Health and Social Care Bill

Baroness Thornton Excerpts

Monday 19th March 2012 Lords Chamber

[Baroness Thornton]

Is the noble Lord aware that all NHS organisations, strategic health authorities, PCTs and local authorities have risk registers and they publish them?

[Lord Birt]

I shall come to the risks of publication in a second. What are the means of creating an effective risk register? You need to involve those in governance and delivery and you need absolute candour and trust in the process. The consequence of making any risk register public is that it will be anodyne and the risks would simply cease to be managed, which is not in the public interest. I would hope that Governments of any persuasion would resist the notion of publishing any risk register. It is a matter of regret that one risk register in respect of Heathrow was published. It follows from that that I am unable to support the amendment.

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[Lord Deben]

My Lords, I would like to share with your Lordships’ House, for the first time, my experience of trying to deal with the complicated matter of BSE as it makes clear this distinction. I committed myself to total openness; I knew nothing that the public did not know. It was the only way in which one could be sure of obtaining people’s trust. Nothing was hidden. We did not have risk registers in the sense that we do today but it would be quite wrong to say that we had not considered every possible risk.

I put it to your Lordships that there is a difference between what you know and the extreme cases which you ask about in order to make sure that what you know covers everything that you could know. If in the middle of that terrible crisis newspapers more interested in their numbers of sales had accused the Minister of uncertainty because he had asked about risk—and I do not need to go into the kinds of risk you had to ask about—it would have been impossible to make what were already difficult enough decisions. It turns out now, 20 years later, that the decisions were right but at the time they could only be what you knew, and what I knew I shared.

Consider also what it meant for my civil servants. Do your Lordships really believe that your civil servants would be able to be as frank and direct and complete if they found themselves and their relationships being used as part of a battle? There were some terrible battles at that time between people who had all sorts of other interests. Compare this to another case, which out of kindness I will not be too detailed about. For many years in the ministry of agriculture a particular view had been upheld and we had been told that it was true. When I sought further information I discovered it was not. It was at that point that I tried to establish a very clear distinction between what you know and what you have to ask about which you do not know.

The risk register has come into our governmental structure largely from private business. I sit on the boards of a number of companies and chair several; in all those cases we have a risk register. That risk register is only useful if it is kept entirely to the company itself, because you want to ask questions of a very extreme kind. I ask the noble Lord, Lord Owen, whether he can imagine a Foreign Secretary who had to reveal his risk register asking what would happen if this or that Government did this or that, or what would happen if some Middle Eastern state refused to allow our ships into the Strait of Hormuz at this moment. Would any Foreign Secretary be able to be Foreign Secretary?

[Baroness Thornton]

Does the noble Lord not think that the Information Commissioner and the tribunal have taken those points into account?

[Lord Deben]

I would not dream of suggesting that I know what the tribunal and the commissioner have taken into account. All I am saying is that if they have taken it into account and come to this decision, I think it is wrong, and if they have not taken it into account they ought to have done. That is why I come to the point that the noble Baroness raised when she said that it is all very good because the National Health Service has risk registers and publishes them. They are not risk registers, not in the sense that a business has risk registers. They are not risk registers in the sense that the Foreign Office has risk registers. They are such risks as the National Health Service believes will stand being in the public domain. The risk registers that a Government have are a wholly different kind of thing and need to be. I believe that we must protect them.

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[Lord Armstrong of Ilminster]

My Lords, I support the noble Lord, Lord Fowler, and my noble friend Lord Wilson of Dinton in advising the House not to support the Amendment to the Motion. I do not want to go into any more detail on the risk registers. They need to be comprehensive and candid; if there is a risk of publishing them, the compilers will be less likely to make them as comprehensive and candid as they need to be in order to be of value. When the Information Commissioner suggests that, even if this is published, people will be equally comprehensive and candid in future, I am afraid that I think he is guilty of wishful thinking.

There is a process with this risk register. I understand that we have not yet seen the reasons for the decision reached by the Tribunal. When that is known, the Government have the right to appeal. I hope that they exercise it because the considerations against publication, as they have been stated more than once today, are very cogent. That process is likely to take a great deal longer than the three weeks that the Amendment of the noble Lord, Lord Owen, gives the Bill. The only sensible course now is to disentangle the business of the risk register and the business of passing the Bill, to let the Bill go forward and not to support the Amendment to the Motion.

[Baroness Thornton]

My Lords, little needs to be added to the eloquent and succinct arguments deployed by the noble Lord, Lord Owen, and built on by my noble friends Lady Jay, Lord Peston and Lord Grocott, and my noble and learned friend Lord Falconer. These arguments are in the best liberal tradition and should be supported by anyone who genuinely believes in openness and transparency.

Many people inside and outside the House have expressed concerns about the risk posed by this Bill, especially the implementation of the biggest-ever reorganisation of the National Health Service. It was those fears that led to the initial request by my right honourable friend John Healey 18 months ago. I do not think that even the noble Baroness, Lady Murphy, could imagine that it was a plot of some kind to delay the Bill at this point. I can assure the noble Baroness that that it is not the case. What is being considered here is a risk register maintained for the transition programme; for the work necessary to implement the changes in the Bill. That is going to be done together with delivering the Nicholson challenge, so there are huge challenges to our National Health Service. It is not the same as a departmental risk register, which might be closer to policy matters and advice, and the concerns expressed by many noble Lords, particularly those who have been Ministers and Permanent Secretaries.

My noble friend Lord Grocott is right. What is being asked for here are three weeks to see what this says. Surely the balance of public interest lies in disclosure, to enable consideration of this Bill to be as effective as possible. In short, we needed it in November to do our job adequately and we still need it. Noble Lords have said that it will be now out of date, but that is a question I asked many months ago and I was assured that it would not be the out-of-date register that would be available, but the most current. I say to those representatives of Permanent Secretaries in your Lordships’ House that the last time they engaged with this matter—never with the Bill, but with this matter—I quoted “Yes Minister” at them. I shall be less elevated this time. I shall use the Mandy Rice-Davies defence and say, “Well, they would say that, wouldn’t they?”.

I agree that it is time to move on. The issue is simple enough; we need to understand the risks in order properly to consider the Bill. We did need them. We have time to take this matter in hand. The answers are very clear and we should support the noble Lord, Lord Owen.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, as ever I am grateful to the noble Lord, Lord Owen, for speaking in such clear terms to the amendment he has tabled. I am equally grateful to other noble Lords who have contributed to this debate, on both sides of the argument. At the heart of this, I suggest that the noble Lord, Lord Owen, is putting forward two propositions. The first is that the Government have concealed the nature of the risks associated with the Health and Social Care Bill and therefore the House has a right to be made aware of what the department’s transition risk register contains. The second proposition is that the Government’s refusal to publish the risk register is inherently improper under the terms of the Freedom of Information Act. In other words, the alleged sin of concealment on the part of Ministers is compounded by an unreasonable obduracy in not complying with the decision of the Information Commissioner and now the First-tier Tribunal. It will not surprise the House to hear that I fundamentally reject both propositions. First, the suggestion that the Government have consciously set about concealing the risks associated with the NHS—

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This is not Second Reading. It is not the time to grind axes. It is time to reflect on the past six months, to await the consideration that the other place will give to the substantial efforts that have gone on in this Chamber and to look forward to the close engagement between the Government and all our key stakeholders on how we can collectively make the most of the opportunities that the Bill presents. I will oppose the noble Baroness’s amendment, and I strongly urge noble Lords to do likewise.

[Baroness Thornton]

My Lords, the time has come for a vote on this matter. I add my own thanks to all noble Lords for the work that they have done on the Bill. I pay tribute to the huge efforts that have been made and the commitment that noble Lords show to doing their job as legislators. I thank my own support on the Front Bench, my noble friends Lord Hunt, Lord Beecham, Lord Collins and Lady Wheeler. I could not have been better supported.

Unlike the Minister with a cast of thousands, I have had a small but perfectly formed team of about three, led by Jessica Levy in the opposition office and with my intern Tom Woodford keeping my papers in good order. However, we on these Benches have also been supported and sustained in our consideration of the Bill by literally thousands of people across the country. I say to the noble and learned Baroness, Lady Butler-Sloss, that it is actually up to the Government what they do about the Bill if they lose this vote.

Perhaps the Minister might agree that this parallel universe that we inhabit in your Lordships’ House, where deals are done and amendments are crafted, is hardly the same as the real world for those who will now manage commissioning, make budget cuts, deploy staff, recruit accountants and try to make sense of the competition and integration strategies and to make the Bill work. I pay tribute to those people.

I feel like saying to noble Lords, “Hands up those who have received letters and e-mails supporting this Bill”. I had two, among a torrent of e-mails, tweets, texts and letters asking us to drop the Bill or dramatically change parts of it. We have received thousands of expressions of concern. Noble Lords have reacted variously to that, and I think that the noble Lord, Lord Greaves, is right to say that in some respects parties have reacted well to this but not in others. It is clear that there are thousands if not hundreds of thousands of people watching us and what we do, and it is for those people—the nurses, the doctors, the healthcare assistants, the patients, my mum with her COPD, my cousin whose daughter has just been diagnosed with a brain tumour, and the hundreds of thousands of people who have signed petitions, sent letters, gone on demonstrations and continue to make our beloved NHS work—that I wish to test the opinion of the House.