NHS Risk Register

Joan Walley Excerpts

Wednesday 22nd February 2012 Commons Chamber

[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.