NHS Risk Register - 22 February 2012

The vote does not matter, but I would not like to be a Government Back Bencher having to go back and explain the matter to my constituents. I certainly would not like to be one of the Lib-Dem Members having to do so, because whatever the arguments and posturing here in the Chamber today, they will not cut any ice with a public who know that the facts are being withheld and feel they are being conned over a measure that they were promised would never be introduced by this Secretary of State.

I do not say this with any malice, but I think that it is too late to restore the Secretary of State’s reputation. Even at this late stage he could agree to release the information, but more importantly he should pause again and, this time, really listen to what people are saying about the NHS. He is probably not keen to take advice from me, but I have consulted my constituents in Selly Oak quite extensively on the Bill, and it is important that he knows that 76% of the people whom I consulted said that it is the wrong priority at the wrong time. Their concerns are about faster diagnosis and treatment and shorter waiting times.

The Secretary of State cited waiting times earlier in his speech, and he will know that the 18-week waiting time in south Birmingham is rising steadily. In fact, I think it has gone up—

Anna Soubry: You think?

Steve McCabe: Off the top of my head. I can check the figure, because the Secretary of State wants to be accurate, but I think it is 36%—since he became Secretary of State. It is going up, and he must know that, because he was quite happy to cite other figures earlier.

The money should be spent on reducing waiting times; it should not be withheld by the SHAs to cover the cost of the reorganisation. The Minister of State says that that is not happening, but his own operating framework shows perfectly well that that is exactly what the money is being withheld for. It is spelt out in black and white in his own documents, and that is what is wrong at the moment.

The public feel that waiting times are rising, they have difficulty accessing GPs and they are worried about the confusion surrounding the measure. As my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) said earlier, in some parts of the country it is already destabilising the NHS, but what we have today is the Government dismissing all those arguments while hiding behind a cloak, saying, “Everything’s going to be okay, but we’re not going to tell you the facts of the matter.” It is disgraceful, and the Secretary of State knows perfectly well that during the years that he spent in opposition he would never have tolerated such behaviour. His behaviour since taking office has been to undermine the NHS and to waste every bit of political capital that the Tory party accumulated during its years in opposition.

That is what is fundamentally wrong with the measure. It does not matter how many times people try to deal with the minutiae of the risk register; the reality is that the report is there and the information is there. There is only one person hiding it, and he is sitting opposite me on the Government Front Bench at the moment. That is what the public know. This is no longer an argument confined to what happens in this Chamber; it has gone way beyond that. It has got to the stage where the Secretary of State’s credibility is on the line, and I am afraid that it has been lost.

Mr Speaker: We are grateful to the hon. Gentleman. The winding-up speeches will begin at 6.38 pm.

Simon Hart (Carmarthen West and South Pembrokeshire) (Con): What an exasperating and frustrating afternoon it has been—for three reasons. First, for the past six hours we have been subjected to the absurd claim from Opposition Members that only they have a monopoly on good sense, compassion and organisational skills when it comes to the NHS. What a ridiculous claim to make. No party is able to make it—ours or theirs; this is a joint effort, and it demeans patients and NHS staff to claim otherwise.

The second frustrating thing about the debate is that I came here to hear about what we could do for patients, but all I have heard is what we can do about Labour party politics. That is no way for an Opposition day debate to be conducted. Those watching it will wonder why on earth we came to discuss that instead of the important reforms that the Bill contains.

Thirdly, and perhaps most importantly, I come here as someone who lives under a devolved Administration. If ever there was an example to demonstrate why reform of the NHS is required, it is Labour’s record as an Administration in Cardiff, where the health service falls solely under their jurisdiction. In Wales, there is an 8.4% reduction in health spending during the lifetime of this Parliament, amounting to £534 million; 27% of people wait more than six weeks for diagnostic services, compared with 1% in England; the number of patients waiting to start treatment has risen by 45% since the election; and the number of patients waiting longer than 36 weeks to start treatment has more than doubled in the past 12 months. That is what one gets with a Labour Administration in charge of the health service, and that is why these reforms are necessary. The debate should have been about those statistics rather than the spurious subject of the risk register that was put before us.

My hon. Friend the Member for Kingswood (Chris Skidmore) put his finger on the matter when he described the register as being out of date. There is nothing particularly new about risk registers. They occur across all Departments of Government, and similar things happen all over the private sector. They are tools of risk management, not tools of party political PR or political one-upmanship, or devices to prop up one leader or another in one political party or another.

There is a fine line between being open and transparent and being irresponsible. It would be irresponsible to put the morale of NHS workers at risk or to scare patients and their families. The Government are absolutely right to resist this proposal, and Members will be right to reject the motion.

Liz Kendall (Leicester West) (Lab): Today’s debate has shown that we have a Government who refuse to be open about the risks of their health Bill and arrogantly reject the widespread concerns of patients, the public, and NHS staff. Instead of providing the leadership that the NHS needs, Ministers have left staff struggling to cope with the effects of their damaging Bill.

Unlike the Government, the NHS is facing up to its responsibilities by publishing local risk registers to try to mitigate the effects of the Government’s plans. NHS North of England warns that the Government’s reorganisation has a high risk of compromising patient safety, as knowledge about how to deal with mistakes and adverse patient events is lost. NHS Midlands and East says that there is a high risk that waiting times will suffer, primary care will be neglected, and joint working with councils will be undermined. As my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) said, NHS London warns that there is a high risk that clinical commissioning groups will not have the skills they need, and that the NHS will fail to deliver either the best outcomes for patients or the best value for taxpayers’ money. NHS Milton Keynes warns that there is a high risk of failure to deliver its statutory requirements, leading to significant harm or fatalities of children and vulnerable adults. That point was raised by several of my hon. Friends, and particularly eloquently by my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell).

However, the Government are not concerned about the risks that the Bill poses to patients, only to their own political prospects. In the past few weeks, we have witnessed the unedifying spectacle of Conservative Ministers scrambling to distance themselves from the wreckage of their Bill and desperately pointing the finger of blame. An anonymous source in No. 10 told The Times that the Health Secretary

“should be taken out and shot.”

Anonymous Cabinet Ministers have told ConservativeHome that the Bill is as bad as the poll tax, that it must be dropped and that the Secretary of State must be replaced. The Financial Times has said that the Chancellor is worried that the Bill will retoxify the Conservative brand. Apparently, the Deputy Prime Minister is furious that the Tory in-fighting is ruining his attempts to get his party and MPs on board. The Secretary of State accuses the British Medical Association of being “politically poisoned” in opposing the Bill; I say that the source of the poison is all on his own side.

Mr Lansley: Just so that the record is clear, when I referred to the phrase “politically poisoned”, I was not saying it myself, but quoting Aneurin Bevan’s description of the BMA.

Liz Kendall: I notice that the Secretary of State does not deny that members of his own Cabinet and Conservative and Liberal Democrat Back Benchers are concerned about the Bill.

Instead of fighting among themselves, the Government should be relentlessly focused on ensuring that the NHS meets the challenges of the future. Our ageing population, the increase in long-term conditions, and the huge medical and technical advances mean that the NHS must continue to change to improve patient care and deliver better value for taxpayers’ money. As my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) said, that means shifting the focus of services into the community and more towards prevention, so that people stay fit and healthy for longer. It means centralising some health services in specialist centres so that patients benefit from medical advances and get the best standards of care. It also means ensuring that local NHS and council services work together so that older and disabled people can stay living independently in their own home.

The NHS needs service reform, not structural reform. The Bill will make the changes impossibly hard to achieve. The recent Health Committee report on social care states that the best examples of integrated services have been achieved by care trusts, which were set up under the Labour Government, and yet those are being swept away by the Bill. In 2009, NHS London centralised stroke services into eight hyper-acute units. That decision was very controversial at the time, but within six months it had more than tripled the number of patients getting vital clot-busting drugs to the highest rate of any large city in the world. The Bill will put strategic service changes such as that at risk.

Tony Baldry (Banbury) (Con): What about the risk register?

Liz Kendall: I have outlined what local NHS services have said about the risk register. If the hon. Gentleman had been in the debate earlier, he would have heard Government Members saying that we are not focusing on patient care or setting out how the NHS needs to change. The point that I am making is that the Bill will prevent the strategic changes that the NHS needs.

There is no evidence that smaller, GP-led commissioning groups can deliver major changes to hospital services. The organisations that have done so, such as NHS London, are being abolished. The real risk is that the full, free and unfettered market that will be introduced by part 3 of the Bill will stop the NHS from making the changes that patients desperately need. It risks preventing hospitals from working together to centralise stroke or trauma care; it risks preventing hospitals from running local community services or working with GPs and local councils to better integrate care, for fear that they will fall foul of UK and EU competition law; and it risks putting power into the hands not of patients and clinicians, but of lawyers and the courts.

Mr John Redwood (Wokingham) (Con): I am delighted by the conversion of the Opposition to more transparency now that they are out of office. Can they show the Government how to do it by publishing the internal documents that are critical of their leader’s strategy for change in the Labour party?

Liz Kendall: With the greatest respect to the right hon. Gentleman, I will not waste my time on that point when we have important issues about the future of the NHS to discuss.

Government Members should realise that GPs, nurses, midwives, health visitors, public health professionals, psychiatrists, physiotherapists, radiologists and Opposition Members are against the Bill not because we are against change, but because it will prevent the changes that the NHS needs.

Government Members do not want to talk about part 3 of the Bill, because they know that people do not want their NHS run like any other market. The Secretary of State and the Prime Minister claim that their Bill is all about cutting bureaucracy and putting patients and clinicians in control, yet the Department of Health now admits in its fascinating document, “Design of the NHS Commissioning Board”, that there will be five layers of management in the Government’s new NHS, except in the performance and operations directorate, in which

“an additional layer (or layers) will be required”.

In place of strategic health authorities and primary care trusts, we will now have the NHS Commissioning Board, four commissioning sectors, 50 local offices, commissioning support units, clinical senates and clinical commissioning groups, as well as Public Health England and the health and wellbeing boards. Patients and staff have been left completely confused about who is responsible for running different services and how they will be held to account.

The Government say that the new structure will cost £492 million a year.

Mr Lansley rose —

Liz Kendall: Let me continue to explain this point. I have given way to the Secretary of State already and I want to finish my point.

According to the Government’s own document, the cost of running commissioning support units and commissioning for Public Health England is not included in the costs that have been given. Indeed, it states:

“The costs of providing clinical advice to the wider system will be separately funded.”

That prompts the question, what are all those different organisations doing if they are not helping to improve clinical care? The Government are not cutting red tape, they are increasing it, and they are not liberating clinicians but suffocating them—not my words but those of the NHS Alliance and the National Association of Primary Care, which used to champion the Bill.

Perhaps the Secretary of State should listen to the advice of Dr Peter Bailey, a GP and former chair of a commissioning group in his own constituency. He recently told Pulse magazine that GPs have

“been duped…set up to fail…We stand baffled in the wreckage…put down the sledgehammer. Get rid of the Bill.”

The Secretary of State should listen to the good doctor’s advice. He should grant the freedom of information request submitted by my right hon. Friend the Member for Wentworth and Dearne (John Healey) and publish the risk register. He should listen to the 78 Opposition Members and 15 Liberal Democrat Members who have signed the early-day motion tabled by my admirable hon. Friend the Member for Easington (Grahame M. Morris) calling for the register to be published.

Even today, as this debate has taken place, the Information Commissioner has told the Evening Standard that he thinks the Government should publish the risk register while peers are still debating the Bill. He has said:

“Where proposals are particularly contentious and with far-reaching consequences, it’s better for more information to be available for a broader discussion about the pros and cons before everything’s decided. By enabling people to express their views on proposals, the final decision will be better informed and better understood.”

I say to Liberal Democrat Members that voting for the motion will show that they really support the early-day motion that they have already signed. It will show their constituents that on this issue, they mean what they say and are different from Conservative Members.

Parliament has a right to know the risks of the legislation that it is debating, and the public have a right to understand the true risks of the Government’s reckless NHS plans. I commend the motion to the House.

The Minister of State, Department of Health (Mr Simon Burns): We have had an interesting debate. The number of right hon. and hon. Members taking part has shown the interest in it. I congratulate Opposition Members who have made speeches—unfortunately, so many spoke that I cannot go through all their speeches—on sticking meticulously to the line in the parliamentary Labour party briefing. They repeated meticulously the mistakes and wrong information in it.

I have a degree of sympathy for the right hon. Member for Leigh (Andy Burnham), because very early in the debate his predecessor as Secretary of State for Health, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), seemed to hole his argument below the line when he came out with what was a rather surprising statement at the time, although having listened to the winding-up speech of the hon. Member for Leicester West (Liz Kendall) it does not seem that surprising. He said that the risk register was a second-order issue. Given that the debate is about the risk register, that struck me as rather odd.

I congratulate my hon. Friend the Member for Finchley and Golders Green (Mike Freer) on an excellent speech. As we listened to more Opposition speeches, his speech began to strike a strong chord that risk registers could be misinterpreted and become a charter for shroud-waving.

I congratulate my hon. Friend the Member for Kingswood (Chris Skidmore), who with great logic and clarity argued an overwhelming case, and I was delighted to hear yet again a speech from the hon. Member for Easington (Grahame M. Morris). A health debate without a contribution from him would be a severe loss. No doubt the news editor of the Morning Star will be fascinated with his comments. I also congratulate my hon. Friends the Members for Boston and Skegness (Mark Simmonds) and for Gillingham and Rainham (Rehman Chishti).

I am disappointed that the right hon. Member for Leigh has decided to politicise a topic that, at its core, is not really about health. The question of publishing risk registers has implications that will be felt across the Government. For the reasons I shall outline, risk registers have implications for the successful running of a parliamentary democracy.

The right hon. Gentleman knows that by heart already, but let me tell him again, in plain English, one last time. The reason why risk registers are not released is the same now as it was when he was in government: if their contents are taken out of context, they could be misleading for parliament and the public.

As many hon. Members have mentioned, the right hon. Gentleman cleared the line in a letter sent from the Department of Health on 1 October 2009, when refusing to publish a departmental risk register. He rightly said that there was a

“public interest in preserving the ability of officials to engage in discussions of policy options and risks without apprehension that suggested courses of action may be held up to public or media scrutiny before they have been fully developed.”

Releasing the risk register is directly contrary to the public interest he described. As he knows, risk registers outline any conceivable situation, however improbable, on the subject they are evaluating. Any risk at all, even the most minuscule or unlikely thing, is included. They help the Department to see the possible pitfalls and to ensure that they do not happen.

This case has implications not only for the Department and Whitehall, but across all levels of government. As hon. Members will know from the debate, risk registers are essential because they are records of frank discussions between Ministers and civil servants on policy formulation. If a precedent were set for those records to be made public, it follows that such discussions and conversations would be a lot less open and a lot more guarded. That would mean that policies might develop with a lot less candid thought and debate than they do now. That might have been the argument under the previous Government, but the reason prevails and the argument is the same today.

The right hon. Gentleman understood that argument when he was Secretary of State for Health. Similarly, the right hon. Member for Wentworth and Dearne (John Healey), who made an interesting speech, understands it. That is why, regardless of what he said in interventions today, during his time in the Treasury—

Kerry McCarthy (Bristol East) (Lab): Will the Minister give way?

Mr Burns: I will not give way. I am afraid I do not have time.

As a Treasury Minister, the right hon. Member for Wentworth and Dearne wrote to Mark Oaten, the then MP for Winchester, upholding the Chief Secretary to the Treasury’s refusal to disclose information about gateway reviews and the identity cards scheme.

Tony Blair—a name that is not often heard with joy on the Opposition Benches now—understood that too. In his memoirs, he calls himself a fool, a nincompoop and an imbecile for introducing the Freedom of Information Act, because, in his words, Governments need to be able to discuss issues

“with a reasonable level of confidentiality”.

He said:

“If you are trying to take a difficult decision and you’re weighing up the pros and cons, you have frank conversations…And if those conversations then are put out in a published form that afterwards are liable to be highlighted in particular ways, you are going to be very cautious. That’s why it’s not a sensible thing.”

Several hon. Members asked about the strategic health authorities that published their risk registers. I would like to clarify this point, because there seems to be considerable confusion about it, particularly among Opposition Members. The purpose of the Department of Health’s risk registers is to allow civil servants to advise Ministers properly about the potential risks of a policy. SHAs, on the other hand, are further removed from Ministers, and are more concerned with operational issues—not policy formulation—and the more day-to-day business of health care. They are not concerned with providing objective guidance to politicians. Their risk registers are routinely published every quarter, and are written with publication in mind. That is evidently not the case with Department of Health registers, which, to remain useful, must be confidential.

Risks are inherent in any programme of change, and we have been open about them, having published a vast amount of detailed information, including the original impact assessment, in January 2011, and the revised impact assessment last September. In addition, the Public Accounts Committee’s health landscape report was published in January 2011, and there has also been the annual NHS operating framework, and the oral and written evidence presented to the Health Select Committee and the PAC. The risks must be scrutinised, we have supported that scrutiny and the risks have been scrutinised. The Bill received 40 sittings and two stages in Committee, and as one hon. Member mentioned, there have been 100 divisions. Even the lead shadow spokesman said, on conclusion of the Committee stage, that the Bill had been thoroughly scrutinised. To claim otherwise is ludicrous.

Julie Hilling (Bolton West) (Lab): I wanted to ask the Secretary of State this question earlier because I was rather confused. The Information Commissioner has said that the risk register should be released. If the Government lose the appeal, will they publish it, given that it would be the right thing to do?

Mr Burns: I am grateful for this opportunity to clarify the situation. The hon. Lady is right that the Information Commissioner has taken a view, and under legislation my right hon. Friend the Secretary of State has the right to appeal to the tribunal. That appeal, which he lodged some time ago, will be heard on 5 and 6 March and a decision will be made according to a timetable set by the tribunal—we have no control over the timing.

Of all the topics that the Opposition could have chosen to debate for the past six hours, this is probably one of the most pointless. The tribunal for publishing the risk register sits in a fortnight’s time, as I have just told the hon. Lady, so why not wait for it to report back and use this opportunity to talk about something more useful? Since they have chosen to race down this particular dead-end, however, all I can say to them is this: wait until after the tribunal. There is nothing to add until then. We have explained which areas the risk register covers; we have subjected the Bill to unprecedented scrutiny and consultation; we have debated it for countless hours, and yet still the Opposition bleat that we have not been open. My advice to them is this: change the record. What they are doing is cynical, opportunistic and shallow. I urge my hon. Friends to vote against the motion.

Question put.

AYES

NOES