of the public’s reaction to the Bill, we have seen more than 150,000 signatures on the “Drop the Bill” petition, while hundreds of my own constituents have contacted me on this issue. My constituents and others up and down the country highlight the Government’s lack of transparency and accountability on this matter. The Information Commissioner has said that there is a strong public interest in disclosure of the information. An important point is being made about the risk register, which reveals that the Government have abandoned principles of proper governance on this matter.
Time and again we have heard the Government promising openness and transparency in government and in the NHS—the Prime Minister, the Deputy Prime Minister, the Health Secretary and others have extolled those virtues—but as the refusal to publish the register shows, those statements are nothing but platitudes. How can the Government claim transparency when they kept key critics of the Bill out of their meeting on Monday? It is a joke. The Government must publish the risk register, allowing proper and informed debate. We owe it to the people of this country who treasure our NHS—and we owe it especially to our vulnerable children.
Steve Brine (Winchester) (Con): I have sat in my place for a long time, and I must say that I find today’s debate deeply troubling in many respects. It is troubling because I dread to think what some people watching our debate must think. It is troubling because, as many of my hon. Friends have said, we are once again not really discussing the principles of the Health and Social Care Bill or what it will mean on the ground in constituencies such as mine. It is troubling, above all, because this Opposition day debate—I note it has fallen rather flat yet again—is not about the NHS. As my hon. Friend the Member for Kingswood (Chris Skidmore) said, it is about politics and about the latest, almost embarrassing, bandwagon rolling out of what used to be new Labour. Today’s Opposition day debate was clearly a Trojan horse for other issues; Labour has been successful in that respect. As has already been said this afternoon—and I suspect that it will be said again—the last Labour Government never routinely released risk registers. I enjoyed the analysis of my hon. Friend the Member for Kingswood, who demolished Labour’s argument earlier.
I am a member of the Justice Select Committee and Members will be aware that this week we began an inquiry into the Freedom of Information Act. The key things I want to understand from that inquiry are whether the shadow Health Secretary was right to refuse freedom of information requests during his time, and what some of the key people involved in the political birth of this Act think of it now. As luck would have it, I have some primary source material, so let us reflect on it.
There is a longer quote, but I will not spoil someone else’s thunder. I will cite what Tony Blair said in his autobiography:
“Freedom of Information. Three harmless words…I quake at the imbecility of it.”
Now, far be it for me to disagree with a former Prime Minister, but that is putting it a little strongly, in my opinion. I do not share his views, but they are, by any standards, astonishingly candid words. He went on:
“I used to say…to any civil servant who would listen: Where was Sir Humphrey when I needed him? We had legislated in the first throes of power. How could you, knowing what you know have allowed us to do such a thing so utterly undermining of sensible government?”
Well, Mr Blair should not have been so hard on himself. He built in safeguards to protect against the very undermining of sensible government—the sensible government that so concerns him now—and I believe that that is the issue we are discussing today.
Were the last Government, and the present coalition Government, right to refuse FOI risk register requests? Let me turn to the wise words of the former Cabinet Secretary Gus O’Donnell, who, when, speaking to the BBC earlier this month, said:
“The problem we face with the way FOI is working is it’s driving stuff underground or into non-FOI-able routes, as the jargon has it. You just don't know when you write something down whether that is eventually going to be decided by a tribunal of people who may have never worked in government whether or not that should be released.”
When asked if he could provide an example of the way in which the Freedom of Information Act was preventing proper discussion between Ministers and civil servants, he cited—yes, you guessed it—the topical example of the calls being made for the publication of Government risk registers, and the dangers, as he saw them, that it would have for contingency planning in the case of a nuclear Iran, when the Government might consider options which, if made public, would undoubtedly provoke an overreaction on the part of the media and the public. It could be said that today’s call from the Opposition is deeply irresponsible.
Is the coalition arguing for secret government, or is this yet another example of the devil having the best tunes, and of our not allowing the facts to get in the way of the myth? The present Government are committed to transparency, and are publishing more information than has ever been published before to help patients to make the right choices about their care. That is at the heart of the Health and Social Care Bill. Governments of all political stripes have recognised that risk registers are specific policy tools that present risks in “worst-case scenario” terms. Releasing such documents would damage the ability of Ministers to receive accurate advice, it would mislead public debate, and be detrimental to the public interest.
Many Members have referred to myths surrounding the Bill, and I have no time to go into some of them now, but let me just say that the myth that annoys and upsets me most as a new Member is that perpetuated by Opposition Members that only they care about the national health service, that only they have ever used the national health service, and that Government Members have no idea about it. Let me, in the words of the Prime Minister, bust that myth. I care deeply about the national health service, and—in the words of the Deputy Prime Minister himself—if I thought for one minute that the Bill would damage the national health service or lead to its privatisation, I would not be supporting the Government, let alone the Bill.
Mr David Anderson (Blaydon) (Lab): I apologise for my earlier absence. I was speaking in a debate in Westminster Hall.
Today’s debate is not just about reform of the health service; it is about democracy, accountability and transparency. For long periods during the last Parliament, the Labour Government were challenged by Members then sitting on the Opposition Benches to initiate an inquiry into what had happened in Iraq. Those Members were right to challenge the Government over what they had done. Ultimately, after the troops had come home safe and sound, the inquiry took place, and we await the results. The Government were wrong to resist the calls for an inquiry at that time, and we should have got it right.
Similarly, as was pointed out earlier, the expenses debacle showed that Parliament as a whole had got it wrong in trying to hide information from the public. The public did not forgive us for that. One of the main reasons Members such as me are sitting on the Opposition Benches today and not over there is the fact that the public did not trust us because of the way in which we had mishandled that debate—and out of that debate came the position of the coalition in regard to transparency.
On 21 May, the Prime Minister said:
“Greater transparency across Government is at the heart of our shared commitment to enable the public to hold politicians and public bodies to account.”
“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.”
In December last year, the Deputy Prime Minister said:
“The third characteristic of an open society is the sharing of knowledge and information. In a closed society the elite think that, for the masses, ignorance is bliss. But in an open society there is no monopoly of wisdom. So transparency is vital.”
Why, then, are we having this debate? if transparency is so vital, why is the risk register not being published? The Government parties are aware of the strength of feeling in the country. The findings of a YouGov poll, published two days ago, showed that 68% of people in the country wanted the register to be released; that 80% of Liberal Democrat voters—that will be only a small sample, of course, because the Liberal Democrats do not have many supporters—wanted it to be released; and that 62% of Conservative voters wanted it to be released.
So what is this about? The hon. Member for Southport (John Pugh), who is sadly not in the Chamber now—although he has been present for most of the debate, unlike his colleagues—got it right when he said that, according to the
Liverpool Daily Post
last week,
“If the Conservatives had gone to the country at the last election and said ‘we want a market-based health system’ they would have lost the election badly.”
That is the truth. This is a smokescreen: it is about detoxifying the Tory brand on the NHS. To give credit where it is due, the public relations master, the Prime Minister, got it absolutely right: he sold the people of this country the PR view that everything would be okay, and said that the NHS would be safe in his hands. He sold the people of this country a pup. It was a PR stunt backed by the coalition partners, who must wake up and realise that they have a responsibility in the House to put that right. There is absolutely no mandate for this piece of work. They told the people of this country that there would be no top-down reorganisation, but that is what is going on.
The coalition partners told the people of this country that the previous Government had failed on the NHS, despite the fact that 1 million people are treated every 36 hours; despite the fact that people across the country are living much, much longer than they were 20 to 25 years ago; despite the fact that satisfaction was at an all-time high; and despite the fact that we had persuaded the people of this country that it was worth saving the health service and putting in three times the amount of money that was paid into it previously. The myth that productivity did not go up under the previous Government was blown away by reports in recent weeks, so at every level, the Government have been proved wrong.
What do the Government do when they are challenged? They begin to blame the trade unions. I want to tell the House something about the trade unions. By and large, the vast majority of people in them are front-line health-service staff, including full-time officials in the unions which I am proud to belong to: in Unison, the deputy general secretary is a theatre orderly. The head of the health section was a nurse for many years; the head of nursing was always a nurse. In the Royal College of Nursing, people have to be nurses to get a job. The important people, who make trade union policy, are hands-on people who, day in, day out, and night in, night out, go into hospitals and other places where care is delivered, so they know exactly when we get it wrong.
The Government got it wrong on something else. From 1992 onwards, the unions advised the last but one Government and my Government that they had got it wrong on the private finance initiative. Last year, it was proved by a national audit that PFI had been a disaster. If the then Government had listened to the unions in 1992, we would not be here, but the option now for the people in the bunker is not to discuss the matter with the trade unions. That is a disgrace, and we should all support the motion today.
John Glen (Salisbury) (Con): I welcome the opportunity to participate in this debate. I want to begin by echoing the views of many Members and put on record my affection and respect for the NHS and everyone who works in it. Contrary to the way in which the debate has been framed, it is not an honest attempt to examine the Government’s intentions for the future of the NHS. It is an opportunistic attempt to use the word “risk” in the context of health to mount a scare campaign. Releasing the risk register is not the key to improving the quality of debate on the Bill. A risk register is routine in all Government Departments, and it allows civil servants to assess measures fully and without fear, and to set out properly, with full candour, their observations when Ministers discuss policy intentions and they give advice.
I want Ministers to receive quality advice. I do not want decisions to be based on advice that is not candid or full, but that will be the consequence of this politically motivated debate if the motion is carried. Is that really the precedent that we wish to set? It would be helpful if many more of us acknowledged that we are not experts on the intricacies of the internal workings of the NHS. If we were deluged with masses of technical comments and hypothetical situations, that would not inform the House or the general public. It would probably alarm the most vulnerable and lead to a complete loss of confidence in the NHS.
The real issue with which the whole House should be concerned is what this legislation is really about: putting this country’s beloved NHS on a sustainable footing for the future. As I said at the outset, I believe in the NHS and I love the NHS, but it is totally wrong to say that money alone is the answer. Politicians need to level with the British public. We are putting more money into the NHS—we ring-fenced the budget, contrary to Labour’s approach—but competition is not a disease. Even in the NHS, it is a legitimate way to drive up standards. The Bill means that providers compete on quality, not on price. The Bill provides a framework for competition to drive up quality according to need, regardless of the ability to pay. Some 75% of clinical commissioning groups attest that they are willing to continue to work constructively on this legislation.
It must be recognised that spending on the NHS accounts for £1 of every £7 spent by the Government—we are spending £100,000 million each year—so the idea that we can reliably and consistently reduce bureaucracy without legislation is unrealistic. By establishing clinical commissioning groups, we will save £4.5 billion by the end of this Parliament. It takes courage on the part of this Secretary of State and his Ministers to face up to this vicious campaign of vilification, misrepresentation and smear. The biggest risk faced by the NHS today lies in not facing up to the challenge of getting more resources to the front line as more people expect and need more from the NHS for much longer. That is the real risk, not the publication of a technical document to which few inside or outside this House could do justice.
Seema Malhotra (Feltham and Heston) (Lab/Co-op): Many right hon. and hon. Members have talked about the importance of the NHS and the need to safeguard its future. I am proud of Labour’s record on the NHS, from its creation in 1948 to what happened under the previous Labour Government, when 119 hospitals were built, hospital waiting times were at a record low and satisfaction with the NHS was at a record high.
In the past few days I have received nearly 50 letters from residents in my constituency asking me to vote for the release of the NHS risk register; that is more letters than for any other campaign in my two months as a Member. This is obviously a matter of great importance to my constituents and to the wider public. They believe, as I do, that transparency about the proposed NHS changes is an issue of national importance.
I wish to share with the House some comments from the many letters that I have received. Nick from Hanworth says that he is
“worried that MPs will be voting on the changes to the NHS without knowing the full facts.”
“It is vital that MPs have the full facts about the risks to the health service before they have to vote”.
“as the NHS is such a significant part of our lives, we the public have a right to know what the government is planning and why it is being so secretive.”
My constituents have also written passionately about the NHS, and what it does for them and their families. Alfred writes that
“getting the NHS was one of the greatest things that happened for health in this country...our NHS is the envy of many nations.”
Last night I replied to each constituent telling them that I share their concerns and those of health professionals, staff and patients, and will be voting for the release of the risk register. Under this Government we have already seen 3,500 nursing jobs cut across the country. That, and other measures, have brought about a decline in the performance in the NHS. Since the previous election, 9% more patients are waiting longer than 18 weeks for their treatment, and accident and emergency waiting time figures published last week show that the NHS missed the target of seeing 95% of patients within four hours for the seventh week in a row.
It is interesting that the first question that I asked in Parliament, on 10 January, was on the impact on waiting times of the NHS reorganisation. The Minister replied that I had raised an extremely important point, but he did not answer my question. Taxpayers who fund the NHS deserve detailed answers about what would happen to the health service if the Government’s proposals were implemented. Good change management has always involved the sharing of risks, so that they can be better understood and mitigated. Surely, when the issue at stake is the future of a national institution that this country holds so dear, it is more important than ever that good change practices should be adhered to, and that the transition risk register should be open to scrutiny. The Health Secretary’s refusal to release the risk register prompts the question: what are he and the Government trying to hide?
My constituents deserve better than this. They deserve the shorter waiting lists that they were getting under Labour, not the longer ones that they are now experiencing. They deserve more front-line staff, not less. They also deserve openness and clarity from the Government, not the present situation in which the risks to their NHS are being kept secret.
Mel Stride (Central Devon) (Con): During my short time as a Member of the House, I have heard many speeches by Opposition Members. While I have often disagreed with what they said, I have found myself respecting them because their speeches have been based on conviction and, sometimes, on the lofty ideal of the pursuit of the truth. In today’s debate, however, I have heard little other than naked political opportunism. It is the kind of opportunism that we see when Labour continually suggests that we are in favour of the privatisation of the health service and, by extension, that we are willing to attack the notion of health care being free at the point of delivery and universally available, irrespective of the ability to pay. That is not only disingenuous; it is a cruel deception, particularly on the elderly and the vulnerable, many of whom live in my constituency, who get very frightened as a consequence.
I am afraid that I see exactly the same game at play in this debate. Opposition Members know that risk registers think the unthinkable. They know that the game plans worked out in them are worst-case scenarios, and that if the information were to be made public, it is likely that it would be misinterpreted. They know that that would probably lead to Ministers and officials not having candid and meaningful discussions about the matters at hand. They also know that we have published a comprehensive impact assessment that ran to 436 pages, and that it was updated as recently as last September. They know that it is conceivable that exposing certain risks to the public domain could make them more likely, rather than less likely, to happen. They also know that if they get what they want, it could set a precedent not only for the Department of Health but for all Departments and for all future Governments.
How do we know that the Opposition know all those things? It is because they, as the previous Government, did exactly the same things that we are attempting to do when they were faced with broadly the same situations. I know that the shadow Secretary of State will quibble with the words “strategic” and “transition”, but I listened carefully to the point made by my hon. Friend the Member for Meon Valley (George Hollingbery) that we might be talking about exactly the same strategic register. The reality is that Labour adopted that position then, but it is not prepared to do so now.
Opposition Members also know that our record on the health service has been good. We should be proud of that record. In contrast to the increasing health inequalities and the decreasing efficiency of health care that occurred under the previous Government, we have seen decreasing in-patient and out-patient waiting times and a 95% reduction in mixed-sex wards. We are the party, after all, that went into the election and honoured our commitment to increase expenditure on the health service in the years to come. We are the only party in this House that was prepared to do that.
In conclusion, I believe that it is unfortunate that we have had to commit so much parliamentary time in the Chamber to this issue. Surely the most important issue we face is not the risk register but getting the health service ready for the 21st century. On that point, I hope that the Government continue to show the courage to take the brickbats, the knocks and the game-playing that the Opposition throw at us, to stand up for the health service, to reform it and to ensure that it is there to deliver for millions of people in the years to come.
Roberta Blackman-Woods (City of Durham) (Lab): I, like my hon. Friend the Member for Easington (Grahame M. Morris), want to begin by paying tribute to the staff of the NHS. I regularly go out with the emergency services and they do a truly amazing job on our behalf in what are becoming much more difficult circumstances. I also want to pay tribute to 38 Degrees and other campaigning organisations, including the British Medical Association and the Royal College of Nursing, for what they have done to give the public more information about these reforms. I do not think that that absolves the Government of their responsibility to publish the risk register, but it is important to put on record the work that those groups have done.
I also want to pay tribute to Anne Hutton and her husband, Neil, two of my constituents who are leading the campaign against the Health and Social Care Bill in Durham. Their street stalls in Durham marketplace are becoming legendary, and I have joined them on a number of occasions. It is clear from the people who visit the stall that the more people know about the Bill, the less they like it. That is probably why the Government will not publish the register: people do not like the opening up of more of the NHS to the private sector, they are worried about fragmentation not only in commissioning but in delivery, and they want answers from the Government that they are clearly not giving.
The second issue that people raise is that they simply cannot understand why the Government are wasting money on a top-down reorganisation of the health service when we are living in such difficult economic times and the NHS is being starved of the resources it needs to meet need locally.
The third issue is that there is absolutely no mandate for either political party in the coalition to undertake such a reorganisation. Unlike those on the Government Front Bench, I have been out and about, talking to people about the reforms. That has included attending consultation events held by shadow GP consortia. The lack of information on the risk of moving to new commissioning arrangements has been a key feature of these discussions, however, as has been the likely negative impact on health outcomes of the fragmentation of services. People are getting increasingly angry that they are being asked to give an opinion on GP consortia and new commissioning arrangements without having access to information that will help them make an informed decision.
It will not have gone unnoticed by my constituents—many have written to me, just as many have written to other hon. Members—that Ministers on the Government Front Bench have today sought only to rubbish Labour’s excellent record on the NHS, rather than explaining why they will not publish the register. I am sorry that the hon. Member for Winchester (Steve Brine) is not in his place, because I wanted to take him to task. I think he insulted those of my constituents who have written to me by saying that they were simply jumping on a bandwagon. Many of them have real concerns about the Bill that should be addressed, rather than the people who write to MPs being rubbished.
I am pleased that the parties in government have raised the issue of Labour’s record, which I shall address in the short time remaining. We are proud of our record. We employed about 90,000 additional nurses and 40,000 extra doctors, and we built more than 100 additional hospitals. That is a good record. In my area we have a new hospital. In 2006, 94% of people were having their operations done in less than 13 weeks, but that waiting time is going up, with 90% now having them done in 18 weeks. Unfortunately, all that very necessary input into the NHS did not reduce health inequalities enough, but we did hit the target for the north-east of reducing health inequalities by 10%. I am really concerned that by not publishing the register we simply will not know how these reforms will exacerbate health inequalities.
Madam Deputy Speaker (Dawn Primarolo): Order.
Penny Mordaunt (Portsmouth North) (Con): I once found myself in the happy circumstance of being in conversation with the former BBC director-general, Greg Dyke, who expounded on the lengths he had to go to in order to change the culture at the Beeb. He told me that one had to have a vision and show leadership, and that one could not be afraid to challenge the status quo. He then described how he was idly playing with the top drawer of his finance director’s desk while waiting for him to return to a meeting—he reassured me that this was absent-minded fumbling rather than a covert management technique—when the drawer happened to slide open to reveal a notepad emblazoned with the legend “Things that could go wrong!” Mr Dyke told me that he was puzzled at how differently that man’s mind worked from his own, but he knew that his ambitions for the corporation were more likely to be successful because his colleague—by himself, unlikely to set the world on fire—was thinking through the possibilities and consequences of his plans.
Vision, leadership and a preparedness to change are vital to improving the NHS, but reform plans must be subject to scrutiny and revision. This Government have welcomed debate on NHS reform because our motivation is to improve health care. We have not embarked upon this reform for its own sake. What a shame that some do not wish to debate, but rather to carp and criticise without offering anything constructive. It is a matter of regret that this debate is about the risk register. That decision should be in the hands of the tribunal. The commissioner has made a judgment and the Government have appealed, as anyone in their position would be entitled to do. I understand that the decision is being fast-tracked at the Government’s request. Good. That is the process, and I will be content with the outcome.
Apparently the Opposition support the Information Commissioner’s decision, so one assumes that they also support the process, which prompts one to ask why they have alighted on this subject for today’s debate. Why not instead set out a motion describing how they might improve the NHS? In choosing this motion the Opposition have ignored the long-term care of the elderly, the shocking amount of unmet need, the growing challenge of dementia and related conditions, opportunities to invest more in medical research and the clinical disengagement felt by many health care professionals. They have also ignored the Grey Pride campaign and the terrible divergence from National Institute for Health and Clinical Excellence guidelines by NHS trusts that means that Members of this House, health care professionals and councillors have to write hundreds of letters of appeal in order to secure for patients the treatment “guaranteed” under the NHS constitution.
Do the Opposition have a vision to tackle those problems? No. For all they have said today, there has been no alternative vision and no constructive criticism—just a lot of opportunism, scaremongering and misinformation. What makes matters worse is that through all that bluster, the shadow health team know that less than two years ago the Government they supported were trying and failing to accomplish many of the things that the Health and Social Care Bill will bring about. During the Labour Administration I was a director of Diabetes UK—the largest patient organisation in Europe—and I worked with the Department of Health and people such as Professor Paul Corrigan, who was then based in Downing street. That is why I find the political opportunism on show today so nauseating. I hope it is in order, Madam Deputy Speaker, for me to suggest that the shadow health team have today invented and taken a new kind of “Hippocratic” oath.
However, for better or worse, we are still debating the risk register, so I will play ball and reluctantly turn away from issues that will actually impact on patients and health care workers across the nation and address myself to Labour’s lack of thought for the day. The risk register is an internal Department of Health document, the purpose of which is to enable Ministers robustly to test their ideas. Challenging and testing a Government’s ideas is part of the role of the civil service and, for obvious reasons, civil servants value the licence to be forthright that confidentiality bestows. One might have thought the Opposition could see the value of that approach, having had so many shocking ideas themselves, but perhaps it is because the Labour party no longer has any ideas that it is now so relaxed about the erosion of good civil service practices.
The risk register is a red herring. Its publication will add nothing to the scrutiny process, and could be detrimental to the good governance of this country. Today’s debate might have availed us nothing so far as the improvement of the NHS is concerned, but we are now at least far better informed about the Opposition’s agenda—not that it took us six hours to learn that the Labour party has nothing to say. A casual glance at the motion tabled by the Opposition for today would have told us that.
Alex Cunningham (Stockton North) (Lab): We have heard much hollow praise for the health service from those on the Government Benches. They say wonderful things about it, then they kick it in the teeth. The NHS is one of the best health care systems in the world, full of dedicated professionals. I am very proud of what Labour did when we were in government. We invested in health and we resuscitated the dying NHS that previous Tory Governments had left starved of resources and unable to meet people’s needs.
When I predict decline, I do not think I have got it wrong, but if the Government want to correct me on that they could publish the risk register so that the medical profession, patients and the House can know the true extent of the potential damage that their Bill will do to our national health service. Perhaps the risk register says the Bill is a great idea. I do not know. Perhaps the Government could share it with us.
Yes, something can be done to build on Labour’s legacy, but we do not need several billion pounds to change something that most people believe is an excellent service already. In November last year the Commonwealth Fund, an international foundation that supports independent research on health care issues, ranked the NHS as the best performer on a range of measures looking at how health systems deal with people with chronic and serious illness. It found that of the 11 high income countries surveyed, Britain was among those with the fastest access to GPs and the best co-ordinated care, and suffered from among the fewest medical errors.
UK patients reported more positive health care experiences than sick adults in the other countries—they were more likely to be able to get a same-day or next-day appointment when sick and to have easy access to after-hours care. They were less likely to experience poorly co-ordinated care. All that was in spite of the fact that per capita health spend in the UK is the third lowest of the 11, at just under £2,000 per head, almost two and a half times less than in the USA.
In the light of these fantastic achievements, it is all the more baffling why the Tory-led Government are so intent on causing such havoc in our wonderful national institution and undoing all the hard work that has gone into making our health care first class. Is it not sad that they are not prepared to reveal the details of their own risk study? Again, I ask what they are afraid of. We are the envy of the world when it comes to health care, most notably leading the field in ease of access, co-ordinated care and good patient-doctor relationships. Although we must not rest on our laurels, our first priority must be to preserve and build on the strengths of general practice by producing more GPs so that even more can be done to improve the health of their patients. The excellent work done by GPs is what makes the NHS safe, fair and value for money.
Instead of looking to us for inspiration, however, the world is now looking on in astonishment that the Tory-led Government are willing to dismantle such an innovative, effective and well loved system. Patients in my constituency, Stockton North, are already feeling the pain from the Tories’ reckless policies. The number of admitted patients who have waited longer than 18 weeks for an operation rose by a staggering 49% between May 2010 and November 2011. James Cook hospital in nearby Middlesbrough serves many of them, and they tell me of mastectomies being cancelled. One patient had an operation cancelled four times owing to a lack of beds. Three patients were left on trolleys, again owing to lack of beds, and another constituent told of an out-patients department closed all afternoon because of a lack of staff. Sadly, I understand that their experiences are mirrored elsewhere in the country.
There are almost 500 fewer nurses in the north-east England strategic health authority area since the Tories came to power—500 fewer nurses who are not treating the sick, the elderly and the vulnerable at a time when health inequalities in the north-east are already unacceptably high. The gap was narrowed under Labour. Now we are seeing it widen again. In total, more than £3.5 million will be spent reorganising the NHS—an astonishing amount to spend when the economy is in such dire straits. That is all the more reason why the risk register should be published, so that we get the truth of these disastrous effects.
Priti Patel (Witham) (Con): Having listened to the majority of this afternoon’s debate, I wish to start by paying tribute to my right hon. Friend the Secretary of State and his team for putting the interests of patients over the vested interests that we have heard continually try to vilify him this afternoon and over the past few weeks.
Many of my constituents have been concerned about the irresponsible spin being peddled day in, day out by Opposition Members and opponents of the Health and Social Care Bill. Frankly, they have become frightened by the rumours, rhetoric and misinformation emanating from Opposition Front Benchers. One constituent forwarded to me an e-mail, circulated by an NHS trust, that had been authored by the shadow Secretary of State. It referred to “our battle to save the NHS” and called on NHS workers to support Labour’s campaign to drop the Bill and stop the “Americanisation” of the NHS. By sending out such a provocative e-mail, he is attempting to demean my constituents and insult their intelligence. The Opposition’s motion refers to informing parliamentary debate—[ Interruption. ]
Madam Deputy Speaker (Dawn Primarolo): Order. The hon. Member for Broxtowe (Anna Soubry) has been told about shouting across the Chamber by Mr Speaker. Will she please stop doing it?
Priti Patel: Those misleading comments from the shadow Secretary of State do nothing to add credibility to the wider debate or the Opposition position. Let us not forget that they went into the general election with a commitment to cut the NHS budget.
The need for this Bill is nowhere more evident than it is in Witham town in the heart of my constituency. Witham has a chronic lack of health care provision, which leaves my constituents with no choice but to travel to either Chelmsford or Colchester for the many treatments they need. That is why the local town council, including Labour and Conservative councillors, and local residents are campaigning for better local services. That is at the heart of the Health and Social Care Bill and will emanate from it—[ Interruption. ] Opposition Members laugh and sneer, but my constituents have been affected disproportionately by the way the previous Government maladministrated the NHS.
What is more, because of the efforts of local primary care trusts, bureaucracy and red tape has taken money from the front-line care that my constituents could have benefited from—[ Interruption. ] It has a lot to do with this, actually. Instead of investing in front-line health care, which is exactly what the Bill is about, the money is going to recruit bureaucrats and managers. They might be part of the wider back-room team, but I am concerned about front-line care for my constituents. My constituents might not be important to Opposition Members, but they really are important to me. This is exactly why the Bill needs to be passed. This layer of bureaucracy needs to be scrapped. There is no doubt about it.
I find it astonishing that this afternoon we have heard Labour Members preach about publishing the risk register. Let us not forget that when they ran the NHS they embarked on widespread, top-down reform on a nearly annual basis, yet they never furnished this House, Parliament or the public with confidential risk registers, analysis or data produced by Ministers and officials, so how genuine and sincere are they? If Labour Members were sincere about the NHS, they would stop their scaremongering and misinformation and recognise that the Bill is about patients’ interests and putting patients first, not their own personal vested interests.
Steve McCabe (Birmingham, Selly Oak) (Lab): It really does not matter what vote the Government Whips are able to secure tonight, because the truth is that the Government have lost the argument. The Secretary of State has squandered whatever political capital the Prime Minister was able to accumulate on the NHS and lost the trust and confidence of the public and professions with this Bill. There cannot be a single person in the country who does not understand that there is secret information, pertinent to the passage of the Bill, that he is determined to withhold from Parliament and the public. That is the position we are in.
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