Health and Social Care Bill

John Healey Excerpts

Tuesday 20th March 2012 Commons Chamber

[John Healey (Wentworth and Dearne) (Lab)]

This Standing Order No. 24 debate is an important statement from Parliament to the Government. We expect better from the Executive, and the public demand better, as they have shown in e-mails, surveys and petitions.

This afternoon, the House is being asked to agree to the longest ever NHS legislation and to back the biggest ever reorganisation of the NHS. We are being asked to accept that from Ministers who have lost twice in law and still keep secret the risks that they are running with our NHS. This is a legal and constitutional argument; it is not a political argument. This is not about being in favour of or against the Health and Social Care Bill; it is about the public’s right to know the nature and scale of the risks that the Government are running with their NHS, and it is about their elected Parliament’s right to know about those risks when it is asked to legislate—as we are being asked to do—on their behalf. We are elected to the House to legislate by the people, for the people.

Nothing is more precious to people than our NHS. We all need the NHS. We depend on it utterly when we are at our most vulnerable and fearful. The NHS in England employs more than 1.4 million people, treats 3 million patients each week and provides each of us, throughout our lives, with some of the best health care in the world, free at the point of need. That is why it matters so much, and that is why people mind so much about the plans for the NHS.

The NHS, as an institution, is exceptional, and the public interest in anything that puts it at risk is exceptional, too. The current reform plans are exceptional in their nature, scale, timing and speed, and concern about the risks to the NHS is exceptional. That was expressed by all NHS experts, professional groups and patients in the consultation on the White Paper, and it was expressed by the Health Committee in its reports in December 2010 and January 2011. Risk was, is and will continue to be at the heart of the concerns about the biggest ever internal NHS reorganisation. That is why I made my original FOI request for the transition risk register in November 2010. That is why I refused to accept the Department’s refusal to release it. That is why I went to court this month to help to argue the case against the Government’s appeal.

Good government demands that Ministers get the best and fullest policy advice from officials, and it requires some safe space in which to make major policy decisions, but I am not asking for the release of policy advice. Risk registers are management, not ministerial, documents. They do not contain policy advice or accounts of policy discussions. They derive from major policy decisions, and the White Paper of July 2010 set out the main policy decisions three and a half months before the first transition risk register was compiled.

Nor am I asking for the release of information that will bring to a halt the Government system of risk management. It did not do so in 2008 when we were forced to release the risk register for the runway at Heathrow. Nor am I asking for the routine disclosure of risk registers. I am asking for the non-routine disclosure of this risk register because of the exceptional case and the balance of public interest that is in favour of disclosure and not in favour of withholding, just as the Information Commissioner and now the Information Tribunal—both of whom have had the benefit of having seen this risk register—have decided.

We are at the very end of the eleventh hour of this Bill’s 14-month forced passage through this House. Beyond today, the Government must decide whether they will respect the law and release the risk register. This is part of the reason why the Government have lost the support of NHS staff and lost the confidence of NHS patients, and have now lost the trust of the British public.

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[Mr Dorrell]

I will give way to my hon. Friend in a moment.

The important principle—it is always an important principle in the law—is certainty: the certainty that people can be clear whether the advice or the register that is being given to a Minister will remain confidential or whether it will be published. My concern is that this motion is seeking to move that line retrospectively, in a way that two distinguished former heads of the home civil service clearly believe would prejudice the space that the right hon. Member for Wentworth and Dearne said was important.

[John Healey]

rose—

[Mr Dorrell]

As I have quoted the right hon. Gentleman, I shall give way to him.

[John Healey]

The right hon. Gentleman is making an argument for blanket secrecy. However, this is less about his view or even mine; rather, the point is that the Information Commissioner and the judge, along with his two wing members on the tribunal, all of whom have seen and studied the risk register, have determined that, in their legal judgment, the balance of interest lies in publishing and not withholding it. Those are the facts of this case.

[Mr Dorrell]

The right hon. Gentleman is correct, but he does not go to the end of the process, because the reasons for that decision have not yet been published. The House is therefore being asked to make a decision on the basis of a judgment that has not yet been published, which cannot be right.

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[Grahame M. Morris]

Absolutely; good point, well made. If the Government had nothing to hide and were not concerned, they would have published the contents of the risk register. We have had a flavour of the contents of the other risk registers that have been compiled at strategic and other levels, and I believe that the Government are concerned about them.

We know that the Bill will increase the risks to the national health service. Indeed, the chief executive of the NHS, Sir David Nicholson, told the Health Select Committee, of which I am a member:

“I’ll not sit here and tell you that the risks have not gone up. They have. The risks of delivering the totality of the productivity savings,”—

that is, the Nicholson challenge; the £20 billion—

“the efficiency savings that we need over the next four years have gone up because of the big changes that are going on in the NHS as whole.”

It is clear that local and national risk registers, as well as the strategic risk registers to which we have had access, have highlighted serious concerns with patient safety, increased costs, the break-up of care pathways—which we have seen on Health Select Committee visits—as well as competition harming integration, about which the Committee was very concerned, and the specific risks during the transition stage.

[John Healey]

Will my hon. Friend also confirm that, in that session on 23 November 2010, Sir David Nicholson stated that the scale of the proposed change was enormous, and that it was beyond anything that anyone in the public or private sector had witnessed? That is why the risks involved in the reorganisation are so great, as is the imperative for the House and the public to know about them.

[Grahame M. Morris]

Absolutely; I completely agree with my right hon. Friend. These are huge structural changes to a beloved organisation, and it is in the public interest that we know precisely what is in the transition risk register.

A little while ago, I tabled early-day motion 2659, which called on the Health Secretary

“to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill reforms in advance of Report Stage in the House of Lords”,

so that we could have proper scrutiny in the Lords and in the House of Commons. We have not seen what is in the transition risk register, but we are aware of the existence of other risk registers. While the Health Secretary has been fighting tooth and nail to prevent the publication of the transition risk register and, in the process, hiding the risks to the NHS in England, other NHS bodies and clinical groups have been compiling their own risk registers into the impact of the Health and Social Care Bill.

One such body is the Faculty of Public Health, the body for specialists in public health, which is a joint faculty of the three Royal Colleges of Physicians of the United Kingdom. I am grateful to Professor Clare Bambra, from the north-east, and Professor John Ashton, from the north-west, for providing this information. In a letter to The Independent, Professor Lindsey Davies, the president of the Faculty of Public Health, outlined his concerns about the pressure that clinicians were now under from their employers for criticising the Government’s plans to reform the NHS. He wrote:

“Public health professionals have the right and duty to speak out on issues which they perceive as threatening the health of the population they serve”.

The bunker mentality of the Health Secretary, and his determination to silence clinical and public opposition, have astounded the country as a whole.

In response to the Department of Health’s refusal to publish its own strategic risk assessment of the impact of the Bill, the Faculty of Public Health has undertaken its own study, in which it has highlighted a number of significant risks, not least the potential for a postcode lottery. It states:

“Clinical Commissioning Group flexibility to determine services will lead to an increase in geographical variation in service provision.”

It identifies the possibility of costs being pushed up, and states that the

“development of more overt market mechanisms, and the greater role for the independent sector in the provision of healthcare is likely to increase the overall cost of providing healthcare.”

It also raises concerns about issues of quality as a consequence of the reforms. If the transition risk register indicates that, we should know about it.

The delaying tactics employed by the Secretary of State are, to my mind, holding Parliament in contempt. He should publish and employ no further delaying tactics. Reports that Tory-Lib Dem Cabinet members banged their Cabinet table in delight and glee at the prospect of the health Bill finally being rammed through and becoming law at the end of today leave a very sour taste in the mouth. I urge all Members to support this motion and get the risk register published.

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[John Healey]

The right hon. Gentleman argues that one of the principal reasons why the Government have not accepted the decision to disclose the risk register is that information about risks has been disclosed to the public already. The Information Commissioner considered that. Will the right hon. Gentleman recognise that, in his legal decision, the Information Commissioner said that he did not accept the argument that the Government advanced, and that he considers that

“disclosure would go somewhat further in helping the public to better understand the risks associated with the modernisation of the NHS than any information that has previously been published”?

[Mr Lansley]

The right hon. Gentleman knows perfectly well that in the debate on 22 February we made it clear that we felt that our appeal to the tribunal was justified, and indeed it was, because we won at appeal on the question of the publication of the strategic risk register. The Government’s objection and my objection to the publication of the risk register is precisely that risk registers are not written for publication. They are written in that safe space within which officials give advice to Ministers.