NHS Risk Register

Ben Gummer Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

I am sorry, but I cannot confirm that, short of being able to do that calculation very quickly in my head, but the simple fact is that a £67 billion commitment was made for the future. It is staggering that the right hon. Member for Leigh (Andy Burnham) and his colleagues used to say, “Look, we’re spending more than ever on the NHS,” and, “Look at all these brand new hospitals”—102 hospital projects. One might have thought that they were spending more than ever in order to build the hospitals. It turned out that they were not even building the hospitals with the money that the taxpayer was providing. The last Government left an enormous post-dated cheque for the NHS to deal with after the election, when they left a deficit for the whole of this country—a country mired in debt by a Labour Government and an NHS with a £67 billion debt around its neck.

There is one more risk that the Labour Government left us with: the escalating cost of bureaucracy. The right hon. Gentleman was in charge of the NHS in the year before the election. The cost of bureaucracy in the NHS in that year went up 23%. At the same moment that he was telling the NHS that there was going to be a £20 billion black hole, he launched the so-called Nicholson challenge, to save up to £20 billion. We did not launch it; it was launched when he was—[Interruption.] Actually, it was launched when the right hon. Member for Kingston upon Hull West and Hessle was the Secretary of State, but it was pursued when the right hon. Member for Leigh was the Secretary of State, and at the same time he allowed the cost of bureaucracy to go up by 23%.

[Ben Gummer (Ipswich) (Con)]

There is a further risk to my constituents in Ipswich as a result of the PFI scheme in the east of England, which is that services had to be stripped out of Ipswich hospital in order to provide funding and patient flow through Norfolk and Norwich hospital, which was the largest PFI scheme at the time.

[Mr Lansley]

It was, and it was staggering—my hon. Friend will remember this—that all the difficulties associated with building the Norfolk and Norwich PFI were evident to the last Government and yet they carried on. They carried on signing up to PFI projects that were frankly unsustainable, including, for example, the project in Peterborough—which, sadly, we had to include in the support that we are offering to unsustainable PFIs—which was signed off although Monitor had written to the Department to say that it did not support the project. I do not know, but perhaps the shadow Secretary of State wants to say something about that.

From my point of view, that is why we need to reform the NHS. It is why we were in the position of undertaking the work as the risk register was being published, because we had to avoid all those risks, reform the NHS and move forward to put doctors and nurses in charge, give patients and the public more control, strengthen public health services and cut bureaucracy.

--- Later in debate ---

[John Healey]

I do not think that the Minister was listening to the point that I just made: on the Freedom of Information Act, the decisions that Ministers make—I hope—as we did, and the decisions that the Information Commissioner would make on a challenge, depend on the specific information and, in this case, the risk register at stake. This case is unprecedented and exceptional and the Information Commissioner has come to this view because we are faced with such huge upheaval. It involves the biggest reorganisation and the longest legislation, at a time of the tightest financial squeeze for 50 years. Furthermore, this reorganisation was explicitly ruled out in the Conservative manifesto and in the coalition agreement. That is why, less than two months later, the huge upheaval of the White Paper was so unexpected, and why the NHS and the civil service were so unprepared for what they are now being forced to implement.

[Ben Gummer]

rose—

[John Healey]

I will not give way again; I have given way twice. The hon. Gentleman has spoken and has not been here for the whole debate.

Risk has been at the heart of the concern about the NHS reforms right from the outset. When I led an Opposition day debate from the Dispatch Box in November 2010, I described the reorganisation as

“high cost and high risk; it is untested and unnecessary.”—[Official Report, 17 November 2010; Vol. 518, c. 908.]

The lack of evidence and lack of confidence in how well the Government were prepared to manage the risks was the major cause of the growing concern among the public and professionals and in Parliament in the late autumn of 2010 and the winter of 2011. That alarm has only grown. It was first expressed by the all-party Select Committee report of December 2010, and reiterated in its January 2011 report, which concluded:

“The Nicholson challenge was already a high-risk strategy and the White Paper increased the level of risk considerably without setting out a credible plan for mitigating that risk.”

Not only is this reorganisation unprecedented and therefore exceptional; the NHS as an institution is exceptional. We all need the NHS. We trust it when we are most fearful, and we utterly depend on it when we are most vulnerable. That is why it matters so much to people, and why there is an unprecedented and exceptional level of public interest in any changes to the NHS and especially any risks to the NHS. The plans are unprecedented in their nature, their scale, their pace and their timing. That means that there is exceptional concern over the risks associated with their implementation. That is why there is an exceptional case for releasing this transition risk register. The Information Commissioner has had the benefit of assessing the risk register, and he has stated:

“There is a very strong public interest in disclosure of the information, given the significant change to the structure of the health service”.

There are two other factors that reinforce the case for, and the public interest in, the publication of the transition risk register. First, the story of this reform is a masterclass in poor policy making. It has been misjudged and mishandled from the outset. Good policy making normally involves policy consultation, followed by legislation and implementation. The Government have turned that on its head. First, we had implementation ahead of any legislation, followed by a forced pause to consult on the policies when they encountered so much resistance. That all adds to the risks and to the public interest in and the case for the disclosure of the risk register.

The Department of Health has a poor track record on risk assessment, on the use of evidence in policy making and on policy delivery. When the Cabinet Secretary did his first capability review of the Department, he concluded:

“Management of risk across the delivery chain is weak. There is no formal linkage between risk registers and mitigation strategies held by the Department and those in the delivery chain.”

Two years later, when the capability review was repeated, many of the same problems still applied, and the Department was again flagged in the review as at an amber state of concern—[Interruption.] Yes, that was under the previous Government. My point is that the Department of Health has a poor track record on planning and dealing with management risk, which is why it is so important to publish the risk register.

Clearly, in a short debate such as this, we cannot nail all the arguments that the Government are trying to put up. Suffice it to say that the Information Commissioner has heard them and has judged that the register should be released. The arguments will be tested in court on 5 and 6 March at the Information Tribunal and I shall give evidence to that tribunal. All I am asking for—and all the motion is asking for—is what the Government have promised. Today, on the Treasury website, one can see 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.”

That is what we are asking for.

--- Later in debate ---

[Ben Gummer (Ipswich) (Con)]

Your predecessor in the Chair, Madam Deputy Speaker, noted that this has been an intemperate debate, and so it has, reflecting a wider debate about the NHS that has become increasingly intemperate with every day that has passed. The reason is in large part the terrible myths, put about by the Opposition and their co-agitators in the health care unions, which we have heard again perpetuated in the leadership, and in the sponsor and proposer of the motion today.

As any demagogue will know, it is always difficult to present a travesty of the truth in a calm and reasonable voice, and that is precisely why the manner in which the Opposition have conducted this debate, and the entire debate about the NHS, belies the fact that they are interested not in a calm and reasonable debate, but merely in smearing the Government and in bringing into disrepute this long-needed reform of the NHS.

The inconsistency of the Opposition’s position is evident even in the motion, which asks for the Government to respect the decision of the Information Commissioner, yet that is based on an Act, the Freedom of Information Act, which the previous Government brought in, and on which I have to say the Conservative party was wrong. This is not just about the decision of the Information Commissioner; the Act describes a process that must be respected in its entirety. We are in the middle of a quasi-judicial tribunal, and it would have been right and respectful to the spirit of the Act if the Opposition had waited until the decision-making process was complete before making this point. Far from dragging it out, as the former shadow Health Secretary, the right hon. Member for Wentworth and Dearne (John Healey), claimed earlier, and as the current shadow Health Secretary says from a sedentary position, the Government have brought forward the tribunal date to expedite it. That is entirely consistent with the Government’s track record on transparency.

Yesterday, in the Justice Committee, we took evidence from Maurice Frankel, who is well known to Labour Members as a champion of freedom of information. He said that we as a Government are doing reasonably well, and that we are certainly ahead of Australia, Canada, the United States and Sweden. When the hon. Member for Kingston upon Hull East (Karl Turner), for whom I have great respect, asked how FOI in England and Wales compares with that in similar jurisdictions, Professor Hazell of the UCL constitution unit said that we compare very well and have a rather more generous regime than in Australia and Canada. We are now improving on that as a Government.

[Karl Turner]

Would the hon. Gentleman say that the question was put in relation to this particular issue? He is rather suggesting that it was, but it certainly was not.

[Ben Gummer]

The hon. Gentleman is entirely correct. I am trying to put in the round the position of this Government on freedom of information—that is, respecting the Act brought in by the previous Government in going through the necessary process, and in the meantime showing greater transparency in their dealings with the public than any previous Government. One need not look only at the transparency inherent in departmental business plans and departmental spending above £5,000. The risk registers quoted by the shadow Secretary of State, which he revealed with a flourish as though he were some latter-day Carl Bernstein, came from the websites of local PCTs and were revealed as a result of transparency initiatives by this Government. In their motion and in their attack on the Government, the Opposition have shown inconsistency that reveals their true intent.

The shadow Secretary of State repeatedly called into question the Government’s motivation for not releasing the risk register. Their motivation is precisely the same as that which drove him to refuse to release a risk register in 2009. In turn, I question his motivation for calling this debate and picking a fight on this matter. It is not, as the motion might suggest, to inform the public debate, but to fuel the misinformation campaign that has been the basis of the Opposition’s attack on the NHS reforms; to take out of context statements from a document that, by its very nature, considers risks rather than benefits; and to use that in an effort to undermine a programme of reform that has the support of increasing numbers of health care professionals in my constituency to whom I have spoken, and is showing real results.

[Jonathan Ashworth (Leicester South) (Lab)]

Will the hon. Gentleman give way?

[Ben Gummer]

I will not, if the hon. Gentleman does not mind.

That is not responsible opposition; it is dangerous opposition. The Leader of the Opposition goes around lecturing everyone about responsible capitalism, but he might like to start at home and have a look at responsible opposition. In undermining the ability of the machinery of government to operate correctly, the Opposition undermine not only this Government’s, but successive Governments’, ability to make decisions on our constituents’ behalf. Wiser colleagues of the shadow Secretary of State might rue the day that they wanted all risk analysis by Departments to be made public, thereby unbalancing our debates. That would have made impossible even the timorous reforms of Tony Blair in academies and in foundation trusts.

Let me inform the shadow Secretary of State of the effects that these health reforms are already having in my constituency. We have better care for the elderly that stops them going into hospital and allows them to be treated at home, and a drugs budget that is being kept under control for the very first time. He turned down a heart unit in my local hospital; we are now having it built at a cost of £5 million. The reforms will deliver real benefits to my constituents in Ipswich, and I wish that his constituents could have received them too.