NHS Risk Register

Liz Kendall Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

Today’s debate has shown that we have a Government who refuse to be open about the risks of their health Bill and arrogantly reject the widespread concerns of patients, the public, and NHS staff. Instead of providing the leadership that the NHS needs, Ministers have left staff struggling to cope with the effects of their damaging Bill.

Unlike the Government, the NHS is facing up to its responsibilities by publishing local risk registers to try to mitigate the effects of the Government’s plans. NHS North of England warns that the Government’s reorganisation has a high risk of compromising patient safety, as knowledge about how to deal with mistakes and adverse patient events is lost. NHS Midlands and East says that there is a high risk that waiting times will suffer, primary care will be neglected, and joint working with councils will be undermined. As my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) said, NHS London warns that there is a high risk that clinical commissioning groups will not have the skills they need, and that the NHS will fail to deliver either the best outcomes for patients or the best value for taxpayers’ money. NHS Milton Keynes warns that there is a high risk of failure to deliver its statutory requirements, leading to significant harm or fatalities of children and vulnerable adults. That point was raised by several of my hon. Friends, and particularly eloquently by my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell).

However, the Government are not concerned about the risks that the Bill poses to patients, only to their own political prospects. In the past few weeks, we have witnessed the unedifying spectacle of Conservative Ministers scrambling to distance themselves from the wreckage of their Bill and desperately pointing the finger of blame. An anonymous source in No. 10 told The Times that the Health Secretary

“should be taken out and shot.”

Anonymous Cabinet Ministers have told ConservativeHome that the Bill is as bad as the poll tax, that it must be dropped and that the Secretary of State must be replaced. The Financial Times has said that the Chancellor is worried that the Bill will retoxify the Conservative brand. Apparently, the Deputy Prime Minister is furious that the Tory in-fighting is ruining his attempts to get his party and MPs on board. The Secretary of State accuses the British Medical Association of being “politically poisoned” in opposing the Bill; I say that the source of the poison is all on his own side.

[Mr Lansley]

Just so that the record is clear, when I referred to the phrase “politically poisoned”, I was not saying it myself, but quoting Aneurin Bevan’s description of the BMA.

[Liz Kendall]

I notice that the Secretary of State does not deny that members of his own Cabinet and Conservative and Liberal Democrat Back Benchers are concerned about the Bill.

Instead of fighting among themselves, the Government should be relentlessly focused on ensuring that the NHS meets the challenges of the future. Our ageing population, the increase in long-term conditions, and the huge medical and technical advances mean that the NHS must continue to change to improve patient care and deliver better value for taxpayers’ money. As my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) said, that means shifting the focus of services into the community and more towards prevention, so that people stay fit and healthy for longer. It means centralising some health services in specialist centres so that patients benefit from medical advances and get the best standards of care. It also means ensuring that local NHS and council services work together so that older and disabled people can stay living independently in their own home.

The NHS needs service reform, not structural reform. The Bill will make the changes impossibly hard to achieve. The recent Health Committee report on social care states that the best examples of integrated services have been achieved by care trusts, which were set up under the Labour Government, and yet those are being swept away by the Bill. In 2009, NHS London centralised stroke services into eight hyper-acute units. That decision was very controversial at the time, but within six months it had more than tripled the number of patients getting vital clot-busting drugs to the highest rate of any large city in the world. The Bill will put strategic service changes such as that at risk.

[Tony Baldry (Banbury) (Con)]

What about the risk register?

[Liz Kendall]

I have outlined what local NHS services have said about the risk register. If the hon. Gentleman had been in the debate earlier, he would have heard Government Members saying that we are not focusing on patient care or setting out how the NHS needs to change. The point that I am making is that the Bill will prevent the strategic changes that the NHS needs.

There is no evidence that smaller, GP-led commissioning groups can deliver major changes to hospital services. The organisations that have done so, such as NHS London, are being abolished. The real risk is that the full, free and unfettered market that will be introduced by part 3 of the Bill will stop the NHS from making the changes that patients desperately need. It risks preventing hospitals from working together to centralise stroke or trauma care; it risks preventing hospitals from running local community services or working with GPs and local councils to better integrate care, for fear that they will fall foul of UK and EU competition law; and it risks putting power into the hands not of patients and clinicians, but of lawyers and the courts.

[Mr John Redwood (Wokingham) (Con)]

I am delighted by the conversion of the Opposition to more transparency now that they are out of office. Can they show the Government how to do it by publishing the internal documents that are critical of their leader’s strategy for change in the Labour party?

[Liz Kendall]

With the greatest respect to the right hon. Gentleman, I will not waste my time on that point when we have important issues about the future of the NHS to discuss.

Government Members should realise that GPs, nurses, midwives, health visitors, public health professionals, psychiatrists, physiotherapists, radiologists and Opposition Members are against the Bill, not because we are against change, but because it will prevent the changes that the NHS needs.

Government Members do not want to talk about part 3 of the Bill, because they know that people do not want their NHS run like any other market. The Secretary of State and the Prime Minister claim that their Bill is all about cutting bureaucracy and putting patients and clinicians in control, yet the Department of Health now admits in its fascinating document, “Design of the NHS Commissioning Board”, that there will be five layers of management in the Government’s new NHS, except in the performance and operations directorate, in which

“an additional layer (or layers) will be required”.

In place of strategic health authorities and primary care trusts, we will now have the NHS Commissioning Board, four commissioning sectors, 50 local offices, commissioning support units, clinical senates and clinical commissioning groups, as well as Public Health England and the health and wellbeing boards. Patients and staff have been left completely confused about who is responsible for running different services and how they will be held to account.

The Government say that the new structure will cost £492 million a year.

[Mr Lansley]

rose—

[Liz Kendall]

Let me continue to explain this point. I have given way to the Secretary of State already and I want to finish my point.

According to the Government’s own document, the cost of running commissioning support units and commissioning for Public Health England is not included in the costs that have been given. Indeed, it states:

“The costs of providing clinical advice to the wider system will be separately funded.”

That prompts the question, what are all those different organisations doing if they are not helping to improve clinical care? The Government are not cutting red tape, they are increasing it, and they are not liberating clinicians but suffocating them—not my words but those of the NHS Alliance and the National Association of Primary Care, which used to champion the Bill.

Perhaps the Secretary of State should listen to the advice of Dr Peter Bailey, a GP and former chair of a commissioning group in his own constituency. He recently told Pulse magazine that GPs have

“been duped…set up to fail…We stand baffled in the wreckage…put down the sledgehammer. Get rid of the Bill.”

The Secretary of State should listen to the good doctor’s advice. He should grant the freedom of information request submitted by my right hon. Friend the Member for Wentworth and Dearne (John Healey) and publish the risk register. He should listen to the 78 Opposition Members and 15 Liberal Democrat Members who have signed the early-day motion tabled by my admirable hon. Friend the Member for Easington (Grahame M. Morris) calling for the register to be published.

Even today, as this debate has taken place, the Information Commissioner has told the Evening Standard that he thinks the Government should publish the risk register while peers are still debating the Bill. He has said:

“Where proposals are particularly contentious and with far-reaching consequences, it’s better for more information to be available for a broader discussion about the pros and cons before everything’s decided. By enabling people to express their views on proposals, the final decision will be better informed and better understood.”

I say to Liberal Democrat Members that voting for the motion will show that they really support the early-day motion that they have already signed. It will show their constituents that on this issue, they mean what they say and are different from Conservative Members.

Parliament has a right to know the risks of the legislation that it is debating, and the public have a right to understand the true risks of the Government’s reckless NHS plans. I commend the motion to the House.