NHS Risk Register

Baroness Keeley Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

It was, and it was staggering—my hon. Friend will remember this—that all the difficulties associated with building the Norfolk and Norwich PFI were evident to the last Government and yet they carried on. They carried on signing up to PFI projects that were frankly unsustainable, including, for example, the project in Peterborough—which, sadly, we had to include in the support that we are offering to unsustainable PFIs—which was signed off although Monitor had written to the Department to say that it did not support the project. I do not know, but perhaps the shadow Secretary of State wants to say something about that.

From my point of view, that is why we need to reform the NHS. It is why we were in the position of undertaking the work as the risk register was being published, because we had to avoid all those risks, reform the NHS and move forward to put doctors and nurses in charge, give patients and the public more control, strengthen public health services and cut bureaucracy.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

rose—

[Charlie Elphicke]

rose—

--- Later in debate ---

[Barbara Keeley]

Will the Secretary of State give way?

[Mr Lansley]

In a moment.

The Health and Social Care Bill underpins those reforms. We need to safeguard the NHS for future generations. The Bill does simple things—many things, but simple things. It cuts out two tiers of bureaucracy. It empowers the NHS Commissioning Board, which we promised in our manifesto. It empowers clinical leaders in local commissioning groups, which we promised in our manifesto. It empowers patient choice and voice, which we and Labour promised in our manifestos, but which only we are doing and Labour is now against. The Bill supports foundation trusts, which Labour said it was in favour of, but which we are going to act on. It introduces local democratic accountability, which the Liberal Democrats promised in their manifesto. It creates new, strong duties to improve quality continuously, reduce health inequalities, promote research and, yes, integrate services around the needs of patients. No fragmentation, no failure to connect up; for the first time, integration as part of the responsibilities, including those of Monitor; no change to NHS values; no undermining of the NHS constitution; strengthening the NHS constitution; free at the point of use, based on need; no privatisation, no charging—

[Barbara Keeley]

rose—

[Mr Lansley]

I will give way shortly.

The only change in the legislation in relation to the private sector is that the Health and Social Care Bill outlaws discrimination in favour of the private sector, which is what happened under the Labour Government, when the private sector treatment centres got 11% more cash for operations and £250 million for operations that they never performed. Perhaps the hon. Lady will explain that.

[Barbara Keeley]

I thank the Secretary of State for giving way—eventually. I want to get back to the risk register, which is the topic of this debate. I understand that staff from McKinsey and Co. attended meetings of the extraordinary NHS management board, which was set up to implement the Health and Social Care Bill. Can the Secretary of State tell us what parts of the transition risk register McKinsey and Co. has been given access to?

[Mr Lansley]

I am not aware of McKinsey getting any access to it, and I have to tell the hon. Lady that since the general election, I can personally say that I have not met McKinsey, so if it is involved in any of this stuff, it is not involved in it with me.

[Barbara Keeley]

rose—

[Mr Lansley]

No, I am not giving way again.

I asked about expenditure by the Department of Health on contracts with McKinsey, because I read about it in the paper and I thought, “Well what’s this all about?” I was told, “Ah, well, £5.2 million was paid to McKinsey in May 2010,” because it related to work done before the election—work done for Labour.

--- Later in debate ---

[Grahame M. Morris]

rose—

[Barbara Keeley]

rose—

[Mr Lansley]

No, I am not giving way.

Before the election, in 2009-10 when the right hon. Member for Leigh was Secretary of State, more than £100 million a year was spent by the Department of Health on management consultants; now less than £10 million is being spent on them, so we will take no lessons from the right hon. Gentleman.

We are managing the risks to the NHS. We have delivered £7 billion of efficiency savings and recruited 4,000 extra doctors, and there are 896 more midwives in the NHS than there were at the last election. We have cut the number of managers, 900,000 more people have gained access to an NHS dentist, and nearly 11,000 patients have had access to cancer medicines through the cancer drugs fund, which they would not have had under Labour. As I have said, waiting times are down, mixed-sex accommodation is down, and hospital infections such as MRSA and C. difficile are at record lows.

That is the progress we are seeing in the NHS today, but instead of celebrating it, the right hon. Member for Leigh has brought us a pointless debate. He talks about risk registers, which he himself refused to release. The debate is pointless, as the issue will come before the tribunal on 5 and 6 March, which is the proper place to examine these issues. It is a waste of Labour’s parliamentary time in an opportunistic attempt to divert attention from its lack of any alternative to the reform processes that the coalition Government are putting forward for the NHS. It is a futile motion, a pointless debate on Labour’s part, while we are supporting the NHS with reform through a Bill that has had unprecedented scrutiny. It has been consulted on through the NHS Future Forum, and through other routes continuously with thousands of NHS staff across the country, and we have listened and responded to everything they said. We are taking the responsible route by taking the NHS away from Labour risks towards a stronger future. I urge the House to reject the Labour motion.

--- Later in debate ---

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I support the motion calling on the Government to publish the transition risk register because I think it is vital to ensure informed public and parliamentary debate on the Health and Social Care Bill. As other Members have experienced, 40 of my constituents have written to me about this issue in the last two days. They rightly worry that the Government’s reforms will damage the NHS. They want to see the risk register released to inform them and to let them make up their own minds about the issues. My constituents also believe that Members here and in the other place should have all the available facts and information when debating and voting on legislation.

The proposed top-down reorganisation of the NHS is unnecessary, costly and a threat to our current health and social care services. As we have to consider these costly and unnecessary proposals, we at least need to know the threats and concerns that exist, about which the risk register might inform us.

Risk registers—like other local registers we have heard about—are routinely published by the North West Strategic Health Authority and other regions to communicate risks about the transition to new NHS structures and to ensure that those risks are understood and managed. Let me point out some of the risks mentioned in a recent risk register report for the North West Strategic Health Authority. The transition might mean a loss of grip on current performance or that organisational and system instability during transition could adversely affect corporate performance. Furthermore, corporate and individual capacity and capability might be diminished by uncertainties arising from transition. Those are all rated as high risk.

I believe that we are already starting to see some of those issues arising in the north-west and nationally. The Health Select Committee recently dealt with some of those issues in its report on public expenditure. The Foundation Trust Network had told the Committee that

“in the short to medium term there is significant disruption in relationships as experienced people leave the NHS or are redeployed.”

It also said:

“With the financial pressures on commissioners, combined with the changes in personnel and disruption of historic relationships, there is growing evidence that commissioners are making unsophisticated attempts to reduce costs.”

Based on all the evidence we heard, the Select Committee concluded:

“The reorganisation process continues to complicate the push for efficiency gains…we heard that it more often creates disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings.”

I can provide a local example. Salford primary care trust was running an effective service of active case management for people with long-term conditions, but it ended that a few months ago. That is a counter-productive change—the sort of change being made by NHS bodies as they rush to meet the pressures of making savings and reorganisation. I know that ending that service was to the detriment of my constituents and other Salford people living with long-term conditions. I have raised the issue in debates with the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is in his place on the Front Bench.

The Bill brings competition into the NHS at a level that I believe is unhealthy and unwanted. What are the potential risks to patients of a massive increase in the use of private clinics, private surgery and other private treatments? Much is said about choice, but what about the risks? We know that tens of thousands of women with PIP breast implants are sick with anxiety; they understand the risks of using private surgeons who then refuse to follow their duty of care to their patients. These are women who fear that they might have industrial-grade silicon leaking into their bodies, giving them immune system problems. They are finding that their surgeons are either untraceable or do not want to know about their problems with the implants.

[Dr Sarah Wollaston (Totnes) (Con)]

Does the hon. Lady accept that GPs will not be commissioning private breast surgery?

[Barbara Keeley]

In fact, there is a link, or a crossover, with the NHS. I have received letters from women who have had breast cancer and whose breast augmentation has been carried out in the private sector. I think that the hon. Lady attended the Select Committee meeting at which the issue was discussed, so she should understand the risks.

Many private clinics that were keen enough to sell surgery now want to charge their past patients just for a scan to check an implant. Women who have undergone surgery in those clinics have told me that the videos and brochures selling the surgery made no mention of the risks, or even of the fact that implants last only up to 10 years and that they would have to repeat the surgery every 10 years of their lives in order to keep replacing them. That was never mentioned.

Some clinics have gone into administration. My right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) described what happens in such instances. The new owners—if there are new owners—tend not to want to know anything about the problems of past patients. Questions of capacity are involved. The largest private medical company undertaking implants dealt with some 14,000 of the 40,000 patients who were given PIP breast implants, and thus could be seen immediately to be liable for 14,000 removal and replacement operations. However, it now says that it has the capacity to deal with only 4,000 operations of this type per year. Having created a problem, that group of private clinics is now saying that it does not have the capacity to solve it. The Committee was worried about the capacity of the NHS to deal with it, but the capacity of the private clinics who sold all those operations is much smaller.

The problem of PIP implants is on a huge scale, and I still believe that far too little is being done to help the women who are sick with anxiety about their implants. As I have said, the private clinics and surgeons do not want to deal with the problems, cannot deal with them because they do not have the necessary capacity, or deal with them only if the patient pays again, often when she cannot afford to do so. As we have seen, the Secretary of State has no power to compel private clinics or private surgeons to meet what we say are the moral obligations and their duty of care to former patients.

We also, sadly, have a regulator for devices such as implants—the Medicines and Healthcare products Regulatory Agency—which seemed to be incapable of conveying to the 40,000 patients with PIP implants the message that the product was faulty and could be toxic, thus causing 21 months of delay before the patients even knew about the new risk to them. Much surgery, including much private surgery, involves various medical devices and implants, and that situation is not acceptable. Given that we have seen such regulatory failure in the case of one sort of implant, I want to know what risk is posed by private surgery involving other devices. It is possible that in future we will see further scandals involving replacement knees and hips.

We need to know what risks, at national level, are inherent in the proposals in the Health and Social Care Bill, particularly the competition proposals. We need to know that in the House, as the Bill progresses, and we need to know it more widely. I support the motion.