NHS Risk Register

John Pugh Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

I have met Bliss—I just said so—and we discussed exactly those kind of issues. I would happily do so again.

The objective of the NHS—this is precisely what we have set out in our focus on outcomes—is to ensure that we seek a continuously improving quality of service for patients. I have many times been on specialist neo-natal intensive care units precisely to understand that. I remember having a long discussion just last year with the staff, including the neo-natal staff, at my local hospital, Addenbrooke’s, and hearing of the importance to them of recruiting an additional neo-natal nursing complement to ensure that they provide the right service. That is nothing to do with the Bill. It is about focusing in the service on delivering quality. That is why we are getting resources into the front line.

The third reason is that the publication of a risk register could take away directly or distract from policy development—the process that it is intended to support. Departmental officials and Ministers should work directly to deliver the policy rather than react to the risks associated with the development of policy before the policy has been agreed.

[John Pugh (Southport) (LD)]

Will the Secretary of State give way?

[Mr Lansley]

I will give way in a moment.

Fourthly, the publication of the risk register would distort rather than enhance public debate. We should remember that a risk register does not express the risks of not pursuing the policy—[Interruption.] Hon. Members should think about it. A risk register does not include the risks of not pursuing a policy and ignores the benefits of a policy—it presents only one side of the cost-benefit equation and is deliberately negative. Effectively, it is a “devil’s advocate” document, not a balanced one.

What is the balanced document associated the Bill? The impact assessment. I have with me a summary of the impact assessment, but there are hundreds more pages. We incorporate all relevant information in the impact assessment because it not only captures the same risks, but puts them alongside the benefits, costs and impacts, including the impact of not taking action.

The impact assessment is the proper evidential and informative basis for parliamentary and public debate. If any hon. Member is in any doubt about the public interest served by not releasing the risk register, I remind them of the advice received by the House nearly five years ago from the shadow Secretary of State. The argument that he put was precisely the argument that we are now putting.

--- Later in debate ---

[Gareth Johnson]

My hon. Friend makes a valid and correct point. Governments need such registers to function efficiently and to cover every eventuality. As he pointed out, a risk register is a mechanism by which civil servants can candidly present a worst-case scenario to Ministers. It is not about what is expected to happen, but about what is the worst that can happen. Risk registers are therefore not Government policy, but preparatory documents.

[John Pugh]

Would the hon. Gentleman be surprised to know that I have here a national risk register that was published by a Department in 2012?

[Gareth Johnson]

Yes, I would be surprised if that had happened.

It would be wrong for there to be routine publication of risk registers without any kind of control. The beauty of risk registers is that they enable civil servants to think the unthinkable.

The hon. Member for St Ives (Andrew George), who is no longer in his place, made the point that there is a difference between the approaches of the Government and the Opposition. If we are honest with ourselves, we must recognise that every Opposition in this place has been guilty of some scaremongering. There is no doubt about that, so let us be mature about it. Whether it has been my party, the Labour party or the Liberal Democrats, we have all been guilty of a certain amount of scaremongering. Presenting a pessimistic view as a real likelihood is part of the game of political football. However, there is a huge danger that information from the risk register could end up misleading the public and giving them inaccurate information.

--- Later in debate ---

[John Pugh (Southport) (LD)]

Another day, another health Bill debate: it is a groundhog day, déjà vu experience for many of us. On these occasions, I often find myself sounding like that irritating little man with the flat cap and glasses who was in Harry Enfield’s programmes and went around all the time saying, “You don’t want to do that.” It is a matter of record that I have described the Health and Social Care Bill as a huge strategic mistake and that I have from the start publicly and privately—but, I hope, politely—tried to discourage the Government from progressing with it. Even though it is Ash Wednesday today, I do not intend to repent of my ways, although I do agree with the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) that the onus is now on critics to come up with a viable alternative to what the Government propose to implement.

Regardless of the merits of the Bill, the politics of it have turned into an absolute nightmare, to the extent that there are now two clearly defined schools of thought in Parliament. There are two opposed camps: those who think that the Bill is very problematic and that we should drop it, and those who think that it is problematic but that we are stuck with it. All that is despite the good intentions of Ministers, the constructive amendments of both Houses and the work of the NHS Future Forum. I essentially agree with Tim Montgomerie, who publicly acknowledged what some Cabinet Members privately acknowledge: it is toxifying for the Tories and detrimental to the Liberal Democrats, which is sad.

Over the past 20 months, I have tried—possibly ineptly—to get that message across. I even e-mailed the Prime Minister’s adviser on strategy, Andrew Cooper, a man for whom I have appreciable respect. On 14 April last year I wrote to him saying that over the previous 10 months I had

“watched the coalition in terms of health policy cheerfully prepare to be driven over the cliff by the”

Department of Health. On 4 May of the same year I told him that the Government risked ending up in a no-win situation, and on 6 September that the Bill was unnecessary and would create uncertainty, divide the coalition, lower morale and harm Government ratings—which it has. There are no happy endings, I said.

I get no satisfaction from being proved right. After all, nobody welcomes a know-all. However, nobody likes gigantic Government schemes that do not come off—especially not, as the right hon. Member for Wentworth and Dearne (John Healey) said, in the Department of Health. That is why it would have helped so much to have had a gateway review of Connecting for Health, the Government IT project. That was not published by the Blair Government, and blew £12 billion of taxpayers’ money. A review was demanded by my hon. Friend the Member for South Norfolk (Mr Bacon), but Blair decided to press on bravely through the signals of danger, aided and abetted by a report from McKinsey. I was relieved to find out that the Government do not rely on advisers to the extent mooted in the press, at any rate, because their advice has not always been solid or sensible.

Would not we all have really liked, however, to see a gateway review of Connecting for Health, and would it not have saved the country an appreciable amount of money? Why did we have to wait nine years—and spend £12 billion—before the NHS essentially settled on the position mapped out by my hon. Friend the Member for South Norfolk in a paper in 2006? Should we not have seen the review? Perhaps Labour should adopt an “I’ll show you mine if you show me yours” policy as the best way forward, for in truth there are not many good arguments against transparency in the case of this NHS risk register—and I have heard some pretty bad arguments, both today and in recent days.

One particularly poor argument has been that Members should not support this call because that would endorse the Labour party’s position. I think that is called political tribalism, which is not attractive and which poisons this place. It is always wiser to agree with people when they are right and to disagree with them if they are wrong, regardless of party. Another bad argument that has been made several times this afternoon is that the Labour Government did the same thing and refused to publish risk registers. That is a pretty weak argument in terms of its general logic. Just because the Labour Government fought an illegal war in Iraq, that would not justify the coalition’s fighting another war in a country of its choosing. Then there is the weak argument that publishing the register would create a precedent, but what is the precedent? Surely, it is that risk registers may be released when the Information Commissioner—a role that was set up by our legislation—so decrees when interpreting our legislation. It appears that most of the arguments that were presented quite cogently by the Secretary of State were attended to by the Information Commissioner at the time.

Some risk registers are voluntarily released, but it has been suggested, including in the other place, that the risk register might unduly alarm the unwitting public, who apparently cannot understand risk, or the difference between the unlikely and the probable. That rather patronising view is hard to square with the fact that risk registers are already published on many subjects, including on more alarming subjects than NHS reorganisation. I am talking not just about local risk registers such as that for NHS London. I have here the risk register on civil emergencies published by the Cabinet Office in 2012. It is not bland or anodyne, as has previously been suggested, and one can download it from the internet. It tells of the possibility of catastrophic terrorist incidents, major pandemics, volcanic eruptions, cyber attacks, floods, pestilence, and even the dangers of rabies and cosmic rays. I think it also gives the probability of all such events occurring. I cannot help thinking that if the public can already find out the chances of being blasted with cosmic rays, they can cope with knowing about the marginally disruptive effects of the abolition of strategic health authorities. I cannot help thinking that if the public have already grappled with the possibilities of being buried under volcanic ash or bitten by rabid dogs, they will not be too hysterical about the potential consequences of setting up health and wellbeing boards.

There is a virtue to transparency, which the Government accept. They have made substantial progress on this issue and it is unfortunate that this episode is going to blot the copybook. I am reminded of the futile attempts that were made by the previous Speaker to block the commissioner regarding our expenses. We risk a replay of that, and I urge all Members, before they troop into the Lobby tonight, to consider what they will say in 10 days’ time when the Government either win or, more probably, lose their appeal.

[Several hon. Members]

rose—