NHS Risk Register

Baroness Primarolo Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Henry Smith (Crawley) (Con)]

I am grateful to have the opportunity to take part in the debate. As I have said in the House before, every right hon. and hon. Member feels passionately about the NHS. We have legitimate disagreements about the best way forward for the national health service, but we all know that it is something that each and every one of our constituents, almost without exception, and each and every member of our families, cares about. We have all relied on our health service at one time or another. It is therefore understandable that debates about the future direction of the NHS should arouse the sort of passion articulated earlier today.

It is important in the debate to reiterate what my right hon. Friend the Secretary of State said, which has been repeated by other hon. Members—that as a result of the Health and Social Care Bill, the national health service will remain free, regardless of the ability to pay, and universally available to all citizens of this country. When we discuss improvements to the health service, it is outcomes that we need to focus on.

I believe that the biggest risk to the NHS—which, as the shadow Secretary of State has said, is one of this country’s most respected institutions—is allowing it to continue with inertia and carry on as it has done in the past. At best that is a sentimental and quaint way of looking at the future of our health service. At worst it is dishonest and dangerous for the future health care of each and every one of our constituents.

Certainly, the experience in my constituency shows that the health service desperately needs change, and that without it we risk the quality of care. In 2001 maternity services were removed from Crawley hospital, and in 2005 we lost our accident and emergency department. The risks that have been experienced since those events have increased immeasurably, but since we have started to move towards the provisions of the Health and Social Care Bill we have seen considerable improvements. Waiting times have reduced for my constituents. Local GPs and clinicians very much support the provisions of the Bill and have already joined together in a GP commissioning consortium. The elected local authorities, which are a welcome addition to local health debates, are engaged, which is great for improving future health care provision and ensuring the involvement not only of patients and clinicians but of elected councillors. Only last week I was delighted to open a new digital mammography unit at Crawley hospital and a new day unit being expanded there, so already there are improvements.

In my concluding remarks I want to talk about the inconsistency we have heard from the Labour party on the release of the risk register. As we have heard, the right hon. Member for Leigh (Andy Burnham), the former Health Secretary, and his predecessor in that job, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), rejected making the risk register available on a total of three occasions. The argument that things are now different is just nonsense; the only thing that is different is that Labour are now in opposition. They are using precious time in this place to call for the release of a risk register that, as my hon. Friend the Member for Kingswood (Chris Skidmore) has said, is now over a year old and no longer relevant, because we have moved on with—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I call Hugh Bayley.

[Hugh Bayley (York Central) (Lab)]

I believe that the Government should publish the risk register relating to the Health and Social Care Bill, and I wrote to the Secretary of State last year to urge him to do so. I received a reply from a junior Minister in the Lords that gave the arguments that were advanced to the Information Commissioner about why it would be dangerous, including the suggestion that civil servants would pull their punches if their risk assessments were made public. The commissioner rejected those arguments, but even after he made his decision they were still being advanced by the Government, and we heard them advanced once again in the Chamber today.

The Government have got themselves into an utterly impossible position. Dozens of constituents have written to me, and I have been told by people with very high posts in the NHS, including senior clinicians, senior mangers and professors of health policy, that the Government ought to publish the register. Underneath this all is a growing belief that the only reason the Government can possibly have for not publishing the register is that it would be politically embarrassing for them to do so. [Interruption.] The Minister shakes his head, but the hon. Member for Southport (John Pugh) drew an interesting parallel. When the former Speaker in the previous Parliament sought to overturn the Information Commissioner’s decision that the information on MPs’ expenses should be published, I tabled a motion stating that we should publish the figures for second-home allowances. This was before The Daily Telegraph exposed what it did, and, had the House published at that stage there would have been a public outcry, but there would not have been the loss of public trust in this House, which came when we were seen to be hiding the data and seeking to overturn a reasonable decision, made by the Information Commissioner, that it should be made public.

The Government have got themselves into precisely that position because if, after the tribunal, they are told that the information has to be published, the embarrassment that they know they will face, they will face, but they will face it against a background of public cynicism that would not have existed if they had published in the first place. If, however, they win their case and the information on the register is not published, the public will still believe that the Government have something to hide, so my advice to them is, “You’re in a hole, stop digging and publish.”

The Secretary of State said in his speech to the House that all the information that is relevant to the debate about the Bill is in the impact assessment so there is no need to publish the risk register. But if all that we—and the public—need to know about the Bill has already been published, the Government have nothing to lose by publishing the risk register.

If we look at the impact assessment, we see that from time to time the Government have redacted certain figures, so if one or two things, for some particular reason, had to be kept secret, they would still be able to publish 99.99% of the risk register, and they would satisfy this House and public opinion and build greater confidence.

There is public fear because there are inevitably risks to increasing competition in the provision of NHS services. Increasing competition is not in itself a bad thing. The Labour Government increased competition between acute London hospitals in coronary care and achieved better coronary care outcomes, but when we contract to private providers we inevitably create risk. I should not need to tell Government Members that risk is what private companies take, and that it is given as a justification for making profit and reward, but if risk applies to profit it can and does apply to the quality of patient care.

Several Government Members have said that they want to drive up the quality of patient care and to drive down the cost of care, but they will do so only if they publish comparable data on outcomes and cost for every supplier of service to the NHS. The Government need to commit to do that and to include it in the Bill; otherwise, members of the public will fear that the consequence of the reforms, forcing competition on the NHS, will mean that some care standards will fall, which is what happens when we have unregulated—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I call Ben Gummer.

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[Mr Marcus Jones (Nuneaton) (Con)]

I rise as a Member who is completely and utterly committed to, and supportive of, our NHS, and completely committed to transparency and openness in government. In that vein, I applaud the Government’s recent moves to extend transparency in the Department of Health, with probably more information being provided than ever before. There is more information on IT projects and departmental spending, to name but two of the many examples of the progress that the Department is making. A similar exercise is going on across government, which I applaud.

Although it can be a ghastly system to administer, I also fully support how the Independent Parliamentary Standards Authority expenses regime is made public. I probably will not get too many cheers for saying that, but I am completely and utterly committed to transparency.

However, we have to recognise that there are often situations in which all risk scenarios are discussed, including doomsday scenarios. We need to consider carefully whether to put all that information directly into the public domain, for fear of the panic and problems that it may cause. For example, if Members saw a copy of the Treasury’s risk register and the wrong information were put out, suggesting an increase in interest rates, growth problems, problems with the banking system and the austerity measures that may be needed in a doomsday scenario, that information would be in the public domain within seconds. It would probably mean the markets going into freefall, and we would all be rushing to the nearest cash machine to take our money out, if we had any left. No Government have released such information in the past, for obvious reasons. The doomsday scenarios that we have to consider are real risks, but they rarely occur.

There is no doubt that the risk register covering the Health and Social Care Bill will include certain such scenarios, and the Government’s approach is critical to developing policy not just on health care but across the piece. That was certainly the Labour party’s view when it was in government and when the shadow Secretary of State was in charge at the Department of Health. Under his stewardship, a very similar request to see the risk register was refused, and section 36 of the Freedom of Information Act was cited as the reason. [Interruption.]

[Madam Deputy Speaker (Dawn Primarolo)]

Order. Let us not have shouting across the Chamber. We need to hear the Member who is speaking. If other Members disagree with what is being said, that is what the debate is for.

[Mr Jones]

The same practice was followed by the shadow Secretary of State’s predecessor as Health Secretary, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson).

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[Several hon. Members]

rose—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. There are still 17 speakers who wish to participate in this debate and we have under an hour to go. May I ask Members not necessarily to take the full five minutes if they can possibly avoid it? [Interruption.] You can all sit down while I am speaking. May I also ask those who have already spoken to observe a self-denying ordinance and not intervene? They have had their chance.

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[Roberta Blackman-Woods (City of Durham) (Lab)]

I, like my hon. Friend the Member for Easington (Grahame M. Morris), want to begin by paying tribute to the staff of the NHS. I regularly go out with the emergency services and they do a truly amazing job on our behalf in what are becoming much more difficult circumstances. I also want to pay tribute to 38 Degrees and other campaigning organisations, including the British Medical Association and the Royal College of Nursing, for what they have done to give the public more information about these reforms. I do not think that that absolves the Government of their responsibility to publish the risk register, but it is important to put on record the work that those groups have done.

I also want to pay tribute to Anne Hutton and her husband, Neil, two of my constituents who are leading the campaign against the Health and Social Care Bill in Durham. Their street stalls in Durham marketplace are becoming legendary, and I have joined them on a number of occasions. It is clear from the people who visit the stall that the more people know about the Bill, the less they like it. That is probably why the Government will not publish the register: people do not like the opening up of more of the NHS to the private sector, they are worried about fragmentation not only in commissioning but in delivery, and they want answers from the Government that they are clearly not giving.

The second issue that people raise is that they simply cannot understand why the Government are wasting money on a top-down reorganisation of the health service when we are living in such difficult economic times and the NHS is being starved of the resources it needs to meet need locally.

The third issue is that there is absolutely no mandate for either political party in the coalition to undertake such a reorganisation. Unlike those on the Government Front Bench, I have been out and about, talking to people about the reforms. That has included attending consultation events held by shadow GP consortia. The lack of information on the risk of moving to new commissioning arrangements has been a key feature of these discussions, however, as has been the likely negative impact on health outcomes of the fragmentation of services. People are getting increasingly angry that they are being asked to give an opinion on GP consortia and new commissioning arrangements without having access to information that will help them make an informed decision.

It will not have gone unnoticed by my constituents—many have written to me, just as many have written to other hon. Members—that Ministers on the Government Front Bench have today sought only to rubbish Labour’s excellent record on the NHS, rather than explaining why they will not publish the register. I am sorry that the hon. Member for Winchester (Steve Brine) is not in his place, because I wanted to take him to task. I think he insulted those of my constituents who have written to me by saying that they were simply jumping on a bandwagon. Many of them have real concerns about the Bill. Those concerns should be addressed, rather than the people who write to MPs being rubbished.

I am pleased that the parties in government have raised the issue of Labour’s record, which I shall address in the short time remaining. We are proud of our record. We employed about 90,000 additional nurses and 40,000 extra doctors, and we built more than 100 additional hospitals. That is a good record. In my area we have a new hospital. In 2006, 94% of people were having their operations done in less than 13 weeks, but that waiting time is going up, with 90% now having them done in 18 weeks. Unfortunately, all that very necessary input into the NHS did not reduce health inequalities enough, but we did hit the target for the north-east of reducing health inequalities by 10%. I am really concerned that by not publishing the register we simply will not know how these reforms will exacerbate health inequalities.

[Madam Deputy Speaker (Dawn Primarolo)]

Order.

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[Priti Patel (Witham) (Con)]

Having listened to the majority of this afternoon’s debate, I wish to start by paying tribute to my right hon. Friend the Secretary of State and his team for putting the interests of patients over the vested interests that we have heard continually try to vilify him this afternoon and over the past few weeks.

Many of my constituents have been concerned about the irresponsible spin being peddled day in, day out by Opposition Members and opponents of the Health and Social Care Bill. Frankly, they have become frightened by the rumours, rhetoric and misinformation emanating from Opposition Front Benchers. One constituent forwarded to me an e-mail, circulated by an NHS trust, that had been authored by the shadow Secretary of State. It referred to “our battle to save the NHS” and called on NHS workers to support Labour’s campaign to drop the Bill and stop the “Americanisation” of the NHS. By sending out such a provocative e-mail, he is attempting to demean my constituents and insult their intelligence. The Opposition’s motion refers to informing parliamentary debate—[Interruption.]

[Madam Deputy Speaker (Dawn Primarolo)]

Order. The hon. Member for Broxtowe (Anna Soubry) has been told about shouting across the Chamber by Mr Speaker. Will she please stop doing it?

[Priti Patel]

Those misleading comments from the shadow Secretary of State do nothing to add credibility to the wider debate or the Opposition position. Let us not forget that they went into the general election with a commitment to cut the NHS budget.

The need for this Bill is nowhere more evident than it is in Witham town in the heart of my constituency. Witham has a chronic lack of health care provision, which leaves my constituents with no choice but to travel to either Chelmsford or Colchester for the many treatments they need. That is why the local town council, including Labour and Conservative councillors, and local residents are campaigning for better local services. That is at the heart of the Health and Social Care Bill and will emanate from it—[Interruption.] Opposition Members laugh and sneer, but my constituents have been affected disproportionately by the way the previous Government maladministrated the NHS.

What is more, because of the efforts of local primary care trusts, bureaucracy and red tape has taken money from the front-line care that my constituents could have benefited from—[Interruption.] It has a lot to do with this, actually. Instead of investing in front-line health care, which is exactly what the Bill is about, the money is going to recruit bureaucrats and managers. They might be part of the wider back-room team, but I am concerned about front-line care for my constituents. My constituents might not be important to Opposition Members, but they really are important to me. This is exactly why the Bill needs to be passed. This layer of bureaucracy needs to be scrapped. There is no doubt about it.

I find it astonishing that this afternoon we have heard Labour Members preach about publishing the risk register. Let us not forget that when they ran the NHS they embarked on widespread, top-down reform on a nearly annual basis, yet they never furnished this House, Parliament or the public with confidential risk registers, analysis or data produced by Ministers and officials, so how genuine and sincere are they? If Labour Members were sincere about the NHS, they would stop their scaremongering and misinformation and recognise that the Bill is about patients’ interests and putting patients first, not their own personal vested interests.