Managing Risk in the NHS

John Pugh Excerpts

Wednesday 17th July 2013 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

Will the right hon. Gentleman give way?

[John Pugh (Southport) (LD)]

Will the right hon. Gentleman give way?

[Mr Hunt]

I will make some progress and then give way, because I want to come on to one of the main things that the right hon. Member for Leigh said, which was to criticise an NHS reorganisation that has put 8,000 more people on the frontline of the NHS.

The right hon. Gentleman said that that reorganisation cost £3 billion, when he knows full well that the National Audit Office shows that it will be half that amount. It will save £5.5 billion in this Parliament alone. For the avoidance doubt, it is that £5.5 billion saving that means we are now employing 1,000 more health visitors, 1,400 more midwives and 5,600 more doctors than at the previous election.

The right hon. Gentleman talked about the risk register. Let us look at what he said about publishing the risk register when he was Health Minister in 2007. These are his own words:

“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.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]

I agree with him.

The right hon. Gentleman is right that pressures on A and E are building, so why does he oppose changing the GP contract to make primary care more accessible? Why does he criticise the extra £2 billion being put into joint commissioning by health and social care systems to reduce the number of delayed discharges? Why does he tell the NHS Confederation he supports the reconfiguration of services and then refuse to support every difficult reconfiguration, such as at Trafford or Lewisham?

--- Later in debate ---

[John Pugh (Southport) (LD)]

This debate is notionally about managing risk in the NHS, but it is actually about reputational risk for Secretaries of State. I genuinely feel sorry for all Secretaries of State, because it is very unlikely that nothing will go wrong on their watch. It is unlikely that the entire NHS will perform optimally, that there will be no significant variation in performance and that the NHS will deliver an absolutely perfect service.

Secretaries of State have to get a whole raft of things right. They have to get the funding, the appointments, the regulation and the legislative framework right, and when something goes wrong, they have to get the troubleshooting right as well. They also have to keep a whole raft of health professionals happy, including pharmacists, dentists, GPs, nurses, midwives and health visitors, as well as patients from the age of nought to 90. Surveying that task, I think we have to agree that it is mission impossible.

The two things that will afford a Secretary of State the most protection are, first, good regulation and inspection, and secondly, the professional commitment, engagement and dedication of health professionals including doctors, nurses, ambulance staff and, dare I say, managers—or, as they are they are sometimes referred to in this place, bureaucrats. I think we all acknowledge the need for good management in the NHS.

We have been appallingly badly served by the regulators. Let us take the Care Quality Commission—where do I begin? And what about Monitor? Yesterday, we had the statement on the Keogh report. Before that, we have had statements on Mid Staffs and Morecambe Bay. Although not many people have acknowledged it yet, the majority of the hospitals involved are foundation trusts, and were inspected by Monitor. The majority were given a positive, green risk rating in 2010. What does that tell us about foundation trust status and its benefits? What does it tell us about Monitor, and the CQC, as regulators? Bizarrely, we seem to have given those bodies, which do not seem to be wholly competent, an increased role in the health service over the past couple of years.

The only other protection from serious embarrassment that is available to a Secretary of State is the fact that the NHS survives most things. There is a huge amount of professional commitment from NHS staff. Ironically, however, that can be undone by unwise, poor, tick-box, target-chasing and clinically unjustified regulation. That applies across the NHS and, I would suggest, across public services as a whole. Regulation and inspection, if ill-advised, can undermine professional standards, with disastrous effects for individuals and institutions. Certainly, those who know anything about Ofsted will know that Ofsted can do that, and I am sure that the CQC has done it. The Government have also done it through distorting priorities or simply by inspecting the wrong thing. The truth is that we need to work more with the grain of professional judgment, to listen to it more and not assume that it is always a self-serving producer interest. We can encourage the best and challenge the worst, without disparaging professional ethics.

Recently, the Government have got themselves into a sort of enviable no-lose situation with regard to the public services. If policies are supported by professionals, it proves that the Government are right. If on the other hand policies are opposed by professionals, it proves that the Government are challenging the provider interest and are right again—so they can never be proved wrong. My simple point—it is the only one I really want to make—is that if Governments were not always so easily persuaded that they were right, we would get a whole lot less wrong.