NHS Risk Register

John Healey Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

I will give way to the right hon. Member for Wentworth and Dearne (John Healey).

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

In January 2011, the Secretary of State's Department set up the audit and risk committee with a commitment to publish minutes of its meetings within three months. The last note of any meeting of that committee published on its website is from February 2011. Is that international leadership or the same cloak of secrecy that prevents him from publishing the transition risk register?

[Mr Lansley]

When the right hon. Gentleman was a Minister he and his colleagues never published such information, so I will not take any lessons on that. As a Treasury Minister, he refused to disclose a Treasury risk register.

Let me explain what risk registers are for, because an hon. Lady on the Opposition Benches keeps chuntering about them. A high-level risk register, such as those being considered by the tribunal on 5 and 6 March, is a continuously reviewed and updated document that enables officials, advisers and Ministers to identify and analyse the risks of, and to, particular policies. Risk registers present a snapshot of the possible risks involved at any one time. Their purpose is to record all risks, however outlandish or unlikely, both real and potential, and to record the mitigating actions that can ensure that such risks do not become reality.

For such a register to be effective and for it to serve the public interest, those charged with compiling it must be as forthright as possible in their views. The language of risk registers must be forceful and direct. That is essential for their operation, to enable Ministers and officials fully to appreciate those risks and to take the steps to mitigate them, or to redesign policy to avoid them.

It is important to note that such high-level risk registers are different to the risk registers of the organisations from which the shadow Secretary of State quoted, such as the risk registers of strategic health authorities. The latter concern operational matters and not matters of developing and designing policy, and they are written with publication in mind—they are intended to be published. By contrast, there are very clear reasons why Departments—under not just this Government, but previous ones—do not publish their high-level risk registers while they are still active and while policy development is ongoing.

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[Andrew George (St Ives) (LD)]

It is a pleasure to follow the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock). In fact, I approach this debate in many of the same ways as the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson). I will not speak for seven minutes on the suggestion that the debate is a sideshow, but if the information were published it would, as the right hon. Gentleman suggested, be unlikely to change a single mind on the issue. That reflects our heated debates and the entrenched positions that people inevitably take. It is the nature of the process of politics—

[John Healey]

rose—

[Andrew George]

I will give way in a moment. I want to make my philosophical point first. In contrast to academia, which begins with a question or inquiry, gathers evidence and comes to a considered opinion, the pity of politics is that we begin with a prejudice and backfill with the evidence that suits our case.

[John Healey]

The hon. Gentleman said that the publication of the transition risk register would not change one mind, but does he not accept that the Information Commissioner, who has read and studied the risk register, is of the view in his decision notice that it would aid public understanding of the reforms and help to reassure the public that all the risks have been properly considered?

[Andrew George]

I agree with the right hon. Gentleman and I have signed the early-day motion supporting the release of the register. The biggest ever reorganisation of the NHS is being undertaken and it is best not to do that in the dark. It is best to have as much information available as possible. I am not suggesting that we are completely in the dark—[Interruption.] I am just saying that it is best to cast as much light as possible upon the information, so that we can have an informed debate, rather than a semi-informed one. He makes a good point about that.

I guess that publication will eventually result from this process, and I do not think it will help the Secretary of State or the Government if it is dragged out rather than conceded. If and when that happens, the Opposition and people who oppose the Bill will inevitably highlight worst-case scenarios and throw them at the Government, and the Government will inevitably look at the best-case scenarios. The nature of political debate will not be improved by this process, but I hope that debate will be better informed.

Much of the debate throughout the course of the Bill’s progress, a process in which I have been involved through the Select Committee and elsewhere, has been about trying to anticipate the effects of the reforms. It would be far better to try to anticipate these things on the basis of the best information given by people who are inside the service and providing that advice. That is why I believe the risk register should be published. The impact assessment perhaps represents the selected highlights of that process. [Interruption.] The Secretary of State may intervene on me, if he wishes to do so.

The underlying core concern—this is in the nature of how we examine these issues—is about whether publishing the risk register will negatively affect the technical delivery of Government policy and services or whether it will affect the political prospects of a party or those in government. The nature of this debate means that we assume that if publication is being resisted, it will have political rather than technical consequences. Obviously, if we thought that the risk register’s publication would have technical consequences for the effective delivery of government—that is the primary point that the Secretary of State is advancing—we would clearly need to think carefully about the release of such information.

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[Chris Skidmore (Kingswood) (Con)]

It is a pleasure to follow two of my fellow Health Committee members. The Chairman of the Committee wrote to the Secretary of State on 16 November 2011 to ask for the Government’s reasons for not publishing the risk register. In response, the Secretary of State wrote:

“It is important to understand that the risk register sets out all of the potential risks identified by the Department of Health for the entire range of areas for which it is responsible. These include financial risks, policy risks and sensitive contractual risks. It is a means by which the Department focuses on risks and acts to mitigate them. If the Department were to release risk registers in the future, there is a genuine possibility that the most significant risks will no longer be recorded, and no solution or mitigating action will therefore be identified. Any action that could deter staff from articulating and addressing business risk to their senior management and ministers carries with it the potential for highly damaging consequences.”

That is remarkably similarly to an answer given in Hansard on 23 March 2007 by the right hon. Member for Leigh (Andy Burnham) in response to a parliamentary question tabled by my hon. Friend the Member for South Holland and The Deepings (Mr Hayes). The right hon. Gentleman stated that the Department’s risk register dealt with

“emerging risks to the Department’s programme and the national health service, and what can be done to control and mitigate these risks. It also informs discussions between the Department and top management in the NHS about addressing key issues in policy, resourcing and service management. Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers. We therefore cannot agree to place a copy of the current version of the register in the Library.”—[Official Report, 23 March 2007; Vol. 458, c. 1191W.]

We had a similar example on 31 July 2008, when the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) responded to a freedom of information request by stating:

“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”

The Department of Health also refused a freedom of information request for copies of any presentations given by the director of public health concerned with the risk of not delivering on targets to reduce health inequalities, so it is not only risk registers that the Department has previously refused to reveal.

Members have talked today about the risk register in apocalyptic terms, as though it were a document that should remain within the confines of MI5 or MI6. The Health Minister, Earl Howe, has revealed details of the broad issues that are covered by this risk register. I should like to read them out, so as to set the debate properly in context. They include:

“how best to manage the parliamentary passage of the Bill and the potential impact of Royal Assent being delayed on the transition in the NHS; how to co-ordinate planning so that changes happen in a co-ordinated fashion while maintaining financial control; how to ensure that the NHS takes appropriate steps during organisational change to maintain and improve quality; how to ensure that lines of accountability are clear in the new system and that different bodies work together effectively, including the risk of replicating what we already have; how to minimise disruption for staff and maintain morale during transition; how best to ensure financial control during transition, to minimise the costs of moving to a new system, and to ensure that the new system delivers future efficiencies; how to ensure that future commissioning plans are robust, and to maximise the capability of the future NHS Commissioning Board; how stakeholders should be engaged in developing and implementing the reforms; and finally, how to properly resource the teams responsible for implementing the changes”.—[Official Report, House of Lords, 28 November 2011; Vol. 733, c. 16.]

[John Healey]

The hon. Gentleman is right to draw the House’s attention to that fact, but does he accept that that is information that has not been published elsewhere and that the Secretary of State’s argument that the impact assessments that have been published are sufficient therefore simply will not wash?

[Chris Skidmore]

It is interesting that the right hon. Gentleman raises that point, because Earl Howe was mentioning the transition risk register, which is continually updated. That is an important point, because the appeal to the Information Commissioner to release the risk register was made on 29 November 2010, in the autumn when the register was live. The Information Commissioner made his ruling based on the fact that there was an issue of public interest at the time of the request. If the risk register is released today, it will be the risk register from autumn 2010 rather than that from February 2012. That is the moment when the wheels come off the bandwagon. The Opposition are asking the Information Commissioner to release the risk register from autumn 2010, not the risk register from February 2012. The risk register that would be released is that from the time of the White Paper, before the changes were made and before the listening exercise. It is complete nonsense. If the document was released, it would be out of date, inaccurate and would scaremonger among the population.

[John Healey]

So the hon. Gentleman agrees with Lord Henley, the Minister in the House of Lords, who told the House in January that if the Government lose the appeal next month they will publish not only the risk register from November 2010 but the updated risk registers, too?

[Chris Skidmore]

The Government do not have to publish the updated registers on the basis of the Information Commissioner’s verdict, which was on the autumn 2010 register. That is the Information Commissioner’s advice that is referred to in the motion. The Opposition are asking for an out-of-date document—we might as well give up and go home.

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[George Hollingbery (Meon Valley) (Con)]

I want to begin by challenging something that was said by the shadow Secretary of State, the right hon. Member for Leigh (Andy Burnham), when he opened the debate. He has also shouted it several times from a sedentary position, and indeed he intervened on my hon. Friend the Member for Dartford (Gareth Johnson) a moment ago to make the same point. He keeps saying “It is a different register”.

Let me quote, at some length, what the right hon. Gentleman said earlier: “This led my predecessor”—the right hon. Member for Wentworth and Dearne (John Healey)—“to initiate a freedom of information request for the transition risk register. I wish to point out that my right hon. Friend did not request the full departmental risk register, which was subject to a similar request in 2009”, which was, indeed, released by the right hon. Gentleman. The right hon. Member for Leigh went on: “There are three crucial differences between the situation and the subject of today's debate. They would do well to listen because the Prime Minister got his facts wrong at Prime Minister's Question Time. The first important difference is that this relates to a different document. This debate is about the transition risk register, not the strategic risk register”.

I may have misinterpreted this, because it is not my key area, but let me refer briefly to the decision notice issued by the Information Commissioner. Paragraph 16 about the “Scope of the request” states:

“At the internal review stage the public authority referred to two separate risk registers which it said were relevant to the request and held by the department – the ‘risk register centred on the Health and Care Bill’ and the ‘strategic risk register'… For the avoidance of doubt, the Commissioner wishes to state that he agrees with the public authority…and that it is the strategic risk register which should properly be seen as falling within the scope of the request.”

In short, the document that is requested now, and the one that the right hon. Member for Leigh refused to release in 2009 are, as adjudged by the Information Commissioner, exactly the same document. The right hon. Gentleman may wish to refer to that later, and I am entirely happy for him to do so. If I have got it wrong, I am happy to be corrected.

[John Healey]

I am grateful to the hon. Gentleman for giving way because, uncharacteristically, I think that he has got it wrong. The Information Commissioner’s notice considered two different freedom of information requests: one for the transition risk register from me, and one for the strategic departmental register from a journalist from the Evening Standard. The decision notice was a decision on both those registers. My right hon. Friend the Member for Leigh (Andy Burnham) is absolutely right: in our motion and the debate, we are talking about a different document—different in nature—from the one to which he referred and the one which was relevant in 2009.

[George Hollingbery]

I am grateful to the right hon. Gentleman for clearing up part of this, but I think that the decision that was made by the Information Commissioner was on the strategic risk register and its release. No doubt we can discuss that later, but I am grateful to him for his intervention and for clearing that up.

More generally, we must consider whether the Bill has been properly assessed both in the House and outside by many people. There are 443 pages of closely worded analysis on the impact of the Bill, and the impact assessments cover every possible aspect imaginable, including risk management and the risks associated with the new Bill. That information has been in the public domain for many months, and I do not honestly believe that there is anything to be gained by issuing further risk registers that may scare a number of people about the things that they have to consider. The risk register would add very little. The answer, basically, is that it is an expedient hook on which to hang a debate: to raise again in the House a topic that has been raised a great many times—quite rightly, in many ways, as many amendments have been made to the Bill. However, the quality of speeches from the Opposition demonstrates to me at least that the point of the debate was not to discuss the risk register but to use it as a hook on which to hang a particular viewpoint.

It is well known that when the right hon. Member for Leigh was Secretary of State he refused to release the risk register. I have examined that, and I was going to quote him further at length, but the House has heard that quote several times today, so I will not trouble hon. Members with it again. The argument that he made then was a sensible one, and it remains sensible now. Do we really believe that it is good for the Government to make public all their plans for the management of every conceivable risk that they might encounter? Some of those risks will scare people rigid, and I do not honestly believe that that is the right use for the strategic risk register.

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

It is good to follow the hon. Member for Meon Valley (George Hollingbery), although he is wrong to say that this debate is simply a device for having a bigger debate. The motion is very simple and I had hoped that it would command wide support across this House, because this is not about being for or against the NHS Bill, or about being for or against the NHS reorganisation. The matter before us is whether we are for or against good government and the proper accountability of government to the public and to Parliament. A more open Government—a Government required to be more accountable—must raise their game and are more likely to be a better Government.

The Prime Minister said as much in the first month after the last election. He said that

“we’re going to rip off that cloak of”—

Government—

“secrecy and extend transparency as far and as wide as possible. By bringing information out into the open, you’ll be able to hold government and public services to account.”

Not for the first time, people are looking to the Prime Minister now to honour the promises he made, especially on the NHS. I have to say that 15 months after I made the original freedom of information request and 13 months after the Government introduced the NHS Bill, they are now dragging out the refusal to comply with the Information Commissioner in a way that prevents the public from getting a better understanding of the plans and prevents Parliament from doing our proper job of legislating well and legislating wisely.

[George Hollingbery]

rose—

[John Healey]

I will give way to the hon. Gentleman, as I have followed his speech.

[George Hollingbery]

I wonder whether the right hon. Gentleman could provide the House with a single example of where, in the transition of a Bill, a risk register of this sort has been used to inform the House’s debate. He may well be able to do so, and I would be grateful if he could.

[John Healey]

There is the precedent of releasing a programme risk register connected with the third runway at Heathrow, but the principle of the Freedom of Information Act is that each case is different—every risk register is different. The reason why this case is important and exceptional and why the Information Commissioner has, on balance, required the Government to disclose rather than withhold the risk register is that the Government’s health reforms are the biggest ever reorganisation in NHS history; that the legislation is the longest in NHS history; and that it has been introduced at a time of unprecedented financial pressure.

[Mr Simon Burns]

Will the right hon. Gentleman confirm for the House that, on behalf of Lord Boateng, he refused to release a risk register when he was a junior Treasury Minister?

[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.

Oral Answers to Questions

John Healey Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend, who clearly understands that NICE is responsible for the methods it uses in the development of its guidance and that it is undertaking a review of its appraisal methods. I expect that that will be published for consultation this year. NICE should issue final guidance only after careful consideration of the evidence and public consultation with stakeholders, including patient and professional groups.

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

It is sometimes hard to follow the Secretary of State as he can get lost in his own jargon. Just to be clear: if NICE says that a drug should be available to patients on the NHS wherever they live and whatever their clinical commissioning group, will they get it? Can he give that guarantee today?

Oral Answers to Questions

John Healey Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Lansley]

I would like to take this opportunity not least to commend the work that the chief medical officer has done this year in encouraging health care workers to have their seasonal flu jab. The latest figures are that 29% have done so, compared with 11% at the same point last year. We heard earlier from my hon. Friend the Member for Kettering (Mr Hollobone) how well Kettering has done, and there are hospitals that are demonstrating that a higher level is entirely achievable. I urge staff across the NHS to have their flu vaccination. It is the ethical thing to do, not least to provide protection to their patients.

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

One of the things that makes the problem of winter pressures much greater is the NHS coping with the biggest reorganisation ever. The public have a right to know the risks that the Government’s policies are placing on our NHS. The Information Commissioner agrees and has judged that the Secretary of State must now release the risk assessments and register for his NHS reorganisation. Will he now obey the law and end his 12-month cover-up?

[Mr Lansley]

I have been very clear and published all the cost-benefit and risk information relating to the modernisation of the NHS, and the impact assessment was published when the legislation was presented to the House of Lords.

Hinchingbrooke Hospital

John Healey Excerpts

Thursday 10th November 2011 Commons Chamber

[Mr Burns]

Under the agreements that have been signed, the consultants are there to manage an NHS hospital treating NHS-only patients and to ensure the finest quality of care for the NHS. That is the safeguard.

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

At a time when progressive reform of our NHS requires greater collaboration and integration of services, with more being done for patients beyond the hospital, cannot Ministers see that that will be much harder to achieve when Hinchingbrooke hospital and others have been handed over to a private company with a single commercial interest in maximising profits and getting more patients into the hospital? Cannot they accept that it is a privatisation and that it is wrong in principle and wrong in practice?

[Mr Burns]

If it is privatisation—I utterly reject the claim that it is—and if it is wrong, it was the right hon. Gentleman’s Government who gave the powers to do this in their legislation and it was his successor as shadow Health Secretary, when Secretary of State, who instigated the proceedings to bring this about. It is a little odd for the right hon. Gentleman for Wentworth and Dearne (John Healey), for narrow, grimy and party political reasons, to try to blame us for something that he and his party instigated.

Oral Answers to Questions

John Healey Excerpts

Tuesday 18th October 2011 Commons Chamber

[Mr Burns]

I am grateful to the hon. Lady. I, too, recognise the small number of organisations that are reporting financial challenges. The Department is continuing to work with strategic health authorities to ensure that those organisations have robust plans in place for financial recovery, while ensuring the quality of services for patients.

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

On the subject of financial pressures on hospitals, does the Minister recall the circular to hospitals from Monitor that was smuggled out on the eve of the royal wedding, which raised the requirement for efficiency cutbacks on hospitals from 4% to 6.5%, which is more than £1 billion in this year alone? Will he admit that the service cutbacks that we are seeing in many hospitals around the country are deeper, as that circular confirms, directly because of the Government’s policies?

[Mr Burns]

No, I do not recognise that, because the figure that the right hon. Gentleman has used is an upper calculation, not an actual figure. I say to him that we are making efficiency savings, and that trusts should be cutting not front-line services but inefficiency, waste and excessive management, and reinvesting every single penny in front-line services.

Health and Social Care (Re-committed) Bill

John Healey Excerpts

Wednesday 7th September 2011 Commons Chamber

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

This Government and this Bill are giving health reform a bad name. The Bill is unwanted and unnecessary. It is reckless to force through the biggest reorganisation in NHS history at the same time as finances are tight and pressures on the health service are growing. The big quality and efficiency challenges that the NHS must meet, and the changes that the NHS must make for the future, will be made harder and not easier because of the Bill.

I thank my shadow ministerial team, who have done such a sterling job. I also thank my Back-Bench colleagues who served on not just one, but two Public Bill Committees, and all my Back-Bench colleagues who have given such strong support to the Opposition in the House.

I should also pay tribute, if I may, to the stamina of the ministerial team, but I say this to them: we will not let up now, because in 13 years of Labour reform and investment, people saw huge improvements in the NHS, the lowest ever waiting times, and the highest ever patient satisfaction; but in this the first year of this Tory-Lib Dem Government, people have instead seen the NHS starting to go backwards. They have seen the Prime Minister breaking the very personal promise that he gave at the election to protect the NHS. As we heard at Prime Minister’s questions today, he and his team are in denial about the damage that his Government are doing to the NHS and the scale of criticism and opposition to it.

The Prime Minister’s pause to listen was supposed to have won back public support and confidence among NHS staff. He failed. It is true that changes have been made to the Bill, but they make the NHS plans more complex, more costly and more confused. Millions of pounds will be wasted on new bureaucracy when it could and should be spent on patient care.

As the House is asked to approve the Bill on Third Reading tonight, the essential elements of the Tory long-term plans to see the NHS broken up as a national public service, and set up as a full-scale market, are still in place. First, on the market, a new regulator will enforce competition law on the NHS for the first time, and it will have the power to fine hospitals 10% of their turnover for working together. The Office of Fair Trading will oversee mergers if a hospital’s turnover tops £70 million. There will be no cap on the number of private patients that are treated in our NHS hospitals as NHS patients wait longer. That means more legal challenges from competition lawyers, more privatisation and the closure of NHS services and hospitals. It means that much of the planning, collaboration and integration that is at the heart of the best of our NHS today will be very much harder, and perhaps illegal, in future.

Secondly, the Bill betrays a founding principle of the NHS. For 65 years, people have known that the Secretary of State and the Government whom they elect are responsible for the definition and provision of a comprehensive health service. The Bill passes that power to at least 250 local commissioning groups and stops the Secretary of State directing them as to the services that they must provide for patients. It makes the Government unaccountable for what health services are provided and unable to guarantee patients a universal service. It is a fundamental and founding principle that our NHS is a national service, equally there for all, whoever we are, wherever we live. This Bill takes the “national” out of the national health service.

In January on Second Reading, I said of the Government’s NHS plans that the more people learn about them, the less they like them. That was true then and it is true now, despite the many changes to the legislation. These are the wrong reforms at the wrong time, driven by the wrong ideology. Labour will continue to lead the challenge against these plans in the other place, and we will oppose this Bill tonight on Third Reading.

[Several hon. Members]

rose—

Oral Answers to Questions

John Healey Excerpts

Tuesday 12th July 2011 Commons Chamber

[Mr Lansley]

Yes, I do indeed welcome that. We all know that last year, this year and in future years, increases in the NHS budget in real terms will not be the kind of real-terms increases we saw in the past, but they will be real-terms increases. What we are already seeing in the NHS—we saw it last year—is that with a 2.2% increase in cash spending, there is none the less an ability to sustain, and in many respects improve, performance.

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

In spite of the spin, the truth is that the Prime Minister’s personal promise to give the NHS a real rise in funding is being broken. It is not just how much that counts; it is how well the money is spent. Today it is one year to the very day since the Health Secretary launched the Government’s plans to “liberate” the NHS. He told the House:

“we will phase out the top-down management hierarchy”—[Official Report, 12 July 2010; Vol. 513, c. 663.]

He said that he would reduce “the number and cost” of NHS-related quangos, so why is he setting up the new national commissioning board, set to employ 3,500 people, when even its chief executive says that it

“could become the greatest quango in the sky we have seen”.

Why is the right hon. Gentleman setting up more than 500 public bodies in the NHS when 161 do the job now, and why are the Government wasting precious NHS funding on the biggest reorganisation in history, when it could and should be spent on patient care?

[Mr Lansley]

Since the election we have reduced the number of managers in the NHS by more than 4,000 and increased the number of doctors by more than 2,000. The NHS commissioning board—I did not hear from the right hon. Gentleman whether he supports it—is part of our strategy to give the NHS not only local clinical leadership but national leadership through it. The functions covered by the board are currently undertaken by something approaching 8,000 staff; the number delivering those functions in future will go down to 3,500 staff, so the reduction in administration will be dramatic.

[John Healey]

We had plans to reduce bureaucracy, which were published, and we also said that the Government should keep Labour’s waiting time guarantees for patients, which the Health Secretary told the House a year ago today were “unjustified” targets, which he would remove. The Prime Minister has now promised to keep waiting times low, but after one wasted year of NHS reorganisation by the right hon. Gentleman’s Government, an extra 25,000 patients a month are waiting more than four hours in accident and emergency departments, an extra 12,000 patients a month are waiting more than six weeks for tests, and an extra 2,300 patients a month are waiting more than 18 weeks to get into hospital for the treatment they need. The NHS deputy chief executive has called the rise in long waiting times this year “unacceptable”. Does the Health Secretary agree?

[Mr Lansley]

As we said in the NHS constitution, we do not intend patients to be waiting for more than 18 weeks. [Hon. Members: “They are!”] The April figures show that we met the operational standard, which is that more than 90% of admitted patients and more than 95% of non-admitted patients should be treated within 18 weeks. The right hon. Gentleman’s analysis of waiting times did not include the fact that the average time for which patients waited for treatment in April was 7.7 weeks, down from 8.4 weeks in May 2010. The average time for which patients wait is being reduced.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

I am grateful to my hon. Friend, because she has been campaigning on this issue for more than a year, and rightly so. Work is being done on the whole issue of PFI and the NHS to ensure value for money. Given her concerns, I would be more than happy to meet to discuss this particular case.

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

I want to say to the Health Secretary directly that it is a disgrace how he and his Ministers have ducked responsibility for reassuring more than 30,000 elderly and vulnerable residents whose homes may be at risk because of the financial crisis at Southern Cross. Today’s urgent question is the second time in a month that this House has had to drag Ministers to Parliament to explain what is going on. Southern Cross is set to close down completely by October. Will the Secretary of State give a commitment this afternoon to the residents of Southern Cross, their families and 40,000 staff that Ministers will in future show leadership and make public statements to this House?

[The Minister of State, Department of Health (Paul Burstow)]

I am grateful to the right hon. Gentleman for his question. He will of course know that when the first urgent question was asked, the Government had already provided a written ministerial statement setting out these matters in great detail, and we are happy to answer the questions that hon. Members will want to put in the urgent question later on. We have also said throughout that we do not help the welfare or interests of residents by an ongoing running commentary on these matters.

Reform of Social Care

John Healey Excerpts

Monday 4th July 2011 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

With permission, I wish to make a statement on the reform of social care.

The coalition Government have from the outset recognised that reform of the care and support system is needed to provide people with more choice and control and to reduce the insecurity faced by individuals, carers and their families. By 2026, the number of people over 85 years old is projected to double. Age is the principal determinant of need for health and for care services. It is further estimated that in 20 years’ time, 1.7 million more people will have a potential care need than do today.

People often do not think about how they might meet the costs of care in later life. They assume that social care will be provided free for all at the point of need, but since the establishment of the welfare state that has never been the case. Currently, people with more than £23,250 in assets, often including their home, face meeting the whole cost of care themselves.

The cost of care can vary considerably and it is hard for people to predict what costs they may face. The average 65-year-old today will face lifetime care costs of £35,000, but as the Commission on Funding of Care and Support notes, costs are widely distributed: one in four will have no care costs, but one in four will face care costs of more than £50,000 and for one in 10 it will be more than £100,000. The lack of understanding of how the system works and uncertainty about costs means that it is difficult for people to prepare to meet potential care costs, and there are currently few financial products available to help them. This means that paying for care can come as a shock to many families and have a severe impact on their financial security.

Change is essential. That is why we took immediate action last July by establishing the Commission on Funding of Care and Support, which was tasked with making recommendations on how to achieve an affordable and sustainable funding system for care and support for all adults in England. In response to its initial advice, we allocated an additional £2 billion a year by 2014-15 in the spending review to support the delivery of social care as a bridge to reform. This represents a total of £7.2 billion of extra support for social care over the next four years, including an unprecedented transfer of funds from the NHS to support social care services that will also benefit health.

Since then we have taken forward wider reform. Last November we published our vision for adult social care, setting out our commitment to a more responsive and personalised care and support system that empowers individuals and communities, including the objective that all those who wish it should have access to a personal social care budget by 2013. In May, after three years of work, the Law Commission published its report on how to deliver a modernised statute for adult social care. Making sense of the current confused tangle of legislation to deliver a social care statute will allow individuals, carers, families and local authorities to understand more clearly when care and support will be provided.

Andrew Dilnot’s report comes at the same time as the final report from the palliative care funding review, which I received last week. Tom Hughes-Hallett and Sir Alan Craft have made an excellent start in looking at this complex and challenging issue. We want to see integrated, responsive and high-quality health and care services for those at the end of life. We will now consider the review team’s proposals in detail before consulting stakeholders on the way forward later this summer. We will also consider how best to undertake substantial piloting, as recommended in the report, in order to gather information on how best to deliver palliative care services.

We are also responding to events at Southern Cross, which have caused concern to residents in Southern Cross care homes and their families. We welcome the fact that Southern Cross, the landlords and the lenders are working hard to come up with a plan to stabilise the ownership and operation of the care homes. We have also made it clear that we will take action to ensure proper oversight of the market in social care. That is why we are seeking powers through the Health and Social Care Bill to extend to social care the financial regulatory regime that we are putting in place in the NHS, if we decide that that is needed as part of wider reform.

A central component of those wider reforms will be the long-term funding of care and support. Over the past 12 months Andrew Dilnot, who chairs the Commission on Funding of Care and Support, together with the noble Lord Warner and Dame Jo Williams, has engaged extensively with many different stakeholders. They have brought fresh insight and impetus to this most challenging area of public policy. We welcome the commission’s excellent work and its final report. I would like to thank Andrew Dilnot, Lord Warner and Jo Williams for their work, which has made an immensely valuable contribution to meeting the long-term challenge of an ageing population.

The report argues that people are unable to protect themselves against the risk of high care costs, leaving them fearful and uncertain about the future. The commission’s central proposal, therefore, is a cap on the care costs that people face over their lifetime of between £25,000 and £50,000—it recommends £35,000. Under the commission’s proposals, people who cannot afford to make their personal contribution would continue to receive means-tested support, but it proposes that the threshold for receiving state help for residential care costs would rise from £23,250 to £100,000. People would make some contribution to their general living costs in residential care, but the commission suggests that this should be limited to between £7,000 and £10,000.

The commission also proposes the following standardised, national eligibility for care, which would increase consistency across the country; universal access to a deferred payments scheme for means-tested contributions; improvements in information and advice; improved assessments for carers and better alignment between social care and the wider care and support system; and considering changing the means test in domiciliary care to include housing assets. The commission makes recommendations about how as a society we can organise and fund social care. We will consider the recommendations as a priority.

The commission recognises that implementing its reforms would have significant costs. In the current public spending environment, the Government will have to consider the recommendations carefully against other funding priorities and calls on our constrained resources. The commission’s recommendations present a range of options, including on the level of a cap and the contribution that people make to living costs in residential care, which could help us to manage the system and its costs. We intend to engage with stakeholders on those issues, including on the trade-offs involved.

Reform in this area will have to meet a number of tests, including whether the proposals would promote closer integration of health and social care and increased personalisation, choice and quality; support greater prevention and early intervention; whether a viable insurance market and a more diverse and responsive care market would be established as a result of the proposals; what is the level of consensus that additional resources should be targeted on a capped costs scheme for social care; and what a fair and appropriate method of financing the additional costs would be.

The Government have set out a broad agenda for reform in social care. We want to see care that is personalised; that offers people choice in how their care needs are met; that supports carers; that is supported by a diverse and flourishing market of providers; that has a skilled work force who provide care and support with compassion and imagination; and that offers people the assurances they expect of high-quality care and protection against poor standards and abuse. Andrew Dilnot’s report was never intended to address all those issues, but it forms a vital part of that wider agenda.

To take the matter forward, we will work with stakeholders in the autumn, using Andrew Dilnot’s report as the basis for engagement and as a key part of the broader picture. That engagement will look at the fundamental issues for reform in social care, such as improving quality, developing and assuring the care market, integration with the NHS and wider services, and personalisation. We want to hear stakeholders’ views on the priorities for action from the commission’s report and on how we should assess the proposals, including in relation to other priorities for improvement in the system. As the right hon. Member for Wentworth and Dearne (John Healey) and I have discussed, the Government will engage directly with the official Opposition to seek consensus on the future of long-term care funding.

We will set out our response to the Law Commission and the Dilnot commission in the spring. There will be full proposals for the reform of adult social care in a White Paper and a progress report on funding reform. It remains our intention to legislate to this effect at the earliest opportunity. The care of the elderly and of vulnerable adults is a key priority for reform under this Government, and I commend this statement to the House.

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

I thank the Health Secretary for the copy of his statement, and for making it to the House himself.

We welcomed the Hughes-Hallett report last week and we welcome the Dilnot report on social care today. The Dilnot report sets out important recommendations on capping the catastrophic costs of care; lifting the wealth threshold for state help; immediate free support for children with care needs on becoming adults; universal disability benefits continuing as now; a standard national needs test; and better information and advice, led by local councils.

The important elements in the Dilnot report are similar to the plans that we set out in government in the care White Paper in March last year. Our concern was and is to protect the one in 10 people who have to pay more than £100,000 for the cost of their care in older age; our concern was and is to protect hard-working people on modest incomes, who are more likely to care for their relatives and a lot less likely to get any help in doing so; and our concern was and is to protect people from the lottery of where they live, rather than what they need, determining their assessment for care and the level of support.

It should be a cause for celebration and pride that one in five of us in this country who are alive today will live to 100, and that our children are likely to spend a third of their lives in retirement. Instead, too many of us approach our older age in fear—fear that we will need care that will not be there; fear that our savings will be wiped out by the open-ended costs of care; fear that we cannot protect our families from that risk; and fear of becoming a burden or being left alone.

Today’s report from Andrew Dilnot is a starting point, but it is what the Government do with it now that counts. My right hon. Friend the Leader of the Opposition has made a big offer to the Prime Minister to put politics aside and work to see a better, fairer and lasting system of support for our older and disabled people in England. Labour is willing to talk to and work with the Government and all other parties to do so, because we know that any new system of care must give all of us long-term confidence about what will be on offer for us and our families as we plan and prepare for older age.

That requires the Prime Minister to give the lead, because discussing and agreeing an affordable, sustainable system and how we pay for it involves important parts of Government beyond the Health Secretary. It requires the Prime Minister to give a guarantee that the Government will not kick Dilnot’s recommendations into the long grass, because as Dilnot says, the system needs “urgent and lasting reform”. If the Government are serious, we are serious; and if they are serious, we need to hear more. Dilnot recommends a White Paper by December this year, so why are the Government already saying that it will be spring before publication?

Any solution is a solution only if it is available and affordable to everyone, so what assurance can the Government give that the voluntary insurance protection will be an option for all? Dilnot states that the current system is

“under extreme strain, and people are experiencing tightening eligibility and reduced care packages.”

Do the Government accept his conclusion that additional public funding for the means-tested system is urgently required?

The corporate crisis at Southern Cross is causing extreme anxiety for many people living in its homes. Do the Government accept that there is a case for regulating business standards as well as care standards, to give people greater confidence in their care?

The Secretary of State said that he would engage directly with me. I thank him, but this is a big challenge not just for him but for the Chancellor and the Prime Minister. Will the Government accept that cross-party talks are required across Government? This is a once-in-a-generation chance, and the House and the public will need to hear from the Prime Minister himself to believe that his Government are determined, as we are, to build a better, fairer and lasting system of care in our country.

[Mr Lansley]

I am grateful to the right hon. Gentleman for the welcome that he gives to the report by Andrew Dilnot and his colleagues, and indeed to the report that Tom Hughes-Hallett and Alan Craft produced on palliative care. They are both immensely valuable.

The right hon. Gentleman rightly says that it is important for us to move beyond many of the suggestions that have been made in the past. One of the essential purposes of the Dilnot commission was to seek something that was affordable and sustainable, that met tests of choice, fairness, value for money and ease of understanding, and that would be sustainable for the longer term. Dilnot has responded immensely well to the issues that we put to him, but that is part of a broader process of reform. In that sense we have not waited for Dilnot, because we have made progress on the wider aspects of reform. Now we have to ensure that we bring them together in a way that is coherent and works to deliver long-term, sustainable reform across the whole social care sphere.

The right hon. Gentleman rightly points to the fact that we inherited a fragile system in which there had already been a substantial tightening of eligibility and loss of care and support, with increasing levels of unmet need. That was precisely why, in an interim report last year, Andrew Dilnot and his colleagues asked us to make additional resources available in the spending review. I set out in my statement precisely how we have done so.

The concerns in relation to Southern Cross are particular to that company, and the Minister of State, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), has made clear to the House how we are interacting with those who are involved with the company. We are making it very clear to the public—I reiterate it today—that we are prepared to act to secure the interests of individuals if there were any threat to their position in care homes. We are working with the Association of Directors of Adult Social Services and local authorities to ensure that those contingencies are in place. What I said today in the statement, and which people have not previously recognised, is that as early as last year we set out in the Health and Social Care Bill that we were prepared for regulatory powers to be available to ensure the future viability of social care providers, as we intend to do in relation to health care providers.

Let me may make one final point. I believe that my statement makes it absolutely clear that we will engage on the basis of the Commission on Funding of Care and Support, and that we will do so on a timetable that will work and that gives stakeholders and the public, and indeed the Government and the Opposition, an opportunity to come forward with a consensus. I discussed that timetable with Andrew Dilnot, and he is clear that he supports it. It will lead to a White Paper in the spring and an associated progress report on funding reform. I am clear that that assures stakeholders that we will take this forward as a priority.

Health and Social Care Bill (Programme) (No. 2)

John Healey Excerpts

Tuesday 21st June 2011 Commons Chamber

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

Last week, we had a political fix on the Government’s health Bill. This week, we have a procedural fix. The way the Government are dealing with the national health service and with the House of Commons is a disgrace. Last week, the Prime Minister was forced to backtrack in some areas to buy off the many critics of his health plans. This week, to head off proper parliamentary scrutiny of his plans, he refuses to put the whole Bill back into Committee.

The changes announced last week to the Prime Minister’s NHS changes are not a proper plan for improving patient care, or for a better or more efficient NHS. Those aims could largely be met without legislation, and certainly without the huge risk and cost of the biggest reorganisation in NHS history. The big quality and efficiency challenges the NHS must meet for the future will be made harder, not easier, by the reorganisation and the announcements last week.

The NHS has seen a wasted year of chaos, confusion and incompetence from the Government. Today, it is clear from the motion that that will continue. The motion signals the onset of sclerosis in the health service. The Bill will mean that the NHS is deeply mired in more centralisation, more complex bureaucracy and more wasted cost in the years to come. There will be five new national quangos and five new local bodies doing the job that one—the primary care trust—does at present.

Today, the motion signals that the essential elements of the Tories’ long-term plan to see the NHS broken up as a national service and set up as a full-scale market are still intact.

[John Pugh (Southport) (LD)]

Regardless of the merits of the Bill, does the right hon. Gentleman accept that what the NHS and the public want is to find out whether the House supports it? They do not want to prolong the agony.

[John Healey]

What the public and patients want is to get to the bottom of the changes the Government said they were bringing in. They want us to do our proper job of scrutinising the detail, and for that we need the time to do so, with the full Bill recommitted to the Public Bill Committee. Even some of the hon. Gentleman’s Lib Dem colleagues are beginning to see through this. Yesterday, the hon. Member for St Ives (Andrew George) wrote that the Government

“leaves many of the previous concerns—about the risk of a marketised NHS, a missed opportunity to better streamline health and social care and a lack of accountability—still unresolved.”

[John Pugh]

But does the right hon. Gentleman accept that those concerns will all be covered in the areas of the Bill to be discussed? Nothing will be left out.

[John Healey]

I do not normally quote the hon. Gentleman’s party leader, but a few weeks ago, the Deputy Prime Minister said:

“It is very important that MPs, who represent millions of patients up and down the country, have the opportunity to really look at the details that we are proposing…I have always said that it is best to take our time to get it right rather than move too fast and risk getting the details wrong.”

The Prime Minister has stopped listening to the Deputy Prime Minister, and that is exactly the mistake the Government are making with the motion.

[Grahame M. Morris (Easington) (Lab)]

Does my right hon. Friend agree that despite the Conservatives saying that they are against cherry-picking, that is exactly what they are doing? They are cherry-picking the elements to be referred to the Bill Committee. Clause 60, for example, which deals with Monitor and the regulation of the NHS, is not included. There are so many inconsistencies in the Bill.

--- Later in debate ---

[John Healey]

One of the deep flaws in the motion is that it is hard to see how the Committee can properly consider the changes that the Government say they want to make without being able to consider the consequences for other parts of the Bill and other parts of the NHS.

[Andrew Percy (Brigg and Goole) (Con)]

Moderation in these debates is always to be welcomed. Surely the right hon. Gentleman must see that he cannot have it both ways. He cannot complain about the money and the length of time spent on the listening exercise. When I was in the House last week to listen to the statement, he said it was time to get on and get it done, yet he argues that we should drag the process out for even longer. He cannot have it both ways.

[John Healey]

I can and I have. This is a reckless and needless reorganisation, which has led to confusion and chaos over the past year. If the House does not help to get the legislation right by doing its proper job, that chaos and confusion and the wasted cost—money that should be spent on patient care—will continue.

[Kevin Brennan]

Is it not an abuse to use this procedure, which is very rare? According to the Library, the most recent example of a partial recommittal of a Bill to the same Committee was the Mineral Workings Bill in 1951 because of an inadvertent error in the original Committee stage. It is totally wrong to use the procedure. The whole Bill should be recommitted.

[John Healey]

My hon. Friend has a point. What is wrong is a partial recommittal of the Bill, because the Bill requires full scrutiny of the full provisions with the changes that the Government propose to make, once we have had a chance to see them.

The Health Minister and Government Members urge us to go faster. Everything this Government have done with their NHS reorganisation has been rushed and reckless, and the motion signals that they are set to repeat the mistake by railroading the Bill through at breakneck speed and denying this elected House its proper role in scrutinising the legislation. Labour tabled a motion a month ago for the full Bill to be reconsidered in Committee, for more time to look at the detail of the amendments and for proper scrutiny and debate in Committee.

[Ian Lucas]

Is it not important to take into account the written answer that I received to the named day question—a very good question—that I put to the Minister? He gave me a very good answer: far from recommittal being a consequence of the NHS Future Forum, the Government were consulting on these very amendments to the Bill prior to the announcement that they made on the consequences of the Future Forum. Is not the entire process a sham?

[John Healey]

My hon. Friend is right. We know that the Prime Minister is a PR man. We know that he was forced to call the pause and that, when he did, he was looking for a PR solution. The answer that my hon. Friend flushed out of the Government stands that up clearly.

To return to the motion before the House and the question whether the Bill requires, as we argue, recommittal in full, parliamentary precedent demands this, proper parliamentary scrutiny demands this and, above all, our responsibility to NHS patients to try to get the legislation right demands this. The parliamentary precedent is clear, as my hon. Friend the Member for Cardiff West (Kevin Brennan) said. The House of Commons Library tells me that the last time a Bill was recommitted in part was 60 years ago. In response to a point of order, the Health Minister cited the Planning and Compulsory Purchase Bill of 2003 as a precedent. The Labour Government recommitted that Bill in full and gave Committee members the whole of the summer recess to examine the detailed amendments before the Committee sat again. Why are the Government not acting as they should and as Labour acted in government with that Bill?

The NHS, the legislation and the changes to the changes announced last week are all complex, and the House cannot do its proper job unless the Government’s changes to one clause can be considered alongside the consequences for other parts of the Bill and for the health service. How can the promised changes to Monitor’s role be considered without looking at all 29 clauses dealing with its licensing powers? The House cannot do its proper job unless all the areas that the Government say they will change are recommitted.

Why are the clauses on the failure and designation regime for hospitals, which the Government say they will change, not covered in the recommittal motion? The House cannot do its proper job, and organisations cannot give proper evidence to the Bill Committee, unless all the amendments are tabled in good time, so why will there be only two full working days between the tabling of amendments and the Committee sitting? The House cannot do its proper job unless the Bill Committee has sufficient time for scrutiny.

The 64 clauses in the recommittal motion took 45 hours of debate in Committee last time. The Government are now cutting that time in half. The Minister said that he expects 160 amendments in Committee. That allows less than 10 minutes for each amendment that the Government table, and that is before the Opposition table our own amendments and before taking into account the six schedules that are being recommitted.

[Mr Simon Burns]

As a former Minister, the right hon. Gentleman knows about taking legislation through Committee. Given that a number of the 160 amendments will be technical and drafting amendments, will he please tell the House how many minutes he needs for each technical and drafting amendment to be debated in Committee?

[John Healey]

The Minister, his colleagues and the Prime Minister have broken their word so often so far on the NHS that we cannot take at face value what the Minister says. We will wait to see and we will judge what he does when we see the detail of the amendments that he tables.

[Mr Dave Watts (St Helens North) (Lab)]

Does not this go to the root cause of the way the Government are dealing with the NHS? They are dealing with it piecemeal. At present we have an integrated health service. Does not their approach show that they want to break that NHS up?

[John Healey]

My hon. Friend is right. What the Government are doing is reckless and rushed. The NHS is still intact, but what they are doing will break it up as a national service, as we know it.

[Several hon. Members]

rose—

[John Healey]

I give way for the last time to the hon. Member for Strangford (Jim Shannon).

[Jim Shannon (Strangford) (DUP)]

The Committee had 28 meetings, 100 Divisions and hour upon hour of debate. That has been reflected in public opinion. The electorate who put us all in the House to represent their views are clear about what they want: a full debate in Committee, not a short-term Committee. They want it to sit until 18 October, not until 14 July.

[John Healey]

The hon. Gentleman served on the Public Bill Committee. I hope he will continue to serve when the Bill is recommitted. He is right. The public and NHS patients expect us to do our best to get the legislation right. To do that, we require the detail, we require the time, and we require the whole Bill to be recommitted.

The House cannot do its proper job without an impact assessment. The current assessment says that

“the full benefits of these changes will not be realised unless there is a change to regulation to promote competition”.

The Government now say that this policy will be altered. There will also be greater bureaucracy, longer time scales and more bodies with more complex accountabilities. Both the supposed benefits and the stated costs have changed, yet the Government tell us that the new impact assessment will not be published until the Bill reaches the Lords.

How much will this reorganisation now cost? How much can the Government now claim this will save? What are the risks? Why has the Health Secretary being blocking my freedom of information requests to release the official risk register since November? Why will the Government not welcome and allow full scrutiny of the Bill in view of the significant policy changes they say they are making? Why are they preventing this elected House from doing its proper job of fully scrutinising the legislation?

If the programme motion is passed, more will need to be done on Report in this House and during the Bill’s passage through the other place. We will continue to oppose this reckless and needless NHS reorganisation, lead the detailed scrutiny this legislation requires and speak up as patients start to see their NHS services suffer again under the Tories. We will oppose the motion.

[Several hon. Members]

rose—

NHS Future Forum

John Healey Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

Thank you very much, Mr Speaker.

We will further clarify the duties on the NHS commissioning board and clinical commissioning groups to involve patients, carers and the public. Commissioning groups will have to consult the public on their annual commissioning plans and involve them in any changes that would affect patient services.

One of the main ways in which patients will influence the NHS is through the exercise of informed choice. We will amend the Bill to strengthen and emphasise the commissioners’ duty to promote patient choice. The choice of any qualified provider will be limited to areas where there is a national or local tariff, ensuring that competition is based solely on quality. The tariff development, alongside a best-value approach to tendered services, will safeguard against cherry-picking.

Monitor’s core duty will be to protect and promote the interests of patients. We will remove its duty to promote competition as though that were an end in itself. Instead, it will be under a duty to support services integrated around the needs of patients and the continuous improvement of quality.

It will have a power to tackle specific abuses and restrictions of competition that act against patients’ interests. Competition will be a means by which NHS commissioners are able to improve the quality of services for patients.

We will keep the existing competition rules introduced by the last Government—the so-styled “Principles and rules for co-operation and competition”—and give them a firmer statutory underpinning. The co-operation and competition panel, which oversees the rules, will transfer to Monitor and retain its distinct identity. We will also amend the Bill to make it illegal for the Secretary of State or the regulator to encourage the growth of one type of provider over another. There must be a level playing field.

We will strengthen the role of health and wellbeing boards in local councils, ensuring that they are involved throughout the commissioning process and that local health service plans are aligned with local health and wellbeing strategies.

In a number of areas, we will make the timetable for change more flexible to ensure that no one is forced to take on new responsibilities before they are ready, while enabling those who are ready to make faster progress. If any of the remaining NHS trusts cannot meet foundation trust criteria by 2014, we will support them to achieve that subsequently. However, all NHS trusts will be required to become foundation trusts as soon as clinically feasible, with an agreed deadline for each trust.

We will ensure a safe and robust transition for the education and training system. It is vital that change is introduced carefully and without creating instability, and we will take the time to get it right, as the Future Forum has recommended. During the transition, we will retain postgraduate deaneries and give them a clear home within the NHS family.

The extension of “any qualified provider” will be phased carefully to reflect and support the availability of choice for patients. Strategic health authorities and primary care trusts will cease to exist in April 2013. By that date, all GP practices will be members of either a fully or partly authorised clinical commissioning group, or one in shadow form. There will be no two-tier NHS.

However, individual clinical commissioning groups will not be authorised to take over any part of the commissioning budget until they are ready to do so. Individual GPs need not take managerial responsibility in a commissioning group if they do not want to, and April 2013 will not be a “drop dead” date for the new commissioners. Where a clinical commissioning group is not able to take on some or all aspects of commissioning, the local arms of the NHS commissioning board will commission on its behalf. Those groups that are keen to press on will not in any way be prevented from becoming fully authorised as soon as they are ready.

I told the House on 4 April that we would secure proper scrutiny for any changes that we made to the Bill. In order to do that without trespassing on the House’s time to review the Bill as a whole on Report, we will ask the House to recommit the relevant parts of the Bill to a Public Bill Committee shortly.

Through the recommendations of the NHS Future Forum and our response, we have demonstrated our willingness to listen and to improve our plans; to make big changes, and not to abandon the principles of reform, which the forum itself said were supported across the service. However, we are clear that the NHS is too important, and modernisation too vital, for us not to be sure of getting the legislation right. The service can adapt and improve as we modernise and change, but the legislation cannot be continuously changed. On the contrary, it must be an enduring structure and statement, so it must reflect our commitment to the NHS constitution and values and incorporate the safeguards and accountabilities that we require. It must protect and enhance patients’ rights and services, and it must be crystal clear about the duties and priorities that we will expect of all NHS bodies and local government in the future.

Professor Field’s report says that it is time for the pause to end. Strengthened by the forum’s report and recommendations, we will now ask the House to re-engage with delivering the changes and modernisation that the NHS needs. I commend this statement to the House.

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

I thank the Secretary of State for an advance copy of his statement, although I learned more from the Prime Minister’s press conference than from the statement.

Humiliating! The Health Secretary has had health policy taken out of his hands. He spent the last nine months telling anyone who criticised the Government’s health plans that they were wrong, and that they did not understand. Today, he admits that he is wrong. How can he argue for this latest blueprint for the biggest reorganisation in NHS history with any credibility or integrity? The man who messed up so badly last year is telling us how he will mess up next year too.

Why no apology to NHS patients and staff for the wasted year of chaos, confusion and incompetence? Why no apology for breaking the coalition agreement to stop top-down reorganisations? Why no apology for patients, who are already beginning to see the NHS go backwards again because of this reorganisation? More than one in 10 people now waits 18 weeks for operations, three times the number of patients wait more than six weeks for tests, and casualty waits are at a six-year high.

This is the first Prime Minister who has been forced to ask 45 experts for a report on how to protect the NHS from his own Government’s policies. Now he is reorganising his reorganisation. The Future Forum report yesterday was a demolition job on the Government’s misjudgments and mishandling of the health service. Why is he wasting £800 million on redundancy payments when some of the same people will be re-hired to do the same job? Why is he holding back £2 billion promised for patient care when it could fund 55,000 nurses? Why is he ploughing on with the Health and Social Care Bill when what he announced today could largely be done without legislation, and certainly without the risk and cost of the biggest reorganisation in NHS history?

This is a political fix, not a proper plan for improving care for patients, or for a better or more efficient NHS that can meet the big challenges that it must face for the future. Make no mistake, today’s plans will mean that the NHS is mired in more complex bureaucracy, more confusion and more wasted cost in the years to come. In the battle of spin, with all parts of the divided Government claiming a win, the big losers will be NHS patients. The Opposition and the public will judge the Government on what they do, not on what they say.

I lost track of the bureaucracy that the Health Secretary announced in his statement. Will he admit that this reorganisation creates five new national quangos, set to spend tens of billions of pounds? Will he admit that this reorganisation replaces one local body—the primary care trust—with at least five others, all of which will play a part in commissioning? Will he admit that the plans still cut hospitals loose from the NHS, with no limits on treating private patients while NHS patients wait longer, and no support from the NHS if they run into financial trouble? Will he admit that hospitals will no longer have the protection as a public service from the full force of competition law?

What was a very bad Bill will still be a bad Bill. This House should be allowed to do its proper democratic job, as the only elected House, and scrutinise in full in Committee the whole Bill. At its heart, the Bill will still be the Tory long-term plan to see the NHS set up as a full-scale market, and the NHS broken up as a national public service, so that patients increasingly see the services on which they depend subject to the lottery of where they live.

The public have rumbled the Prime Minister. They know that they cannot trust him with the NHS. Fewer than one in four now trusts him to keep his NHS promises, and more than half believe that the Conservative party’s plans for the NHS are just a way to privatise the health service. Today, the Government have recycled their plans for the NHS when they should have been scrapped. People are right to conclude that they cannot trust the Tories with our NHS.

[Mr Lansley]

Well, I was hoping that, having got past the abuse, the right hon. Gentleman would tell us whether he agreed with the NHS Future Forum, but he did not even mention it. He welcomed the listening and engagement exercise that we announced—he said it was the right thing and that it would be good government to do it—but then when an independent group of experts reports and makes recommendations, he ignores it and says he will oppose the Bill regardless. He did not listen to what people in the NHS were saying. I think it was shameful how he dismissed everything that has happened over the past year as though it did not matter at all—a year in which the coalition Government said we would increase resources to the NHS. We have done that and are committing to investing an extra £11.5 billion in the NHS over the next four years. That is money that, as we will continue to remind the British public, the Labour party told us we should not give to the NHS.

In the past year, the coalition Government and the NHS across the country have implemented a cancer drugs fund from which 2,500 more patients have benefited, and in the past four months, we have cut the number of breaches of the single-sex rule by three quarters, and the number of hospital infections by 22% and C. difficile infections by 15%. Some 750,000 more people are accessing dentistry, and waiting times for people going into hospital are down compared with March 2010. We said that we would reduce management costs, and we will do so, and we have taken 3,800 managers out of the NHS since the election, while the number of doctors has gone up. Six months ago, the right hon. Gentleman said that he supported the reform principles in the Bill. All he said today was sheer opportunism, but it will come back to haunt him, because the NHS will benefit from the changes we are proposing today. It will take greater ownership of its own service; patients will be empowered; and clinicians across the service will be empowered and will deliver better outcomes for patients, and when that happens, we will be able to say, “The Labour party would have denied the NHS the resources and the freedom and responsibility to deliver those better outcomes.”