NHS Risk Register

Debate between Alan Johnson and Hugh Bayley

Wednesday 22nd February 2012 Commons Chamber

[Alan Johnson]

Thank you, Mr Deputy Speaker.

I believe I heard the Secretary of State say that he did not really want to talk about the risk register, and neither do I, but I think it is important to the Government’s basic problem and the threat to the national health service.

Three important and interlinked reforms can be summed up in five words: “better outcomes for lower costs”. Does the private sector have a role? Of course it does.

Let me say a word about the introduction of independent treatment centres, which seem to have been used by some in this debate to suggest that this Bill simply carries forward policies pursued by the Labour Government. ITCs were introduced to deal with the perennial problem in the NHS—long waiting lists. We should remember that in the late 1990s about one in 25 people on the cardiac waiting list died before they were operated on. Rudolf Klein, in his seminal history of the NHS, said that ever since it was created, there has been a tail of around 600,000 people on waiting lists. He said that the captain shouted his order from the bridge and the crew carried on regardless.

In 1995, after 16 years in power, the Government before the last one decided to reduce the guaranteed in-patient waiting time under the citizens charter from two years to 18 months. That was the best they could do after being so long in power. For us, it was an absolute priority. Let me say to Members of all parties that independent treatment centres transformed behaviour in the NHS. Suddenly, it became possible for surgeons to operate on Fridays and on Saturday mornings as hospitals reacted to the threat of competition.

[Hugh Bayley (York Central) (Lab)]

Does my right hon. Friend agree that performance in the NHS was transformed only because the NHS published clear data on the costs and outcomes of procedures in independent treatment centres, compared with those in other NHS hospitals? If the present Government do not publish comparable information from all providers, including private providers, we will get chaos, confusion, declining standards of care and rising costs.

[Alan Johnson]

My hon. Friend makes an important point.

As Health Secretary, I cancelled ITC contracts where there was sufficient NHS capacity, and I approved them where there was not. I recall a visit to the Derwent centre in Bournemouth, where the NHS had taken over a hospital from BUPA and was doing knee and hip replacements more quickly than the private sector. That transformed elective surgery, but although competition is good for elective surgery it is far less important than collaboration in managing chronic disease. I agree with the NHS Future Forum, which said in a report last year:

“The place of competition should be as a tool for supporting choice, promoting integration and improving quality. It should never be… an end in itself.”

The NHS is not a collection of separate and autonomous units of varying degrees of independence, responding to the invisible hand of the market. It is, above all, an integrated health care system. The fear of the vast majority of clinicians is that the Bill will damage that crucial principle.