NHS Risk Register

Simon Burns Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Andy Burnham]

Those on the Government Front Bench are laughing. They will not be laughing when I have finished my speech.

More than 150 experts in child health wrote to a newspaper last week to say that health inequalities among children will widen as a result of the Bill. Are Ministers listening? No. It is disgraceful that they behave as they do.

[The Minister of State, Department of Health (Mr Simon Burns)]

Will the Secretary of State confirm—sorry, the shadow Secretary of State—that in clause 3 of the Health and Social Care Bill for the first time in the history of the NHS reductions in inequalities in health have been put on the face of a Bill as a duty to achieve?

[Andy Burnham]

I confirm to the Minister that I am the shadow of my former self, but it sounds as though he would like to have me back. Expert opinion says that health inequalities will widen. Is he listening to that opinion? That is the question he should answer today.

--- Later in debate ---

[Valerie Vaz (Walsall South) (Lab)]

It is always a pleasure to follow my hon. Friend the Member for St Ives (Andrew George), a fellow member of the Select Committee on Health.

[Mr Simon Burns]

Friend?

[Valerie Vaz]

I thank the Minister for making his sedentary intervention.

Obviously, I rise to speak in favour of the motion and I humbly request the Secretary of State for Health to publish the risk register, as recommended by the Information Commissioner. I thank my right hon. Friends the Members for Wentworth and Dearne (John Healey) and for Leigh (Andy Burnham) for taking up this issue. As most people will know from their e-mail inbox and their postbag, and from letters that have gone into various newspapers, the professionals are behind us, as are the public.

I have an image of the Cabinet sitting round the table singing the classic Irving Berlin song, “Anything you can do, I can do better”, as each Secretary of State tries to please the Prime Minister by showing how far they can go beyond what was agreed in the manifesto and the coalition agreement. The Secretary of State for Health, who obviously does not want to hear a good argument, is not so much nudging the NHS—to use his favourite phrase—but giving the NHS a great big shove off the end of the cliff; this is more about the chaos theory than the nudging theory. There is a fundamental flaw at the heart of his reasons not to publish the risk register, which is that it contains the information that the public need to see whether the decision that he has reached in the Bill is without risk to the NHS. The Information Commissioner has deemed this to be in the public interest but the Secretary of State chooses to hide it from the public. The public have a right to know that when a decision is taken in their name the relevant considerations have been taken into account. If this reorganisation goes wrong, as it is doing—the good people in the NHS who are working hard are leaving now—could that possibly amount to misfeasance in public office?

In the Health Committee, we have seen what can be done with co-operation. We visited Torbay and saw public sector leadership at its best. I have absolutely no idea who the staff there voted for—nor do I particularly care—but I know that they saw a system for elderly people that was not working, and they worked hard, not thinking about their pensions or asking for overtime, to devise a system in which there was one point of contact for elderly people. Under the system, the risk is shared, 50% with the NHS and 50% with the local authority. They devised a system with consistency of leadership and long-standing good relations across the system. A care package that might take eight months to deliver elsewhere can now be delivered in two hours. By spending £l million on community care, they saved the hospital £3 million. A seven-step referral is now down to two steps. All of that is at risk, however. The NHS and local authorities could learn from that good practice and evolve in that way.

Some people say that, as a result of the Bill, the people around the table will be the same; they will just have different titles. People need to know that the risk is not just about getting rid of managers. The Secretary of State might say that he is reducing the number of managers by making them redundant, but the NHS still needs some managers—so step forward McKinsey and KPMG to help the GPs who do not have, or might not want, management skills. Members of the public need to know the risk associated with the loss of expertise that has stayed in the public sector for the common good, but which will now be lost by the dismantling of structures.

--- Later in debate ---

[John Healey]

There is the precedent of releasing a programme risk register connected with the third runway at Heathrow, but the principle of the Freedom of Information Act is that each case is different—every risk register is different. The reason why this case is important and exceptional and why the Information Commissioner has, on balance, required the Government to disclose rather than withhold the risk register is that the Government’s health reforms are the biggest ever reorganisation in NHS history; that the legislation is the longest in NHS history; and that it has been introduced at a time of unprecedented financial pressure.

[Mr Simon Burns]

Will the right hon. Gentleman confirm for the House that, on behalf of Lord Boateng, he refused to release a risk register when he was a junior Treasury Minister?

[John Healey]

I do not think that the Minister was listening to the point that I just made: on the Freedom of Information Act, the decisions that Ministers make—I hope—as we did, and the decisions that the Information Commissioner would make on a challenge, depend on the specific information and, in this case, the risk register at stake. This case is unprecedented and exceptional and the Information Commissioner has come to this view because we are faced with such huge upheaval. It involves the biggest reorganisation and the longest legislation, at a time of the tightest financial squeeze for 50 years. Furthermore, this reorganisation was explicitly ruled out in the Conservative manifesto and in the coalition agreement. That is why, less than two months later, the huge upheaval of the White Paper was so unexpected, and why the NHS and the civil service were so unprepared for what they are now being forced to implement.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

We have had an interesting debate. The number of right hon. and hon. Members taking part has shown the interest in it. I congratulate Opposition Members who have made speeches—unfortunately, so many spoke that I cannot go through all their speeches—on sticking meticulously to the line in the parliamentary Labour party briefing. They repeated meticulously the mistakes and wrong information in it.

I have a degree of sympathy for the right hon. Member for Leigh (Andy Burnham), because very early in the debate his predecessor as Secretary of State for Health, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), seemed to hole his argument below the line when he came out with what was a rather surprising statement at the time, although having listened to the winding-up speech of the hon. Member for Leicester West (Liz Kendall) it does not seem that surprising. He said that the risk register was a second-order issue. Given that the debate is about the risk register, that struck me as rather odd.

I congratulate my hon. Friend the Member for Finchley and Golders Green (Mike Freer) on an excellent speech. As we listened to more Opposition speeches, his speech began to strike a strong chord that risk registers could be misinterpreted and become a charter for shroud-waving.

I congratulate my hon. Friend the Member for Kingswood (Chris Skidmore), who with great logic and clarity argued an overwhelming case, and I was delighted to hear yet again a speech from the hon. Member for Easington (Grahame M. Morris). A health debate without a contribution from him would be a severe loss. No doubt the news editor of the Morning Star will be fascinated with his comments. I also congratulate my hon. Friends the Members for Boston and Skegness (Mark Simmonds) and for Gillingham and Rainham (Rehman Chishti).

I am disappointed that the right hon. Member for Leigh has decided to politicise a topic that, at its core, is not really about health. The question of publishing risk registers has implications that will be felt across the Government. For the reasons I shall outline, risk registers have implications for the successful running of a parliamentary democracy.

The right hon. Gentleman knows that by heart already, but let me tell him again, in plain English, one last time. The reason why risk registers are not released is the same now as it was when he was in government: if their contents are taken out of context, they could be misleading for parliament and the public.

As many hon. Members have mentioned, the right hon. Gentleman cleared the line in a letter sent from the Department of Health on 1 October 2009, when refusing to publish a departmental risk register. He rightly said that there was a

“public interest in preserving the ability of officials to engage in discussions of policy options and risks without apprehension that suggested courses of action may be held up to public or media scrutiny before they have been fully developed.”

Releasing the risk register is directly contrary to the public interest he described. As he knows, risk registers outline any conceivable situation, however improbable, on the subject they are evaluating. Any risk at all, even the most minuscule or unlikely thing, is included. They help the Department to see the possible pitfalls and to ensure that they do not happen.

This case has implications not only for the Department and Whitehall, but across all levels of government. As hon. Members will know from the debate, risk registers are essential because they are records of frank discussions between Ministers and civil servants on policy formulation. If a precedent were set for those records to be made public, it follows that such discussions and conversations would be a lot less open and a lot more guarded. That would mean that policies might develop with a lot less candid thought and debate than they do now. That might have been the argument under the previous Government, but the reason prevails and the argument is the same today.

The right hon. Gentleman understood that argument when he was Secretary of State for Health. Similarly, the right hon. Member for Wentworth and Dearne (John Healey), who made an interesting speech, understands it. That is why, regardless of what he said in interventions today, during his time in the Treasury—

[Kerry McCarthy (Bristol East) (Lab)]

Will the Minister give way?

--- Later in debate ---

[Mr Burns]

I will not give way. I am afraid I do not have time.

As a Treasury Minister, the right hon. Member for Wentworth and Dearne wrote to Mark Oaten, the then MP for Winchester, upholding the Chief Secretary to the Treasury’s refusal to disclose information about gateway reviews and the identity cards scheme.

Tony Blair—a name that is not often heard with joy on the Opposition Benches now—understood that too. In his memoirs, he calls himself a fool, a nincompoop and an imbecile for introducing the Freedom of Information Act, because, in his words, Governments need to be able to discuss issues

“with a reasonable level of confidentiality”.

He said:

“If you are trying to take a difficult decision and you’re weighing up the pros and cons, you have frank conversations…And if those conversations then are put out in a published form that afterwards are liable to be highlighted in particular ways, you are going to be very cautious. That’s why it’s not a sensible thing.”

Several hon. Members asked about the strategic health authorities that published their risk registers. I would like to clarify this point, because there seems to be considerable confusion about it, particularly among Opposition Members. The purpose of the Department of Health’s risk registers is to allow civil servants to advise Ministers properly about the potential risks of a policy. SHAs, on the other hand, are further removed from Ministers, and are more concerned with operational issues—not policy formulation—and the more day-to-day business of health care. They are not concerned with providing objective guidance to politicians. Their risk registers are routinely published every quarter, and are written with publication in mind. That is evidently not the case with Department of Health registers, which, to remain useful, must be confidential.

Risks are inherent in any programme of change, and we have been open about them, having published a vast amount of detailed information, including the original impact assessment, in January 2011, and the revised impact assessment last September. In addition, the Public Accounts Committee’s health landscape report was published in January 2011, and there has also been the annual NHS operating framework, and the oral and written evidence presented to the Health Select Committee and the PAC. The risks must be scrutinised, we have supported that scrutiny and the risks have been scrutinised. The Bill received 40 sittings and two stages in Committee, and as one hon. Member mentioned, there have been 100 divisions. Even the lead shadow spokesman said, on conclusion of the Committee stage, that the Bill had been thoroughly scrutinised. To claim otherwise is ludicrous.

[Julie Hilling (Bolton West) (Lab)]

I wanted to ask the Secretary of State this question earlier because I was rather confused. The Information Commissioner has said that the risk register should be released. If the Government lose the appeal, will they publish it, given that it would be the right thing to do?

[Mr Burns]

I am grateful for this opportunity to clarify the situation. The hon. Lady is right that the Information Commissioner has taken a view, and under legislation my right hon. Friend the Secretary of State has the right to appeal to the tribunal. That appeal, which he lodged some time ago, will be heard on 5 and 6 March and a decision will be made according to a timetable set by the tribunal—we have no control over the timing.

Of all the topics that the Opposition could have chosen to debate for the past six hours, this is probably one of the most pointless. The tribunal for publishing the risk register sits in a fortnight’s time, as I have just told the hon. Lady, so why not wait for it to report back and use this opportunity to talk about something more useful? Since they have chosen to race down this particular dead-end, however, all I can say to them is this: wait until after the tribunal. There is nothing to add until then. We have explained which areas the risk register covers; we have subjected the Bill to unprecedented scrutiny and consultation; we have debated it for countless hours, and yet still the Opposition bleat that we have not been open. My advice to them is this: change the record. What they are doing is cynical, opportunistic and shallow. I urge my hon. Friends to vote against the motion.

Question put.