NHS Risk Register

Debate between Sajid Javid and Joan Ruddock

Wednesday 22nd February 2012 Commons Chamber

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

I should like to tell the hon. Member for Finchley and Golders Green (Mike Freer) that it is hard to take seriously all the points that he made, as the strategic health authority in London has published a risk register. I want to devote my contribution to that issue.

That risk register lists 18 areas of risk. It describes the risks to the improvement programmes agreed by the strategic health authority, including London’s contribution to the Government’s £20 billion efficiency savings, and to the public health transition programme, in which some mitigating actions would be beyond the direct control of NHS London. It goes on to list the risks involved in the transition to the reorganisation that the Government plan for the NHS. It makes devastating reading. I shall highlight a few of the 18 risk areas. On the risk to the efficiency savings and improvement plans, it says that they

“may not be realised in full or are delayed, thereby undermining significant improvements in the health of Londoners.”

On the public health transition, which involves NHS public health staff dispersing into local government, it says:

“The consequence of this risk would be a negative impact on the leadership and structure of the public health workforce, and thereby delivery of public health services.”

On the abolition of primary care trusts next year, it says that the result

“may be poor, both in securing the best health outcomes for London’s population and in maximising value for money.”

In all cases, I am quoting directly from the reports.

[Sajid Javid]

We have heard from two former Labour Health Secretaries, both of whom refused to release the risk register. Does the right hon. Lady think that they made the right decision?

[Dame Joan Ruddock]

The decision that was made was about strategic health risks, and reference was made to things such as nuclear war, climate change and pandemics. We are talking about the transition, and we want to see a risk register on that. As my right hon. Friend the Member for Leigh (Andy Burnham) said, the London risk register goes on to describe risks to the safeguarding of children and maternity services as creating possible harm to patients. On patient safety and clinical quality, it concludes that the risks are such that the consequence

“could be poor or unsafe care for patients and loss of public confidence in healthcare in London.”

I understand the argument made by Members from all parts of the House that the point of a risk register is to enable mitigation measures to be applied to those risks. That is exactly what the London document does, but in half the risk areas the original red risk is still red after the mitigation measures are proposed. In all areas, the risks after mitigation are still amber. That is an extraordinarily serious matter of which we have to take account when we look at how the planned reorganisation will affect the health of Londoners and of my constituents.

How is it possible, I ask the Secretary of State, for staff already under pressure to deliver more with less, to carry on doing their job against the change programme that their strategic managers believe poses such risks? With so many issues raised by the London risk register, is it any wonder that the British Medical Association, the Chartered Society of Physiotherapy, the Royal College of Midwives and the Royal College of Nursing have all called on the Government to publish their risk register, which, as my right hon. Friend the Member for Leigh pointed out, relates specifically to the transition required by the Health and Social Care Bill and, presumably, the very changes already under way that are forcing people to wait longer and most definitely undermining confidence in the service?

In Lewisham alone, nearly £21,000 has been spent reorganising the PCT, and now the number of those patients waiting more than 18 weeks has gone up by 73%. How can that be the improvement of which the Secretary of State speaks? Even more worrying for my constituents are the difficulties faced at Guy’s and St Thomas’ foundation trust, where the latest available figures showed that over 20% of patients urgently referred by their GPs and subsequently treated for cancer in those hospitals waited more than two months for hospital admission. I tell the Secretary of State that if I had a diagnosis of cancer, I would be terrified of waiting more than two months to begin my treatment.

I do not blame the Guy’s and St Thomas’ foundation trust, where I myself have had excellent treatment in both hospitals, but I do blame this Government. I blame them for this top-down reorganisation that is already under way at a time of straitened financial circumstances.

I could not end without paying tribute to two of my constituents—Jos Bell and Dr Brian Fisher—who have mounted a superb local campaign, with thousands and thousands of people signing their petition. In 2010, the NHS was shown by the World Health Organisation to be the most efficient health service, and one of the best health services in the world. Patient satisfaction in that year was at its highest ever rating. We now face rising waiting lists; a fragmented service; a focus on finance, profit and private patients; and poorer health outcomes for those of us who cannot pay or who refuse to pay for private health insurance. The Secretary of State, I suggest, faces two challenges: he should either publish that risk register and let us make our own decisions or, frankly, he should just drop the Bill.