Health and Social Care Bill

John Pugh Excerpts

Tuesday 20th March 2012 Commons Chamber

[Tony Baldry (Banbury) (Con)]

I start by apologising to the House for making what I suspect may sound like a slightly portentous speech. It is not meant to sound portentous, but if it does I apologise.

Because of the effluxion of time, there are not many former Ministers on the Government Benches are, but there is, irrespective of the topic, an important point that needs to be made in the context of today’s debate. I urge every right hon. and hon. Member, before they vote at the end of this debate, to get a copy of House of Lords Hansard for yesterday’s debate, where this matter was debated. There are, in that Lords Hansard, two speeches that hon. Members would do well to read: those of Lord Wilson of Dinton and Lord Armstrong of Ilminster, both former heads of the civil service.

Lord Wilson was head of the civil service during the time of a Labour Government, and both he and Lord Armstrong made it very clear in their speeches yesterday that to release the risk register would be extremely bad news for the relationship between the civil service and Ministers generally. Irrespective of this issue, irrespective of the topic, if risk registers were to be released, officials would needlessly be politicised and thus be concerned about the advice that they gave to Ministers. Ministers would then find themselves being given verbal advice, fewer people would be involved and that would not help the machinery of government.

[John Pugh (Southport) (LD)]

Will the hon. Gentleman give way?

[Tony Baldry]

May I just make some progress?

--- Later in debate ---

[Tony Baldry]

I understand that point, but they are very different registers. The register to which the right hon. Lady refers is meant to be publicised. The two are of an entirely different nature, and that point has been explained to the House by my right hon. and hon. Friends on the Treasury Bench on a number of occasions.

We are discussing departmental risk registers and the advice that civil servants give to Ministers. All I am saying is that right hon. and hon. colleagues, before they vote, should at least take care to consider the advice of former heads of the civil service on the effect that publication would have on the relationship between civil servants and Ministers.

[John Pugh]

If what the hon. Gentleman says is true, why has the Cabinet Office released the register on civil emergencies and put it on the internet?

--- Later in debate ---

[John Pugh (Southport) (LD)]

It is a sure sign of a deranged mind when one starts to repeat oneself. I have said previously that the Bill is a huge mistake, that not releasing the risk register merely creates further alarm, and that abandoning the Bill could be the safer option. I have also said that the Secretary of State’s intentions are noble and that the Opposition’s objections are—in part, at any rate—considered and compelling. However, I have clearly failed to persuade many of my parliamentary colleagues to share that point of view, as last night’s voting showed.

[Karl Turner]

I am grateful to the hon. Gentleman for giving way. He says that he has been opposed to the Bill from the outset. As he knows, I served on the Public Bill Committee with him. Why did he not vote against it? He had ample opportunity to make the Government drop the Bill.

[John Pugh]

If the hon. Gentleman checks Hansard carefully, he will find that there were occasions when I did. We must all agree, whether sadly or happily, that the vote in the Lords last night was conclusive, even if some, like Baroness Williams, were voting for legislation that they said they did not particularly like. That is in part because of the modifying genius—I put it as strongly as that—of Earl Howe.

There are risks attached to the legislation. The risks that I face are small in comparison with those faced by the Secretary of State. I risk being found out for having fears that are misplaced. I risk having my forebodings exposed. He risks a great deal more than that. The House does not need a risk register to find out what those risks are. If he proceeds rapidly at a time of huge upheaval in the NHS, he will actually promote that upheaval. If he goes ahead, he will be doing so at a time of austerity, in the teeth of wholesale professional opposition and in a climate of genuine legal uncertainty, with legislation that has, in part, been cobbled together. We will soon find out what has been scaremongering and what is plain scary. Crucial to mitigating the risks will be the pace and the extent of enactment and implementation. There will be a mopping-up phase. It will be crucial for the Government to woo back professional opinion. The risk register would have told us, to some extent, how easy or difficult that will be.

Already we hear that the Government are struggling with the central plank of the legislation: GP commissioning. We wait with interest to see the regulations on that. It is hard to see how GPs can commission basic out-of-hospital services in primary care, which is a central thrust of the Government’s legislation, and not be seen, as small businesses or associations of undertakings, to be benefiting themselves with public money. In the legislation, we have made the biggest provider the biggest commissioner as well. GPs will have no problem commissioning hospital services without any legal obstacle, but they will lack the expertise to do so. That is what primary care trusts found when they did the commissioning. The risk is that we will end up with GPs not being able to commission what they do understand, and being asked to commission what they do not understand. We therefore await the regulations with considerable interest.

I suggest that although Cabinet members have been banging the table today, they may well be banging their heads against the wall in the years to come.

--- Later in debate ---

[Dr Wollaston]

The equivalent of that is actually the impact assessment. However, as I have said, I would be prepared to allow the publication of the register, because, in this internet age, the misrepresentation of the Bill, and the extrapolation out of all proportion to the risks, has been a complete disgrace.

[John Pugh]

Does the hon. Lady recall saying that the absence of an intermediary body between small GP commissioning and the National Commissioning Board was a serious flaw in the Bill? Clearly that flaw is still there.

[Dr Wollaston]

I believe that by the time of the next election, our patients will still be going to see GPs. They will still be referred to the hospitals of their choice, that referral will still be free at the point of use, and it will still be based on their needs and not on their ability to pay. The only thing that will be missing will be an apology from the Labour party.