NHS Risk Register

Andy Burnham Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House calls on the Government to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill in order to ensure that it informs public and parliamentary debate.

These are extraordinary times for the national health service and, indeed, for our democracy. A top-down reorganisation that nobody voted for, which was ruled out by the coalition agreement and which Parliament has yet to approve, is happening anyway. From the moment the White Paper was published 20 months ago, the NHS began to change in every constituency represented in the House. From that very moment, the Opposition consistently argued that the Prime Minister was making a catastrophic error of judgment in allowing that to happen.

[Charlie Elphicke (Dover) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

Not at the moment.

When the Government chose to combine the biggest ever financial challenge in the NHS with the biggest ever top-down reorganisation, they gave the NHS mission impossible. The £20 billion so-called Nicholson challenge was always going to be a mountain to climb—it is an all-consuming challenge on its own—but with this reorganisation the Government have effectively tied not one but two hands behind the NHS’s back and taken away the maps and safety equipment. The Health Secretary began to dismantle the existing structures of the national health service across England before he had permission from Parliament to put new ones in their place. The result has been a loss of grip and focus at local level in the NHS just when it was most needed.

[Several hon. Members]

rose—

[Andy Burnham]

Let me make this point, and I will give way in my own time.

People talk of confusion and drift, of a huge loss of experienced staff and established relationships and of an NHS in which no one knows who is making the decisions. That leads to concerns about the risks being run with our NHS—risks to patient safety, service standards and in relation to the efficiency challenge. The chief executive of the NHS confirmed that to the Public Accounts Committee when he said:

“I’ll not sit here and tell you that the risks have not gone up. They have.”

So, that is a fact. The Prime Minister who promised to protect the NHS has put it at risk. That much is clear, but what are the precise risks that the Health Secretary and the Prime Minister are taking with the NHS, and how serious are the risks? Does not the public have a right to know what they are? You would think so, would you not, Mr Speaker, given how much the NHS matters to people and how utterly so many people with long-term illnesses and disabilities depend on it.

[Graham Evans (Weaver Vale) (Con)]

When the right hon. Gentleman was Secretary of State he refused a freedom of information request to publish risk registers in September 2009. Why was that? Was he aware of the request, and why did he not publish?

[Andy Burnham]

I will come to that in a moment. If the hon. Gentleman is patient, I will answer his point directly.

Given the risks that are being taken, and given how much the NHS matters to people and how utterly they depend upon it, particularly those with long-term illnesses and disabilities, one would think they had a right to know about the risks that the Secretary of State is running with their health service. Well, one would be wrong. Instead, Members of this House and of another place have been asked to approve the most far-reaching reorganisation of this country’s best-loved institution by a Government who have not had the courtesy to give them the fullest possible assessment of its potential impact on the NHS.

[Brandon Lewis (Great Yarmouth) (Con)]

The right hon. Gentleman is clearly arguing for transparency on risk registers. Will he outline how many risk registers he used when he was the Secretary of State, and how many of them were published?

[Andy Burnham]

I did not launch the biggest ever reorganisation of the national health service, but I will come to the hon. Gentleman’s point in a moment, if he is patient.

The Government have not given the House the courtesy of their own assessment of the risks that they are running with the NHS before they ask us to approve the biggest ever reorganisation at a time of financial challenge. It is quite simply disgraceful.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

I thank my right hon. Friend for giving way and for his excellent opening remarks. He knows that every year 37,000 people die earlier in the north of England because of health inequalities. Does he agree that as a result of the Government concentrating on a top-down reorganisation and making primary care trusts put aside billions for this reorganisation, risks to health inequalities can only grow?

[Andy Burnham]

Those on the Government Front Bench are laughing. They will not be laughing when I have finished my speech.

More than 150 experts in child health wrote to a newspaper last week to say that health inequalities among children will widen as a result of the Bill. Are Ministers listening? No. It is disgraceful that they behave as they do.

[The Minister of State, Department of Health (Mr Simon Burns)]

Will the Secretary of State confirm—sorry, the shadow Secretary of State—that in clause 3 of the Health and Social Care Bill for the first time in the history of the NHS reductions in inequalities in health have been put on the face of a Bill as a duty to achieve?

[Andy Burnham]

I confirm to the Minister that I am the shadow of my former self, but it sounds as though he would like to have me back. Expert opinion says that health inequalities will widen. Is he listening to that opinion? That is the question he should answer today.

[Several hon. Members]

rose—

[Andy Burnham]

I will give way later.

We called this debate today to give the House a chance to vote for the openness and transparency that the Government once promised. More specifically, in opening the debate, I have three clear purposes. First, I want to test the Government’s argument for withholding the transition risk register and clear up the confusion about current Government policy on risk management and freedom of information. Secondly, I want the debate today to give people watching in the country the real picture of what is happening on the ground in the NHS across England. I know that Labour Members’ contributions will bring that out.

Faced with a conspiracy of silence on the Government Benches to keep the risk register secret, it falls to the Opposition to tell patients and the public what this Government do not want them to know. Today I will reveal new information from locally held NHS risk registers about the real risks that the Government are running with patient care, public safety and the quality of NHS services in communities across England. Based on the information that I will reveal, my third purpose today is to counter what seems to be the Government’s main remaining argument in favour of their reorganisation—namely, that things have already gone so far that it is now better to carry on than to stop.

That argument will be demolished by the new information that the House will hear. It explains why so many professional organisations and royal colleges have already made the judgment that even now it is safer to drop the Bill and work back through the existing structures of the NHS than to proceed with the turbulent and risky experiment of introducing an entirely new legal structure for the NHS based on markets and competition. Indeed, the new information is so troubling that it raises a simple question for the Prime Minister and the Health Secretary: if they were aware of the risks on such a scale arising from their reorganisation, how could they possibly have allowed it to carry on so long?

Let me deal with the first point, testing the Government’s reasons for their action and their policy on FOI and risk management. Let us recap the events leading up to today. We on the Labour Benches always said that it was dangerous to reorganise the NHS at a time of intense financial pressure.

--- Later in debate ---

[Mr Speaker]

Order. I remind the House that there is a lot to get through, many Members wish to contribute, and interventions in any event should be brief.

[Andy Burnham]

I have never believed in a free market in the NHS. I did not believe it then and I do not believe it now. That is why I oppose the Bill that the hon. Lady supports.

I was saying, before I was rudely interrupted, that we say it is dangerous to reorganise the NHS at this time. On the day the White Paper was published, I stood opposite the Secretary of State and described his plans as

“a huge gamble with a national health service that is working well for patients.”—[Official Report, 12 July 2010; Vol. 513, c. 663.]

He never has explained why this successful NHS needs to be turned upside down. From day one we have asked the Government to be up front about the precise nature and scale of the risks that they are taking. Their failure to provide a full assessment of those risks to inform the House’s consideration of their Bill led my predecessor, my right hon. Friend the Member for Wentworth and Dearne (John Healey), to initiate a freedom of information request for the transition risk register. I wish to point out that my right hon. Friend did not request the full departmental risk register, which was subject to a similar request in August 2009 at the height of the swine flu pandemic.

Let me now directly answer the question that the hon. Member for Weaver Vale (Graham Evans) asked. There are three crucial differences between that situation and the subject of today’s debate. The first important difference—[Interruption.] The hon. Gentleman would do well to listen, as the Prime Minister got his facts wrong at Prime Minister’s Question Time.

The first important difference is that the debate relates to a different document. This debate is about the transition risk register, not the strategic risk register held by the Department. They are different things. The transition risk register relates solely to the reorganisation and the effects that the reorganisation could have. That brings me to my second reason why the situation is different. I did not initiate the biggest ever top-down reorganisation of the NHS. It is the policy of the hon. Gentleman’s Government to do that. We on the Labour Benches who care about the NHS have a right to know what damage that reorganisation might cause. The Government are not just launching the biggest ever reorganisation; they are doing it at a time of the biggest ever financial challenge in the history of the NHS.

The third reason—

[Several hon. Members]

rose—

[Andy Burnham]

Conservative Members should listen. The hon. Member for Weaver Vale asked for the reasons. The third reason the situation is different is that the request submitted in August 2009 was from a member of the public, not from a Front-Bench politician—

[Several hon. Members]

rose—

[Mr Speaker]

Order. May I make it clear to Back Benchers that the shadow Secretary of State is clearly not giving way at present, and that in the circumstances they should exercise some self-restraint?

[Andy Burnham]

They do not want to listen because it does not suit their argument. This was meant to be their whole reason today, and we heard it from the Prime Minister earlier, but now they do not want to hear the reasons.

The third reason this situation is different from the one in August 2009 is that at that time there was not a precise ruling from the Information Commissioner, but there is a clear ruling from the commissioner in this case. Those are three important differences. Let me remind the House of that ruling. It stated:

“The Commissioner finds that there is very strong public interest in disclosure of the information, given the significant change to the structure of the health service the government’s policies on the modernisation will bring.”

That is where one of the Government’s key arguments for withholding the register falls apart. The Minister in another place has repeatedly defended the Government’s action by saying that they had published a full impact assessment for the Bill—[Interruption.] “It’s true”, says the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns). Let me answer that point. Having had sight of the impact assessment and the transition risk register, the commissioner said that

“disclosure would go somewhat further in helping the public to better understand the risks associated with the modernisation of the NHS than any information that has previously been published.”

In other words, the impact assessment that the Secretary of State has published is not good enough and the public deserve to know the full truth about his reorganisation.

[Mr Alan Reid (Argyll and Bute) (LD)]

I am pleased that the right hon. Gentleman has been converted to the cause of freedom of information but hope that it is not for a fourth reason: he was then in government but is now in opposition. Will he give a commitment that, should he ever again become Secretary of State for Health, he will grant every FOI request for a risk register?

[Andy Burnham]

They should be judged on their merits, but let me say that it was the Labour party that introduced the Freedom of Information Act, so we will take no lectures from the hon. Gentleman. As I will explain in a moment, we did publish risk registers under freedom of information rules, so let us keep the high horse out of today’s debate, if he does not mind. We were used to hearing pious lectures from Liberal Democrat Front Benchers on openness, transparency and how the supremacy of freedom of information trumped everything else, and we heard from Conservative Front Benchers that sunlight was the best disinfectant, but that all seems a long time ago. We now have the sorry spectacle of Government Members on both Front Benches defying a clear ruling by the Information Commissioner and taking it to a tribunal hearing early next month. This action raises serious questions on what precisely is the Government’s policy on these matters, as there is a real danger that it will look confused and contradictory. A search of the Treasury website brings up a clear statement of policy on the Government’s principles for risk management. It states:

“Government will be open and transparent about its understanding of the nature of risks to the public and about the process it is following in handling them. Government will make available its assessments of risks that affect the public, how it has reached its decisions, and how it will handle the risk. It will also do so where the development of new policies poses a potential risk to the public.”

That is the statement of the Government’s policy as it stands today. Why on earth are they not following it?

[Keith Vaz (Leicester East) (Lab)]

I declare my interest. I remind my right hon. Friend that yesterday statistics were published showing that 1.3 million diabetics had not had their annual checks. It is important that we have this information on the risks posed to diabetics by the new commissioning arrangements. Does he not think that that is an argument for full transparency?

[Andy Burnham]

My right hon. Friend eloquently makes the point I made at the beginning of the debate: people with long-term conditions, such as diabetes, who depend utterly on the NHS have a right to know whether there is any risk to the continuity or integration of the care they receive. I understand that representatives of patient groups, who perhaps have not been heard enough in this debate, made that point directly to the Prime Minister on Monday. It is absolutely essential that their voice is heard. They say that the Bill represents a danger to the integrated care that they receive and depend upon. It seems pretty clear to me that the Government are not following their own policy—[Interruption.]

[Anna Soubry (Broxtowe) (Con)]

indicated dissent.

[Andy Burnham]

I quoted from the policy, but the Secretary of State is not publishing the risk register—

[Mr Speaker]

Order. I am sorry to have to interrupt, but I must say to the hon. Member for Broxtowe (Anna Soubry), who no doubt is an immensely brilliant individual, that in her capacity as Parliamentary Private Secretary to the Minister of State, at this stage in her career her role is to fetch and carry notes and nod in the right places, not to conduct a running commentary on the debate. I trust that she will now exercise a self-denying ordinance for the remainder of the debate.

[Andy Burnham]

As I was saying, the Government clearly are not following the statement of policy set out on the Treasury website, but the strange thing, as the House will hear shortly, is that NHS bodies across the country at local and regional level are following the policy closely. As I understand it, the Treasury’s theory is that the more widely the risks are understood and shared, the greater the ability to mitigate them. Indeed, I recall the Minister stating in a press release as recently as last October, the month before the commissioner’s ruling, that an open and transparent NHS would be a safer NHS. Two simple questions follow: why is the Department for Health not following stated Government policy and what it said in October was its own policy; and is the Department in breach of Government policy, or has it secured an exemption from it? I hope that the Health Secretary will shed light on this point today, because at present it does not look too good.

Let me turn to the Government’s other reasons for fighting publication. First, it is claimed that disclosure would

“jeopardise the success of the policy”

That is a moot point. The Information Commissioner said that it is a strange defence, given the Government’s other statements on openness and scrutiny building more robust plans. Secondly, it is claimed that it could have a chilling effect and that officials would be less frank in future. Given that risk assessment is a core part of all public servants’ responsibilities, not an optional activity, that claim was not accepted by the commissioner. Thirdly, it is claimed that the names of junior officials could be disclosed, but the commissioner has said that he was satisfied that the register would identify only senior civil service or senior NHS officials.

Fourthly, it is claimed that disclosure would set a difficult precedent and could lead to the publication in future of information relating to national security. The weakness of this argument, as the commissioner pointed out, is that a precedent has already been set, and it was set by the Labour party when we were last in government. A comparable risk register linked to the specific implications of a particular policy—the Heathrow third runway—was released by the previous Government in March 2009 following a ruling by the Information Commissioner on a request from the current Transport Secretary. Why are this Government not following the clear precedent set by the previous Government? That is the answer to the hon. Member for Weaver Vale. In truth, these four reasons seem to me to be the desperate defences of a desperate Government who have something to hide and a desperate Secretary of State.

[The Secretary of State for Health (Mr Andrew Lansley)]

Let me offer the shadow Secretary of State a view that has been put to the House previously:

“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]

Does he recognise that view?

[Andy Burnham]

The Secretary of State clearly was not listening. It is not a comparable situation. We are talking about a different document. Does he understand that? It is a different document. How more simply does he want me to say it? He was just talking about the strategic risk register. Today the House is debating the transition risk register, and I would be grateful if he did not continue to muddy those waters.

Why are the Government not following the precedent we set? I do not know whether they will try to produce any more desperate reasons today, but it looks to me as though they have no real defence, as the hon. Member for Cities of London and Westminster (Mark Field) has pointed out. People will be expected later to troop through the Lobby for the Government, without so much as a fig leaf of a principled argument to support their call. Liberal Democrats, who used to lecture us on the supremacy of freedom of information, will be exposed once again: spineless, co-conspirators against the NHS, acting out of nothing but gut loyalty to the suicide pact that is this coalition.

That brings me to my second point. What exactly are Government Members all so desperate to hide, and what precise risks are they running with the NHS? When the Prime Minister made his disastrous decision to allow the Health Secretary to break the promises that he had personally made to NHS staff—indeed, those promises were then enshrined in the coalition agreement—and to proceed with his top-down reorganisation, we warned that the hard-won improvements in waiting times over the Labour years would be placed at risk. That is exactly what has happened.

The Government inherited a strong, self-confident NHS, independently judged one of the best health services in the world, if not the best, and in just 20 months they have reduced it to a service that is demoralised, destabilised and fearful of the future. Throughout the country there are growing signs of an NHS in distress. A and E departments are under increasing pressure, with figures published last week showing that the Government missed their own lowered A and E target for the seventh week in a row.

Between December 2010 and December 2011, there was a 13% increase in the number of people waiting longer than 18 weeks and a 105% increase in people waiting longer than a year. The number of patients waiting more than six weeks for their diagnostic tests has more than doubled, and the number waiting more than 13 weeks has more than trebled.

We have a habit in this House of reeling off such statistics, but every single one represents a family living with worry, a life on hold. On Monday the Health Secretary said that

“pressure on hospitals is reducing.”

If ever I heard it, there speaks a voice from the bunker: a sure sign of what happens when you surround yourself with people who say only what you want to hear.

[Mr Lansley]

We must proceed from facts and be accurate. The number of patients waiting more than a year for treatment in May 2010—the time of the most recent election—was 18,458. In the latest figures, published for December 2011, that figure had more than halved, to 9,190.

[Andy Burnham]

I will trade figures with the right hon. Gentleman. He quotes a different time frame from the one that I quoted. If he is going to resort—

[Mr Lansley]

rose—

[Andy Burnham]

No, I have given way to the right hon. Gentleman. He resorts to those tactics and gives us the view that the pressure on hospitals is reducing, when all over the country hospitals are under intense pressure and A and E departments and wards are being closed, but, if he expects us to take those statements from him, he should know that we are not going to do so. This is not a man living in the real world, and he is not listening to the warnings that are coming from the NHS. It can be no surprise to people that the NHS is slipping backwards, because that is precisely what local and regional NHS bodies have been warning him. The fact is—[Interruption.] I will not give way. The fact is—

[Mr Lansley]

On a point of order, Mr Deputy Speaker. For the purposes of accuracy, I understand the right hon. Gentleman to have said that 105% more patients waited longer than a year for their treatment in December 2011 compared with December 2010, when he should know that the figure—[Interruption.]

--- Later in debate ---

[Mr Deputy Speaker]

That is not a point of order for the Chair, Mr Lansley. As—[Interruption.] Order. As you well know, that is a point of debate.

[Andy Burnham]

Even though it was not a point of order, Mr Deputy Speaker, let me just answer it. I was comparing December 2010 with December 2011. That is a different time frame from the one that the Secretary of State quoted, which involved a time frame since the election. The Government inherited an NHS in which those waiting times were going down, and that is why he quoted those figures. On his watch, they are going back up, and it is a disgrace that he does not have the courage to admit it.

The fact is, as I said a moment ago, that warnings have been coming from the NHS, and I want the House to listen carefully to this information. The right hon. Gentleman has not been listening. The Government will not publish the transition risk register, but we have a pretty good understanding of what is in it from the local and regional risk registers that have been made public in line with Government policy as expressed on the Treasury website. So what do they say about waiting times?

Let us take the risk register from NHS Bradford and Airedale. Its assessment warns of

“a risk of poor patient access and assessment within four hours at Leeds Teaching Hospital due to significant staffing pressures resulting in potential patient safety issues and delay”.

The likelihood of that happening is considered 4, likely to happen, and the consequences are rated 4, major, giving an overall risk register rating of 16, which is extreme.

[Mr Lansley]

It’s not actually going to happen.

[Andy Burnham]

The Secretary of State says that it is not actually going to happen, but that assessment was made after mitigation. The assessment states that it is likely, that it is major and that mitigating effects have not taken the risk away. He should probably learn to understand the risk register before he refuses to publish it.

NHS Surrey warns of

“performance measures as set out in vital signs for 18 weeks are not met due to a loss of capacity or focus or availability of funding”.

The rating is 16: extreme, likely to happen, with major consequences. The risk has not been mitigated.

What do the local risk registers say about care for cancer patients? Worryingly, some predict—[Interruption.] The Secretary of State would do well to listen; he is not good at listening. He would do well just to listen to what I am saying. Worryingly, some predict poorer treatment for cancer patients.

NHS Lincolnshire’s corporate risk register states:

“New risk in December—the continuation of the Cancer Service improvement, cancer network and the achievement of cancer waiting time targets”.

The risk rating is 16: extreme, likely to happen, with major consequences.

At NHS Bradford and Airedale again, there is a similar risk, with

“poor patient access to cancer waiting times 62 days urgent referral to first treatment, resulting in poor patient care.”

Its rating was 16: extreme, likely to happen, with major consequences.

[Julian Smith (Skipton and Ripon) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

No, the House will listen to this information.

What do the risk registers say about patient and public safety and about staffing levels? South Central strategic health authority’s risk register warns—

[Christopher Pincher (Tamworth) (Con)]

He’s frit.

[Andy Burnham]

The hon. Gentleman would do well to listen—[Interruption.] I have taken interventions, and he would do well to listen. I am trying to get through my remarks so that colleagues can speak. He should try listening for once. He is not doing a very good job of it at the moment.

South Central strategic health authority warns of a

“risk that the pace and scale of reform, if coupled with savings achieved through cost reduction rather than real service redesign, could adversely impact on safety and quality, with the system failing to learn the lessons from Mid Staffordshire and Winterbourne View.”

NHS London warns:

“There is a risk that women may be exposed to unsafe services which could cause them harm.”

NHS Northamptonshire and NHS Milton Keynes warn that

“failure to deliver national objectives, business continuity and statutory functions due to lack of capacity, capability, retention and availability across the workforce resulting from the proposed Health and Social Care Bill.”

Those are risks created by the Secretary of State and his Bill. It is utterly disgraceful.

[Mr Ben Bradshaw (Exeter) (Lab)]

Given that this House and the other place are having to decide on the biggest upheaval in the NHS’s history, is it not absolutely essential that all the information and all the risks are in the public domain? In that context, and in the context of what my right hon. Friend has said, is it not absolutely imperative that the Francis report into the scandal at Stafford hospital is published before the Bill has completed all its stages in Parliament?

[Andy Burnham]

Of course, there are lessons to be learned for those in all parts of the House when the Francis report is published, and I can say, on behalf of Labour Members, that we will learn those lessons. However, this Bill goes to the heart of what happened in that case, because it is about autonomy in hospital services, and we know that when one makes an organisation autonomous it can sometimes fail as well as get better. I cannot understand how the Government can be legislating before they have even waited to hear the conclusions of the public inquiry that they set up. Surely that has implications for the Secretary of State’s Bill. Why has he not waited to hear what it says so that it can be properly reflected in the design of the service that he is creating?

[Jeremy Lefroy (Stafford) (Con)]

Given that the right hon. Gentleman opposed the public inquiry at the time, will he now agree with Government Members, particularly the Secretary of State, that it was vital that it took place and that the lessons be learned?

[Andy Burnham]

One of my first acts as incoming Health Secretary was to commission Robert Francis QC to conduct an independent investigation into the events at Stafford on a local level. [Interruption.] Government Front Benchers are saying that it was not a public inquiry. They are right, but let me explain why. I did not commission a full public inquiry because, in my judgment, such an inquiry at that time, with all the glare and focus that it would bring to the hospital, would distract the hospital from its more immediate priority of making services safe as quickly as possible. I said to the chairman of the independent inquiry that if, at any time, he wanted to come back to me and ask for powers to compel witnesses, I would be well disposed towards receiving such requests. Given all the events that have taken place, to hear that the hospital is again having difficulties—that the A and E department is temporarily closed—gives me genuine cause for concern that the fundamental and far-reaching problems there have not been adequately addressed. That should concern us all.

I was talking about the risks identified by the NHS Northamptonshire and Milton Keynes risk register regarding the loss of capacity and problems in carrying out statutory functions resulting from the chaos caused by the Bill.

[Rehman Chishti (Gillingham and Rainham) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

Not for the moment.

The risk rating in that risk register was 16—extreme. Let me focus on the phrase, “statutory functions”, because it is important that the House fully appreciates what that involves. One of the statutory functions of the primary care trusts that have been wound down before new structures are in place is the safeguarding of children and vulnerable adults. What does the NHS London risk register say on this point? [Interruption.] Government Members do not want to listen. I am sorry if it is inconvenient for the Parliamentary Private Secretary, the hon. Member for Broxtowe (Anna Soubry), but she will listen. The risk register makes the chilling prediction that the huge loss of named or designated professionals from PCTs across London, and the subsequent damage to information sharing, may lead to “preventable harm to children”. That risk was rated at 20 pre-mitigation and 15 post mitigation.

It is not just NHS London that is saying this. Let me quote again from the NHS Northamptonshire and Milton Keynes risk register; this time I ask the House to listen very carefully. It warns of a

“failure to deliver statutory requirements which leads to the significant harm or fatalities of children and vulnerable adults”.

That was originally rated as an extreme risk and, even after mitigation measures, it is still rated as “very high” with the possible frequency of occurrence being “monthly”.

This is what the national health service is telling the Health Secretary and the Prime Minister about the potential effects of their reorganisation. It is appalling and shocking. They are taking unacceptable risks with children’s safety and people’s lives. If this is what the NHS has been telling Ministers for 20 months, since the White Paper was published, how can they possibly justify pressing on with this dangerous reorganisation? Has not what remained of any justification for carrying on just collapsed before us? If this is what is published in local risk registers, that prompts the question of what on earth they are trying to hide in the national assessment. The simple truth is that they cannot publish because if people knew the full facts, that would demolish any residual support that this reorganisation might have.

That brings me to my third point—the Government’s claim that it is safer to press on with reorganisation than to deliver GP commissioning through the existing legal structure of the NHS. The evidence that I have laid out comprehensively dismisses that argument. If the Government were to abandon the Bill and work with the existing legal structure of the NHS, that would bring immediate stability to the system and, as the British Medical Journal has calculated, save over £1 billion on the cost of reorganisation. The Government’s claim that it is safer to press on is rejected by the overwhelming majority of clinical and professional opinion in England. The royal colleges and other professional organisations have given careful consideration to the pros and cons of proceeding and abandoning. Some disruption comes with either course of action, but given the terrible mess that we are now in, those royal colleges have concluded, one by one, that the interests of patients are best served by working to stabilise the system through existing structures.

It is not difficult to do that. PCT clusters could be maintained and the emerging clinical commissioning groups could simply take charge of the existing legal structure that is the residual PCT, and indeed any buildings and staff that they may still have. The painful truth is that delivering GP-led commissioning, which is where the Health Secretary began, could have been delivered without this Bill. Let me say to him again today that my offer still stands. If he drops the Bill, I will work with him to introduce GP-led commissioning using his emerging clinical commissioning groups.

However, that must be done in the right way. The local NHS risk registers raise concerns not only about reorganisation but about fundamental flaws in the policies that the Health Secretary wants to take forward. NHS Lincolnshire warns of a

“conflict of interest in CCG commissioning and provision: perceived or actual conflicts of interest arising from GPs as both providers and commissioners may impair the reputation of the CGG and, if not managed, may result in legal challenge.”

That has a moderate likelihood of happening but a consequence rated as catastrophic. A GP surgery in West Sussex has written to all its patients offering them

“private screening for heart and stroke risk”

from Health Screen First, for which, in return, the surgery receives a nominal fee from Health Screen First. In Haxby, GPs tried to restrict minor operations that are currently free on the NHS and at the same time launch their own private minor operations service, sending patients a price list. More broadly, stories are emerging around the country of plans by clinical commissioning groups to stop purchasing services from local hospitals, such as dermatology in Southwark and out-patients in south London. There are also plans to remove services from Stafford hospital, which we talked about earlier.

This unstable market in health care could have a very real effect on the viability and critical mass of essential hospital services, resulting in full or partial hospital closures. I have never heard of any plans from the Government to mitigate these risks other than the simple statement, “The market will decide.”

[Joan Walley (Stoke-on-Trent North) (Lab)]

In view of what was said about Stafford hospital and the implications for patient care in North Staffordshire, may I say to my right hon. Friend and to the House that it is vital that we get the full information and full risk assessments that are required in order to be able to plan for the NHS that we need, and that this important debate is part of that?

[Andy Burnham]

What happened at Stafford gives us very important lessons about the dangers of autonomy, and this Bill is all about extolling the benefits of autonomy. As Health Secretary, I had to deal with that situation. In some ways, it was a legacy of problems with our own policy; I accept and acknowledge that before the House. Because of that situation, I proposed the power to de-authorise a foundation trust and brought it forward in the Health Act 2009. If a hospital gets into trouble, it cannot carry on being autonomous and unable to improve, but should be brought back and helped to improve. I proposed the duty of autonomy.

In fact, that duty was recommended by Robert Francis QC in the first stage inquiry that he delivered to me. I accepted his recommendation. The Health and Social Care Bill abolishes the power to de-authorise a foundation trust. A recommendation from Robert Francis is being abolished by the Bill before the Government even give him the courtesy of allowing him to report. I say again that I do not have a good answer to why they are legislating before hearing from his inquiry. As was said a moment ago, there are plans in Stafford for GPs to do more in the community. That might be a good idea, I do not know, but it might further destabilise that hospital. That should be a cause for concern.

[Julian Smith]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will give way one last time to a Government Member, then I will close.

[Julian Smith]

Last week, I met Airedale NHS Foundation Trust, to which the right hon. Gentleman referred earlier. To clarify, neither the chief executive nor the chairman raised any of the points that he has raised. Not only that, but the local GP commissioning consortia are perfectly happy and are asking me and other local MPs to push ahead with the Bill. Why is the right hon. Gentleman such a scaremongering buffoon?

[Julian Smith]

I withdraw it fully.

[Andy Burnham]

I do not know why the hon. Gentleman thinks that such an intervention is appropriate. Why did he not ask the chairman and chief executive about this matter? Why does it take me to go and research the risk register—[Interruption.] Listen to the answer. Why does it take me to research the risk register in his constituency and to tell him about the risks to the NHS in his constituency, which he clearly does not know about? I suggest that he goes away from this Chamber right now and searches online, where he will find that risk register. Perhaps he will learn something about his constituency.

We are told that the market will decide. Last week, the Government received a specific warning from more than 150 members of the Royal College of Paediatrics and Child Health that the market-based approach envisaged in the Bill will have

“an extremely damaging effect on the health care of children”.

They went on to say:

“Care will become more fragmented, and families and clinicians will struggle to organise services for these children. Children with chronic disease and disability will particularly suffer, since most have more than one condition and need a range of different clinicians.”

They stated that:

“The Bill is misrepresented by the UK Government as being necessary”

and that it will

“harm those who are most vulnerable.”

Those are not my words, but those of clinicians. [Interruption.] If the hon. Member for Suffolk Coastal (Dr Coffey) wants to dismiss them, that is up to her, but she would do well to listen to them.

Warnings do not come any more serious than the one that I have just read out. It shows why the Government will not publish the risk register: they know that the case for their Bill would be demolished in an instant. People watching this debate will ask how it is possible to proceed when experts make such warnings and when NHS bodies warn of fatalities. To press on regardless would be utterly irresponsible and unforgivable. That is what the Prime Minister said today that he plans to do.

The truth is that the Government are not listening, as we have seen throughout this debate. The Prime Minister is surrounding himself with people who say what he wants to hear, while closing the door of No.10 Downing street in the faces of those who do not. He will not listen to the doctors and nurses with whom he was once so keen to have his photograph taken. It could not be clearer: he is putting his political pride and the need for the Government to save face before the best interests of the national health service. He is gambling with patients, with public safety and with this country’s best-loved institution. The Prime Minister asked people to trust him with the NHS, but we have learned today that he is running unforgivable risks with it. What his Government are doing is wrong and they need to be stopped.

I call on Members across the House to put the NHS first tonight. Vote with us for the publication of the risk register so that the public can see what this reorganisation will do to their NHS. They deserve the full truth and tonight this House can give it to them and correct the Government who have got things so badly wrong. I say to people outside who are watching this debate, join this fight to save the NHS for future generations. The NHS matters too much to too many people for it to be treated in this way. People have not voted for what is happening. [Interruption.] Not a single Government Member who is shouting at me now can look their constituents in the eye and say, “I told you that I was going to bring forward the biggest ever top-down reorganisation.” The more people who join this fight, the stronger our voice will become.

We promised this Government the fight of their life for betraying that trust and that is what we will give them. Tonight, this House has an opportunity to speak for the millions of people who care about the NHS and are worried about what is happening to it. I implore this House to take that opportunity and I commend the motion to the House.

[Mr Deputy Speaker (Mr Nigel Evans)]

Before I call the Secretary of State for Health, I say to the House that in my time as Deputy Speaker, this is easily and by some margin the worst-tempered debate that I have chaired. I ask Members on both sides of the House to lower the temperature so that we can have a decent and full debate.

--- Later in debate ---

[Mr Lansley]

The curious thing, as I know my hon. Friend will appreciate, is that even the Leader of the Opposition says that reform is needed in the NHS because of the challenges that it faces. Of course we can debate what the nature of the reform should be, but the idea that we can simply stand still and that nothing in the NHS needs to change is not the view of NHS staff, patients, the Labour party or the Government. We therefore have to consider what the nature of that reform needs to be, and I believe in patient choice and empowering doctors and nurses on the front line to deliver care. I believe in cutting bureaucracy and removing whole tiers of management to enable that to happen, and in common with my Liberal Democrat friends and colleagues I believe in strengthening democratic local accountability in the NHS and strengthening public health services through local government operations.

The worst possible thing for me to do would be to say, “We need to reform the NHS because it is doing so badly.” I do not believe that, but I do believe we have to root out poor performance. I was shocked to hear the shadow Secretary of State and the right hon. Member for Exeter (Mr Bradshaw), who has disappeared, talking about Stafford hospital. They were the ones who never appreciated the risk of what was happening there. They know that they went through reorganisations without ever addressing the risk. The dreadful things there happened on their watch, so they might at the very least have come here and apologised. The right hon. Member for Exeter came to the Dispatch Box when he was a Minister and said, “Oh, it’s nothing to do with me, it’s all to do with the management of the hospital.”

I believe in foundation trust hospitals, which apparently the Labour party now does not. [Interruption.] The shadow Secretary of State is trying to have it both ways. He is trying to say that he is in favour of foundation trust hospitals, but that if they get into difficulties the best thing is for them to be run by the Secretary of State. He might talk to the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who was the Secretary of State when, in the Maidstone and Tunbridge Wells NHS Trust, dozens, perhaps hundreds of patients died of clostridium difficile infection at the Kent and Sussex hospital. That was an NHS trust, not a foundation trust. The Department of Health and the Secretary of State have no God-given ability to run hospitals directly and do so better than they can be run by the doctors, nurses and managers in charge. The point is that there must be proper accountability, and through HealthWatch, local government and the responsibilities of Monitor we will have a proper accountability structure in the Bill.

[Andy Burnham]

I said that we would learn the lessons of what happened in the Mid Staffordshire trust, and I apologised at the time on behalf of the Government.

The first-stage Francis inquiry recommended the de-authorisation of foundation trusts. Why is the Secretary of State removing that power in the Bill before Robert Francis has reported again?

--- Later in debate ---

[Mr Lansley]

We will, of course, fully abide by the terms of the Act. As my hon. Friend knows, and as the Information Commissioner himself said, we are proceeding precisely in line with the provisions of the Act.

[Andy Burnham]

Will the Secretary of State give way?

[Mr Lansley]

Let me make one additional point, and then I will give way to the right hon. Gentleman—again.

All the information was in the original impact assessment. Information was put into the revised impact assessment in September, as is customary on the introduction of a Bill to another place, but in recognition of the Information Commissioner’s decision on 2 November, the Minister in another place, my noble Friend Lord Howe, described—[Interruption.] I will if I need to, but I do not intend to read it all out. He set out the issues covered by the transition risk register to make Members in the other place aware of precisely what those risks were.

[Andy Burnham]

As I mentioned, there is a precedent here under the terms of the Freedom of Information Act. I refer to the request for the risk register on the Heathrow runway. The Information Commissioner having ruled on it, the previous Government published the register. The Government are not following that precedent but instead fighting it in a tribunal. If, on 5 and 6 March, the tribunal does not find in the Government’s favour, will he publish the risk register, or will he carry on fighting?

[Mr Lansley]

I heard the right hon. Gentleman mention his precedent, but it was not a precedent, because that was a risk register relating to an operational matter. I explained to him that the risk registers published by strategic health authorities relate to operational matters.

[Andy Burnham]

This is operational.

[Mr Lansley]

No, the risk register that the right hon. Gentleman is talking about relates to policy development, not an operational matter. It is a high-level risk register akin to others across Government that, if published, would be prejudicial to frank advice in policy development. [Interruption.] I am only repeating the position that he took when Secretary of State. Let me quote him:

“We have determined that the balance of public interest strongly favours withholding the information”.

I will take his advice and stick to my view: the release of the risk register does not serve the public interest, even if it might serve his political interest to make a song and dance about it. I have been clear about it, as has my noble Friend. The information on which any debate about the Bill should be conducted is already in the public domain.

--- Later in debate ---

[Gareth Johnson]

Yes, I would be surprised if that had happened.

It would be wrong for there to be routine publication of risk registers without any kind of control. The beauty of risk registers is that they enable civil servants to think the unthinkable.

The hon. Member for St Ives (Andrew George), who is no longer in his place, made the point that there is a difference between the approaches of the Government and the Opposition. If we are honest with ourselves, we must recognise that every Opposition in this place has been guilty of some scaremongering. There is no doubt about that, so let us be mature about it. Whether it has been my party, the Labour party or the Liberal Democrats, we have all been guilty of a certain amount of scaremongering. Presenting a pessimistic view as a real likelihood is part of the game of political football. However, there is a huge danger that information from the risk register could end up misleading the public and giving them inaccurate information.

[Andy Burnham]

May I remind the hon. Gentleman that the words of mine that he referred to related to the strategic risk register? We are debating a different document today. He seems to misunderstand risk registers, because he described them as presenting a worst-case scenario. They do not, and I can provide him with the material showing that right now if he would like to see it. The examples that I read in my speech were given a likelihood rating. They were said to be likely to happen and not mitigated by the steps that had been taken. I am afraid he has not grasped that point, and he needs to.

--- Later in debate ---

[Rehman Chishti (Gillingham and Rainham) (Con)]

It is a pleasure to follow the right hon. Member for Holborn and St Pancras (Frank Dobson), although given that the Order Paper reads,

“this House calls on the Government to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill”,

I wondered whether he was in the right debate. He spent most of his time not mentioning the Information Commissioner, although he mentioned risk in the last minute.

I want to focus on the argument over the risk register. I support the Secretary of State’s decision to challenge the Information Commissioner’s decision ordering the release of the Department of Health risk register. It is important to consider the procedure followed by the commissioner in determining whether it was the right decision to make. The Secretary of State’s decision to challenge the commissioner’s ruling is, procedurally, absolutely correct. The procedures set out in the Freedom of Information Act, as amended—[Interruption.] It is important to set the tone and background.

[Andy Burnham]

It’s not a court.

[Rehman Chishti]

The shadow Secretary of State does not understand the legislation. That is why he is making these assumptions. Section 35(1) makes it clear that:

“Information held by a government department…is exempt information if it relates to…the formulation or development of government policy”.

[Interruption.] Opposition Members do not like what they are hearing, but I hope that they will show the same common courtesy that I have shown them in the past. Section 35(1) makes it clear that the procedures applied by the Secretary of State were in line with the Freedom of Information Act, which was enacted by the previous Labour Government. Under that procedure and statute, he is entirely within his rights, using the correct procedure, to apply section 57 to appeal the ruling to the tribunal. That is absolutely right and proper.

It is important to say that we have the right—[Interruption.] I will come to the point on which the shadow Secretary of State keeps interrupting me—I am sure that he is not doing so to put me off making the point that he does not want to hear. Under the procedure in section 57, the Secretary of State can challenge a decision. It is important in our system—whether the criminal justice or the civil system—to have checks and balances on decisions that are made, whether by the Information Commissioner or by judges. If the shadow Secretary of State is now saying that the Information Commissioner’s ruling should be final, with no right of appeal, he should have said that when the Freedom of Information Act was being passed. However, he did not do so, and there is a right of appeal, where cases go to the tribunal. Even beyond that though, he asked earlier whether the Secretary of State could give us an assurance that he would not challenge the decision of the tribunal. Being realistic, how can the Secretary of State give that guarantee? The right hon. Gentleman knows, and I know, that the Secretary of State does not know what the judgment of the tribunal will be. He also knows that the rules that his Government passed, in section 59 of the Act, enable a referral to the High Court where there might be a wrong point of law.

[Andy Burnham]

Briefly, does the hon. Gentleman not accept that there is a big difference between the Secretary of State being within his rights and his being right not to publish? We accept that he is within his rights, but is he right? The precedent was set by the previous Government. We published a risk register after receiving a ruling from the Information Commissioner. That is the precedent.

[Rehman Chishti]

I am grateful to the shadow Secretary of State for that point, to which I shall return. In my view, the Secretary of State is absolutely right to use that discretion. The shadow Secretary of State knows the Department of Health well because he has been there, but I should point out to him that a spokesman for the Department of Health said:

“We have never previously published our risk registers as we consider them to be internal management documents. We believe that their publication would risk seriously damaging the quality of advice given to Ministers and any subsequent decision-making”.

I would say to the shadow Secretary of State—[Interruption.] He asked the question; I would be grateful if he listened to the answer. The reason why I say that the Secretary of State is within his powers and is right to do what he did is that never before have any Government or Secretary of State released that information. Being a sensible, considerate and fair man—which the Secretary of State is—he is right to challenge the decision, because that information has never been released before, as stated by the spokesmen for the Department of Health and made clear on page 2 of the information pack provided by the Library.

I also want to refer the shadow Secretary of State to another point. He has previously used the exemptions in section 36. Either we have exemptions or we do not, but the current exemptions, whether in section 36 or section 35, were put in place by the previous Government. If they did not want those exemptions—if they had said that everything should be in the public domain—they should have made that clear. I remind the Opposition of the saying “What’s good for the goose is good for the gander”. The fact is that you applied similar provisions, whether in section 35 or section 36, to withhold information. If you were able to do that in the public interest, then this Government, applying the same procedures and the same rules, can do so too. There is simply no point having legislation, in the form of the Freedom of Information Act, and now suddenly, when you are in opposition, you move the goalposts. In my view, that is totally and utterly unacceptable. It is also important to note that the Department of Health—