Health and Social Care Bill

Andy Burnham Excerpts

Tuesday 20th March 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House has considered the matter of whether the House should defer consideration of Lords Amendments to the Health and Social Care Bill until after disclosure of the NHS transitional risk register.

My right hon. Friends and I are grateful for your agreement to give the House this opportunity, Mr Speaker. On this of all days we should be celebrating what a much-valued social institution has done to bind our nation together throughout the 60 years of Her Majesty’s reign. Instead, we gather to dismantle it. A health service that is judged by international experts to be one of, if not the, best health service in the world is about to be inexplicably and unjustifiably broken apart by an ideological Bill ending 63 years of NHS history.

This is a difficult day, but what makes it all the harder to stomach for people watching is the manner in which things are happening. People outside will struggle to understand how Members of this House could make such momentous decisions without having carefully considered all the facts and all the evidence. The truth is that Members will go through the Lobby tonight without knowing the full implications of what it means for the NHS in their constituencies. How do they begin to justify that to their constituents, to patients who depend on the NHS and to staff who devote their lives to it? We have argued from the beginning that the Government’s decision to combine an unprecedented financial challenge in the NHS with the biggest ever top-down reorganisation has exposed the NHS to greater risk, and the truth is that we are beginning to see the effects of that. In our constituencies, they have already dismantled the existing structures of the NHS before the new ones are in place, leading to a loss of grip just when it was most needed. So we are seeing A and E waits getting longer, staff shortages leading towards A and E closures, and patients in our surgeries beginning to complain of treatments being restricted or of longer waits.

We have also heard from the health professions—from GPs, nurses, midwives and physios—who one by one have made clear their considered professional judgment that, on the balance of risks, it would be safer to abandon the Bill than to proceed with the upheaval of reorganisation. Ministers by their actions are putting the NHS at greater risk, but even today this House does not know the assessment that was given to Ministers or the precise nature and scale of those risks.

[Mr John Redwood (Wokingham) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

I do not plan to give way because I want other Members to have the chance to contribute to the debate.

Ministers want the House to back the gamble they are taking with the NHS without having the courtesy to tell it the odds. The Information Commissioner thinks we should see the risk register and so does the Information Rights Tribunal, which brought forward its ruling so that it could influence our proceedings. If the NHS starts to struggle because of all the change being thrown at it and if services in some parts of the country start to fail, how will Members of the House respond when people come to our surgeries and ask whether we did everything we could to anticipate the dangers? We will remind them of the truth—that Government Members put politics before the national health service and signed up to a reckless reorganisation without knowing all the facts.

[Mr Redwood]

rose—

[Andy Burnham]

I will give way once to the right hon. Gentleman and then I will finish my remarks.

[Mr Redwood]

I am very grateful. When Labour introduced private contractors to carry out NHS treatments, did that undermine the NHS?

[Andy Burnham]

No, because we brought down NHS waiting lists to their lowest ever levels and we left patient satisfaction at its highest ever level. Those same waiting lists are going up under the right hon. Gentleman’s Government and he should be ashamed of that. He will not publish the information about the risk to waiting times because he is frightened of putting it before the House and the public, but we will remind them of the truth.

The Government proclaimed that they were going to be the most open and transparent Government in history. Today, it still says on the Treasury website in a statement of the Government’s principles for risk management:

“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.”

May I suggest that the Government take down that misleading statement of policy? Their actions have left it in tatters, together with the grand claims of openness and transparency. The tribunal, they will say today, has not given us its reasons. Ministers will try to argue that the public and Parliament’s right to know about the impact of their policy decisions is outweighed by the public interest in the preservation of a safe space for policy advice.

Those arguments were considered, first, by the Information Commissioner, and subsequently by the Information Rights Tribunal. They found the opposite to be the case: that the public interest lay in full disclosure. But it does not matter; Ministers are simply re-running the arguments of a case that they have lost. They have no leave to reopen the substance of that argument, but they are not the only arguments that they have lost.

In an attempt to rescue the Bill last year, the Prime Minister made a number of claims for it. They cover issues that we know are in the local and regional risk registers which have been published. First, he said the Bill was needed as the NHS does not

“deliver the patient-centred, responsive care we all want to see”.

He cited heart services and claimed that someone in this country is twice as likely to die from a heart attack as someone in France. That was before new research in January reported a 50% fall in heart attack deaths in the past decade.

Then the Prime Minister said that cancer services were failing people, compared with other countries. That was before new research in November 2011 which showed that the NHS in the past decade achieved the biggest drop in cancer deaths of any comparable health system in the world. Thirdly, the Prime Minister and all the Ministers on the Government Front Bench have routinely trotted out the same script for years—that NHS productivity has declined in the past decade. That was before new research on NHS productivity from Professor Nick Black published in February in The Lancet showed that, far from falling, NHS productivity increased in the past decade at the same time as the NHS achieved patient satisfaction.

One by one the Government’s arguments for the Bill have fallen apart. They have comprehensively lost the argument. They have convinced nobody and now they are running scared, resorting to the only remaining option of ramming the Bill through Parliament before they are required in law to publish the real assessment of their policies.

[Alex Cunningham (Stockton North) (Lab)]

I am sure my right hon. Friend will join me in wishing well 11-year-old Bailey Stark in my constituency as he and his family cope with his condition that means that he is unable to swallow. His mother is worried sick about the changes in the health service, which might mean that he will not get the treatment he requires in Newcastle. Does my right hon. Friend agree that that risk is all the more reason for publishing all risks, as we should know the truth about what is happening to our NHS? [Interruption.]

[Andy Burnham]

Members shout “Scaremongering” from the Government Benches, but the Government will not publish the evidence to back up their claims. We have read the local and regional risk registers which warn precisely of the case that my hon. Friend mentions—of damage to the continuity of care, risks to patient safety, longer waits for cancer patients, risks to child safeguarding. Those are the facts in the regional risk registers and they are the facts that Ministers are trying to withhold from the public.

[Caroline Lucas (Brighton, Pavilion) (Green)]

Does the right hon. Gentleman share my surprise and sadness that the Liberal Democrats, who were once the defenders of freedom of information, are now trooping through the Lobby in support of a dangerous Bill shrouded and protected by the restriction of information?

[Andy Burnham]

I am grateful to the hon. Lady for her point. The Liberal Democrats once derided the Freedom of Information Act as too weak. Today they cower behind it, trying to use any scrap of protection they can find within it to prevent the publication of the information that patients and the public deserve to have. That says everything that people need to know about today’s Liberal Democrat party.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will not give way. I will now bring my remarks to a close.

We are clear that the risks in the Bill arise not just from the organisational turbulence that the Secretary of State is inflicting on the NHS, but from the specific policies in the Bill. Today we table a package of amendments in a last-ditch attempt to provide the necessary safeguards that the Liberal Democrats failed to secure in another place—

[Mr Dorrell]

On that point, will the right hon. Gentleman give way?

[Andy Burnham]

They are safeguards in light of the huge potential for the conflict of interests in the award of contracts under the “any qualified provider” provisions, which will not be addressed by a simple register of interests, and safeguards on a stronger local HealthWatch—the Government have watered that down since the Bill left this House of Commons. There are safeguards too—

[Mr Dorrell]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will give way for one last time.

[Mr Dorrell]

I am grateful to the right hon. Gentleman. Will he just clarify one issue of principle for the House? Are Labour Front Benchers now arguing that every Government Department should publish its strategic risk register? If not, can he justify his proposition that the Department of Health should do so uniquely?

[Andy Burnham]

I refer the right hon. Gentleman to the Information Commissioner’s ruling on the decision about a third runway at Heathrow. That is the precedent his Government should be following, but instead they have chosen to defy the commissioner. It was the Labour party that published the decision on a third runway at Heathrow, and I refer him to the ruling from the Information Rights Tribunal, which made a clear distinction between the strategic risk register, which covers all the uncontrollable risks that any Department will face, and the transition risk register, which deals specifically with the effects of Ministers’ decisions, in this case on the NHS. There is a real difference between the two. The tribunal said that the transition register should be published. His Government should respect the law and publish today.

We will table amendments to provide safeguards today, but in future it will not just be the cover-up of the risk register that we will have to worry about—that is just a taste of things to come in the new NHS. Members will have to get used to the words “commercial confidentiality” when inquiring about local services, because that is what they will find in the NHS that Ministers are creating. Let us look at the risks inherent in the proposed relaxation of the private patient income cap. One risk assessment that Ministers have published—the revised impact assessment—states that

“there is a risk that private patients may be prioritised above NHS patients, resulting in a growth in waiting times for NHS patients.”

That is all they have told us, but that alone is reason enough to oppose the Bill.

The only hope I can give people worried about the future of the NHS is that this might be the end of the Bill, but it is just the beginning of our campaign. The NHS will find a way of working around these changes and will not deteriorate overnight. We will be working to mitigate the worst effects of the Bill. This is the eleventh hour; our only hope would be a change of heart from the Liberal Democrats. We will call a vote on this motion and ask people to vote against it to show that we have not had enough time to debate these important issues.

I respect those Liberal Democrat Members who have had the courage to defy their orange book leadership, and I respect their grass-roots members who did the same at their spring conference, but the truth is that from today the Liberal Democrats will be remembered not only for tuition fees, but as the party that stole people’s votes in May 2012 in order to secure jobs for themselves and sell out the national health service. They could have stood up to the Prime Minister and enforced the coalition agreement, but they chose not to do so.

That brings us back to where we started: a Bill that nobody voted for, rammed through this place tonight in the teeth of near-universal professional opposition and in defiance of a major legal ruling; a Bill about which no Member of this House can look their constituents in the eye and say they have a mandate to support. Tonight Government Members will inflict this Bill on the NHS without knowing the potential damage it can do to the health service in their constituencies. They have made their choice; I have made ours. Although on a day like today it is hard for me to give any encouragement to people worried about what the Government are doing, I can at least say this: we will repeal this legislation at the first opportunity and restore the N in NHS. We have given this fight everything that we had. All I can say is that our fight will go on to protect and restore the Labour party’s finest achievement.

[Several hon. Members]

rose—

--- Later in debate ---

[Henry Smith]

I think the biggest risk to the national health service is if we do not reform it and move it forward. It needs reform to stay relevant to the needs of all our constituents. I find the Opposition’s position strange—I would put it down to political opportunism, but I am happy to take another intervention if Opposition Members want to state their case—given what happened with the three requests made when the right hon. Member for Leigh (Andy Burnham) was Secretary of State and under his predecessor.

[Andy Burnham]

Does the hon. Gentleman understand the difference between a strategic risk register and a transition risk register?

[Henry Smith]

I believe I do understand the difference between the different types of risk register, but if we simply stand still and have inertia in our health service, it will become less relevant.

The right hon. Member for Holborn and St Pancras (Frank Dobson) accused members of my party of being chancers. I prefer to consider us as reformers, and only if we embrace reform will we be able to provide a better NHS.

--- Later in debate ---

[Dr Wollaston]

I am not trying to trivialise the issue; believe me, I understand how vital the NHS is to all our constituents and to patients. My view is that the transition risk register has been elevated to a status far out of proportion to what it merits. I completely understand the points made by Lord Wilson and Lord Armstrong—very experienced civil servants who tell us that they would feel constrained in giving full and frank advice. However, we have seen how any detail can be taken out of all proportion in this House; we are all partly responsible for that. As I said, some of the shroud waving over this Bill has been disgraceful, and I know of patients who have been genuinely frightened by it. I would be prepared to see the risk register published, but I accept the point of my right hon. Friend the Member for Charnwood (Mr Dorrell) that it has to be done on the basis of a clear understanding.

[Andy Burnham]

I am listening carefully to what the hon. Lady is saying. I remember, however, a comment that she made to The Guardian, I believe, at the start of this process, when she said that this Bill was like throwing a hand grenade into the NHS. What has changed?

[Dr Wollaston]

There we go—a deliberate misrepresentation. After I made those comments, I wrote to senior colleagues and told them that what I had said was completely different. I was deliberately misquoted on that statement and have been consistently misquoted by Labour Members. They should go back and look at the original.

I feel that it would be reasonable to present all the risks, but it would be crucial for Members of all parties to recognise that we are talking about a lasting change. We would also need to see a change in how risks are extrapolated out of all proportion to what they represent and an end to the deliberate frightening of patients into believing that they will have to pay for health care, which has been a consistent feature of how this Bill has been misrepresented by Labour Members.

--- Later in debate ---

[Andy Burnham]

In the past few minutes, we have seen a perfect demonstration at the Dispatch Box of why the right hon. Gentleman has spent 20 months trying to sell this Bill to the country but has comprehensively failed to do so. He had nothing to say in response to the speeches of Opposition Members and he did not respond with appropriate seriousness to the points that we have put to the House, namely that it should not put through far-reaching changes to this country’s most valued institution without knowing all the facts. Not one Member can go through the Lobby and say that they know all the facts about what this Bill will do. Instead, what we have heard from the Secretary of State, the hon. Member for Banbury (Tony Baldry), the right hon. Member for Charnwood (Mr Dorrell) and the hon. Member for Totnes (Dr Wollaston) is a rerun of the arguments that were heard in detail by the Information Commissioner and the Information Rights Tribunal. I have news for them all—and, indeed, for the hon. Member for Broxtowe (Anna Soubry)—they lost. Those arguments have been heard, a ruling has been made and the Government should surely respect the law, and of all people, the hon. Member for Broxtowe should respect the law.

The Secretary of State said there was a very simple point—that the Government have a responsibility to respect the law. They are the Government who told us they would be the most open and transparent Government in history. What total nonsense. Our point is simple: he is passing a Bill with far-reaching implications for the NHS in England in defiance of a legal ruling that he should publish all the information about his Bill. He made three points that were simply wrong. He said that the transition risk register deals with the worst-case scenario. It does not. It deals with the likelihood of a range of events and the impact of those events, and gives a judgment about whether or not they can be mitigated and the likelihood of mitigation. Has he read his own risk register?

The Secretary of State made a point about the strategic and transition risk registers. Has he read the ruling from the Information Commissioner and has he understood the implications of what the Information Rights Tribunal said? They said that the Government should not publish the strategic risk register because it deals with uncontrollable risks that are outside the control of Ministers, but that the Minister should publish the transition risk register because that is what he is inflicting on the national health service.

Let us not forget that the Secretary of State has chosen to inflict the biggest ever top-down reorganisation on the national health service at this moment of greatest financial challenge. That was his decision. His right hon. Friend the Prime Minister ruled that out. He said that there would be no top-down reorganisation. The coalition agreement ruled it out, but the Secretary of State brought it forward. It was his decision and if he wants this Parliament to endorse his plan, he should have the courtesy of putting before Members all the information that he has seen, but he is not prepared to do that.

Why will the Secretary of State not publish this information? What has he got to hide? Is it the fact that it would prove that all the people who are lined up in opposition to his Bill are right—the doctors, the nurses, the midwives, the physios? Is it possible that they are right in their judgment that the Bill will cause more harm than good? Would not the pitiful levels of support that he still has for the Bill be wiped out by the publication of the risk register?

The Secretary of State made no argument today at the Dispatch Box. The Government are doing what they are doing in total defiance of the law, in the teeth of professional opposition. They do not have the permission of the people of this country to put the NHS through the biggest ever reorganisation in its history. They promised in their manifesto that they would not do it. The Prime Minister promised us that he would protect the NHS and there would be no top-down reorganisation, but the Government have introduced the biggest ever top-down reorganisation. They are making a catastrophic political mistake by doing so. We will remind them every day of the damage they have done to our national health service.

Question put.