“All hospitals will become Foundation Trusts”.

Interestingly enough, that was in the 2010 Labour party manifesto. Thirdly, there is the plan to

“support an active role for the independent sector”

in providing services. That too was in the 2010 Labour party manifesto. Fourthly,

“Foundation Trusts…given the freedom to expand…their private services”.

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That was in the Labour party 2010 manifesto, as was the proposal to ensure that family doctors have more power over their budgets.

Who was the man in charge of putting that in the Labour party manifesto? It was the current shadow Secretary of State, which just shows how far the Labour party has moved to the left since the May 2010 election. If there is one thing that he and his supporters behind him need to understand, it is that general elections are won from the centre ground, not from the extremes of either left or right.

In the time remaining to me, I shall mention two key areas and bust some myths. The first area is competition and choice, which have always been part of the national health service. The original 1948 NHS leaflet stated that patients must choose their own GP. We should be discussing the benefits that choice can bring to patients, and how we can facilitate innovation and better patient outcomes. The evidence is clear: competition based on choice and quality, not on price for elective care, drives and improves not just efficiency and shorter hospital stays, but better management and, most importantly, patient care and outcomes.

The second area, which both the shadow Secretary of State and the Secretary of State mentioned, is integration, and it is absolutely key if we are to improve patient pathways and outcomes. Care is currently fragmented, and the state monopoly is under little pressure to deliver integrated care or new models of care. The national health service to date has been poor at integrating services, and the Secretary of State and his team need to be careful to ensure that the health service understands that the merger of organisations is not the same as integration, which is about integrating care pathways, and must not be used as an excuse to protect poor providers and weak management, or to block clinically led reconfiguration.

The successful integration of patient care, and in particular of chronic disease management, will, however, dramatically improve quality and outcomes. The Secretary of State also needs to address the issue of funding flows, moving them away from episodic care to year-of-care funding to enable integration to take place properly.

In conclusion, the national health service deserves our wholehearted support, but if it is to survive as a taxpayer-funded service free at the point of use, it must evolve and reform.

3.53 pm

Rosie Cooper (West Lancashire) (Lab): I congratulate my right hon. Friend the Member for Leigh (Andy Burnham) on his persistence with these Opposition day health debates. I am sure that he shares with me a deep-seated hope that the Secretary of State will soon see the light, publish the risk register and drop the Bill.

“The public can be forgiven for being bewildered by the latest round of plans to reform the National Health Service in England. The set of proposals is large, many are highly technical, why they are needed is not clear and the protests from key respected groups are loud.”

Those are the words of Jennifer Dixon of the Nuffield Trust in her most recent paper for The Political Quarterly, and I am sure that many in the Chamber will agree wholeheartedly with them; I certainly do. They are an incisive analysis of the state of play with regard to the

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Health and Social Care Bill and the planned NHS reforms. The short opening paragraph of the paper begins to explain why it is essential that the Department of Health publish the transition risk register, as ordered by the Information Commissioner.

As each day passes, there are ever more reasons why the British people need to be able to see for themselves the risks associated with the Bill and how the Department of Health proposes to mitigate them. This is about a broader, more fundamental and more important issue than publication in itself. Many people are fearful about what the Secretary of State’s plans really mean for them and their families, and for the health service that so many people rely on. I cannot understand what is in the risk register that the Government are so frightened of revealing to the people who are actually paying for this.

The message of what the public think is loud and clear: they simply do not believe and do not trust the Government, the Prime Minister or the Health Secretary. A ComRes poll says that 69% of respondents do not trust the Government to get it right on health, while YouGov says that six out of 10 people think that the Prime Minister has failed to deliver.

Gloria De Piero: Perhaps one of the reasons why there is such a lack of trust is what is going on in our own constituencies. In my constituency of Ashfield, waiting times have gone up and the NHS walk-in centre has closed. That is the reality of what is happening on the ground.

Rosie Cooper: I am dreadfully sorry that my hon. Friend is able to say such a sad thing, and Government Members do not hear any of it.

People have listened to what the Secretary of State has said and they are telling the Government clearly that they think that their proposals are complex, muddled and expensive, and that they do not trust what they have been told. I wonder why they have such difficulty in accepting the Secretary of State’s words of reassurance, but perhaps there is a clue in the track record of the Government, the Prime Minister and the Secretary of State in making promises. They promised no top-down reorganisation and then did it anyway with no mandate, no mention of huge reform having been made by the coalition Government. We have a so-called Government of openness and transparency who will not publish the transition risk register despite being ordered to do so by the Information Commissioner. So much for “No decision about me without me”; these decisions seem to be about us without us—all of us. The Government say that there will be no cuts to front-line services, whereas we have just heard about cuts to front-line staff and the down-banding of members of staff. They say that waiting times will not increase, but they have increased. Yet the Government still press on.

This reminds me of a story about a man who is stranded as flood waters rise. The water is getting higher and higher, and he prays to God to save him. He refuses help from a neighbour in a rowing boat, from someone in a speedboat, and even from someone in a helicopter, saying, “No, thank you—I have faith that God will save me.” Of course, he is washed away.

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Standing before his maker, he says, “I had faith that you would rescue me,” and is told, “I sent you two boats and a helicopter. What more did you want?” In this case, the Secretary of State has been sent the Royal College of General Practitioners, the Royal College of Midwives, the Royal College of Nursing, the British Medical Association, the physiotherapists and other professions allied to medicine—need I go on? Those are just a few of the signals to the Secretary of State that he has got it wrong.

If the Secretary of State continues with the Bill, before long he will be meeting the Prime Minister on the day of a reshuffle, but by that time the people in the NHS will have suffered hugely for these silly mistakes. The risk register is so potentially damaging that the Department of Health refuses to publish it, thereby spending taxpayers’ money on preventing taxpayers from knowing what it is doing with their money. That is absolutely ridiculous. It is imperative that the transition risk register be published.

The Government have been the architect of their own problems by breaking their promises, failing to demonstrate the need for such extensive reform of the NHS, and not listening to the people who use the service and the people on the front line who deliver the service—the very patients and staff whom the Government keep telling us that we forget about, and who are at the core of this matter.

When the Secretary of State assumed responsibility for the NHS there had been a sustained period of increased funding, lower waiting times had been achieved, the quality of care had improved significantly, and there were some of the highest levels of public satisfaction in the history of the NHS. In a little under two years, that situation is being reversed. I would put it to the Secretary of State, if he were here, that surely even he can see that now is the time to be honest and up front with the people of this country. It is time for the Government to take another deep breath, publish the risk register and put their trust in the people.

4 pm

Gareth Johnson (Dartford) (Con): It is a pleasure to follow the hon. Member for West Lancashire (Rosie Cooper), although I disagreed with much of what she said. If we had listened to organisations such as the British Medical Association in the past, we would not even have a national health service. The BMA opposed the very creation of the national health service, so we should take no lessons from such organisations. What we have heard from Opposition Members today shows their culture of saying, “Do as we say, not as we have done.”

Although I disagreed with much of what the hon. Member for West Lancashire said, I did agree with something that the shadow Secretary of State said when he was in charge of the Department of Health in September 2009. He said that Ministers and their officials need space in which to develop their thinking and explore options, and that the disclosure of the risk report may deter them from being as candid in the future, which would lead to poorer quality advice and poorer decision making. The right hon. Gentleman was absolutely right then and that ethos has run through Governments across the ages.

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Like most Members in this House, I support the principle of open government. I support the fact that the Department of Health has divulged far more information since the general election. We all want open and free government, but that will inevitably always be up to a point. No Government since the dawn of time have felt it prudent to publish a risk register and divulge it in the public domain, whether it be a transitional register, a strategic register or any other kind of register.

Bob Stewart (Beckenham) (Con): I have used risk assessments or risk registers in a different way. The military used them as a management tool to look at the worst-case situation and the best-case situation. We did not publish them or make them public for the simple reason that they would have worried people too much. They set out “what if” scenarios. That is why the previous Government did not publish them and why we do not want to publish them.

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.

Andy Burnham: May I remind the hon. Gentleman that the words of mine that he referred to related to the strategic risk register? We are debating a different document today. He seems to misunderstand risk registers, because he described them as presenting a worst-case scenario. They do not, and I can provide him with the material showing that right now if he would like to see it. The examples that I read in my speech were given a likelihood rating. They were said to be likely to happen and not mitigated by the steps that had been taken. I am afraid he has not grasped that point, and he needs to.

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Gareth Johnson: Risk registers play devil’s advocate and ensure that there are contingency plans for every eventuality. The shadow Secretary of State has mentioned the transitional document, but nothing in the motion mentions a transitional or strategic document. Those words are not used in the motion.

When information on doomsday scenarios is released in an uncontrolled manner, it is easy to see how it can be viewed as being what is expected to happen. If a best-case scenario is released in an uncontrolled manner, that can raise unwarranted optimism. Ministers need to be able to plan for the best and worst-case scenarios without being seen as either overly complacent or doom merchants. Good government is about examining theoretical risks and assessing potential problems and hypothetical scenarios.

The last thing we want is for a Government to tone down their risk planning through fear of propagating alarm or panic. We want civil servants to feel that they can fully paint the picture of the extremes that need to be prepared for, without tempering their advice. We do not want them to have to keep one eye on risk management and the other on how the information will be perceived by the public when it is divulged.

Governments need to consider the commercial ramifications of publishing risk registers. Will the sales of certain products collapse unjustifiably? Are there potential unforeseen consequences? We literally need a risk assessment of the publication of risk registers.

Darent Valley hospital, only the second private finance initiative hospital to be built, is in my constituency. The disabling effect of the agreement is only now being dealt with, thanks to the decisions of Ministers. I do not recall the previous Government rushing to disclose the risk register that was drafted in connection with that commercial decision. Perhaps they were wise not to do so.

Although we all instinctively want transparency to prevail in what we do, we need to think through the repercussions carefully. If the Government lose their appeal against the decision, they will have to disclose the information required, and I believe that there could be serious consequences. Disclosure of the risk register would herald not a new era of open government but rather an end to proper, full risk management. Proper transparency is about the Government publishing what they believe will happen, not what they do not believe will happen but are making contingency plans for. Open government will always be desirable to a point, but as with all previous Governments we should not be in the business of publishing every scenario for which every Department is preparing.

4.9 pm

Frank Dobson (Holborn and St Pancras) (Lab): I think the Government will conclude that it is foolish of them not to publish the register, because everybody assumes that they must have something to hide—something to do with policy development.

In the absence of publication, we can only speculate on what the register contains. I should like to know, for instance, whether there is any reference to the risk that is being taken by inviting American health corporations to bid for services in this country. After all, all the leading American health corporations have, at one time or another, been indicted for defrauding patients, doctors

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or taxpayers. I asked the Secretary of State whether he would ensure that no contracts are given to any American corporation that has been indicted for fraud. He refused to ban them, so we can expect them to come in.

There is also the question of marketisation and of putting things out to tender. We have an example in my constituency. The Camden road practice was put out to tender in 2008 and the existing practice doctors put in a bid that met all the requirements. According even to the stuff that was published, they did better than the private sector bidder in respect of the requirements, but the private sector firm bid to provide the services at a lower cost to the NHS and got the contract.

When I asked for details of all the bids and considerations, I was told that they could not be disclosed because they were commercial and confidential. I warn all hon. Members who think they will get the details of what happens in their areas—we can safely bet that the words, “No you can’t have the information. It is commercial and confidential”, will come up time and again.

As it happens, a US company, UnitedHealth primary care, got the contract. I admit to having a touch of cynicism in my make-up and rather assumed it would do a rattling good job to demonstrate what a wonderful outfit it is, but it was not so. It did not even bother to act as a loss leader. It reduced the amount of time patients had with doctors and at one time suggested that patients could raise only one topic with their GP. Opening hours were changed. It closed a baby clinic, but because there was a great row, it reopened it. The PCT contemplated taking legal action to enforce compliance with the contract but was advised by its lawyers that the contract was not enforceable.

Last year, that triumphant outfit suddenly sold all its GP contracts, including the one at the Camden road practice, and said it would concentrate on offering support to GP commissioning boards because that is easier and more profitable than supplying a GP service. It sold the Camden road surgery contract to an outfit called The Practice plc. The contract was not put out to tender and nobody was consulted about the transaction—not the NHS or the staff, or least of all patients.

Patients—my constituents—were chattels in that transaction, but they might have been reassured when they saw the publicity for The Practice plc, which states:

“At The Practice we offer clinical services to NHS patients who need to be sure of the very highest standards. But it’s how we do what we do that makes the difference. We aim to deliver genuinely caring and thoughtful patient centered services, minimise waiting times and make the whole experience one to remember with satisfaction. From first referral through diagnosis to effective treatment we promise true professionalism…At The Practice, patients come first.”

Not any more they don’t. It has been announced that the practice in both centres is closing down because the lease has run out. The patients have been left bereft and bewildered. It is not a question of integrated care between primary care and social services. There will be no integrated care at the practice because people will be spread around half a dozen neighbouring practices. And why? It is because this commercial organisation, dedicated to profit and lining the pockets and handbags of its shareholders—the sacred shareholders, whose interests must always come first—has decided that it

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cannot find alternative premises. What is the risk of that happening when the Government spread this practice right across the country? Is the risk of that happening mentioned in this famous risk assessment? I doubt it very much.

A constituent of mine wrote to me:

“Before United Health took over…we had an excellent surgery with excellent…doctors. They knew their patients’ medical histories and the patients trusted them…. What are we left with? A Surgery which started to deteriorate almost as soon as the original doctors left/were forced to leave, one which continued to deteriorate… So much unnecessary disruption and upset… Totally ridiculous and unprofessional and with no sensitive consideration or understanding being afforded to patients.”

We hear a lot about patients from Government Members. They need to consider what will happen to their patients when this is all marketised.

4.17 pm

Rehman Chishti (Gillingham and Rainham) (Con): It is a pleasure to follow the right hon. Member for Holborn and St Pancras (Frank Dobson), although given that the Order Paper reads,

“this House calls on the Government to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill”,

I wondered whether he was in the right debate. He spent most of his time not mentioning the Information Commissioner, although he mentioned risk in the last minute.

I want to focus on the argument over the risk register. I support the Secretary of State’s decision to challenge the Information Commissioner’s decision ordering the release of the Department of Health risk register. It is important to consider the procedure followed by the commissioner in determining whether it was the right decision to make. The Secretary of State’s decision to challenge the commissioner’s ruling is, procedurally, absolutely correct. The procedures set out in the Freedom of Information Act, as amended—[Interruption.] It is important to set the tone and background.

Andy Burnham: It’s not a court.

Rehman Chishti: The shadow Secretary of State does not understand the legislation. That is why he is making these assumptions. Section 35(1) makes it clear that:

“Information held by a government department…is exempt information if it relates to…the formulation or development of government policy”.

[Interruption.] Opposition Members do not like what they are hearing, but I hope that they will show the same common courtesy that I have shown them in the past. Section 35(1) makes it clear that the procedures applied by the Secretary of State were in line with the Freedom of Information Act, which was enacted by the previous Labour Government. Under that procedure and statute, he is entirely within his rights, using the correct procedure, to apply section 57 to appeal the ruling to the tribunal. That is absolutely right and proper.

It is important to say that we have the right—[ Interruption. ] I will come to the point on which the shadow Secretary of State keeps interrupting me—I am sure that he is not doing so to put me off making the point that he does not want to hear. Under the procedure

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in section 57, the Secretary of State can challenge a decision. It is important in our system—whether the criminal justice or the civil system—to have checks and balances on decisions that are made, whether by the Information Commissioner or by judges. If the shadow Secretary of State is now saying that the Information Commissioner’s ruling should be final, with no right of appeal, he should have said that when the Freedom of Information Act was being passed. However, he did not do so, and there is a right of appeal, where cases go to the tribunal. Even beyond that though, he asked earlier whether the Secretary of State could give us an assurance that he would not challenge the decision of the tribunal. Being realistic, how can the Secretary of State give that guarantee? The right hon. Gentleman knows, and I know, that the Secretary of State does not know what the judgment of the tribunal will be. He also knows that the rules that his Government passed, in section 59 of the Act, enable a referral to the High Court where there might be a wrong point of law.

Andy Burnham: Briefly, does the hon. Gentleman not accept that there is a big difference between the Secretary of State being within his rights and his being right not to publish? We accept that he is within his rights, but is he right? The precedent was set by the previous Government. We published a risk register after receiving a ruling from the Information Commissioner. That is the precedent.

Rehman Chishti: I am grateful to the shadow Secretary of State for that point, to which I shall return. In my view, the Secretary of State is absolutely right to use that discretion. The shadow Secretary of State knows the Department of Health well because he has been there, but I should point out to him that a spokesman for the Department of Health said:

“We have never previously published our risk registers as we consider them to be internal management documents. We believe that their publication would risk seriously damaging the quality of advice given to Ministers and any subsequent decision-making”.

I would say to the shadow Secretary of State—[ Interruption. ] He asked the question; I would be grateful if he listened to the answer. The reason why I say that the Secretary of State is within his powers and is right to do what he did is that never before have any Government or Secretary of State released that information. Being a sensible, considerate and fair man—which the Secretary of State is—he is right to challenge the decision, because that information has never been released before, as stated by the spokesmen for the Department of Health and made clear on page 2 of the information pack provided by the Library.

I also want to refer the shadow Secretary of State to another point. He has previously used the exemptions in section 36. Either we have exemptions or we do not, but the current exemptions, whether in section 36 or section 35, were put in place by the previous Government. If they did not want those exemptions—if they had said that everything should be in the public domain—they should have made that clear. I remind the Opposition of the saying “What’s good for the goose is good for the gander”. The fact is that you applied similar provisions, whether in section 35 or section 36, to withhold information. If you were able to do that in the public interest, then this Government, applying the same procedures and the

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same rules, can do so too. There is simply no point having legislation, in the form of the Freedom of Information Act, and now suddenly, when you are in opposition, you move the goalposts. In my view, that is totally and utterly unacceptable. It is also important to note that the Department of Health—

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. May I gently remind the hon. Gentleman that I am not responsible? He keeps saying “you”, and I assure him that I will not and do not want to take responsibility for the NHS.

Rehman Chishti: I am grateful, Mr Deputy Speaker, and I am sorry to put the previous Government’s legacy on you.

Moving on, it is important to bear in mind the previous Secretary of State’s decisions in 2008, to which I referred earlier. However, it was not just him who acted in that way; the Secretary of State for Health before him, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), made similar decisions, under section 36 of the Act. In view of the procedure provided under the Freedom of Information Act and the similar decision taken by previous Labour Health Secretaries on public interest grounds, I feel that the Secretary of State is absolutely right to challenge the current Information Commissioner’s ruling.

On such an important issue, it is absolutely right to say that in the interest of fairness and transparency, the matter should be looked at by a higher authority. If a point of law is at stake, I would say that section 59 should be used to refer the matter to the High Court. The debate has touched on the excellent work going on—whether in respect of the cancer drugs fund or the reduction of viruses in hospitals—so I endorse the view of my constituent, Mr Thomas, sitting in the Public Gallery, who says that the Government are doing an excellent job.

4.25 pm

Barbara Keeley (Worsley and Eccles South) (Lab): I support the motion calling on the Government to publish the transition risk register because I think it is vital to ensure informed public and parliamentary debate on the Health and Social Care Bill. As other Members have experienced, 40 of my constituents have written to me about this issue in the last two days. They rightly worry that the Government’s reforms will damage the NHS. They want to see the risk register released to inform them and to let them make up their own minds about the issues. My constituents also believe that Members here and in the other place should have all the available facts and information when debating and voting on legislation.

The proposed top-down reorganisation of the NHS is unnecessary, costly and a threat to our current health and social care services. As we have to consider these costly and unnecessary proposals, we at least need to know the threats and concerns that exist, about which the risk register might inform us.

Risk registers—like other local registers we have heard about—are routinely published by the North West Strategic Health Authority and other regions to communicate risks about the transition to new NHS structures and to

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ensure that those risks are understood and managed. Let me point out some of the risks mentioned in a recent risk register report for the North West Strategic Health Authority. The transition might mean a loss of grip on current performance or that organisational and system instability during transition could adversely affect corporate performance. Furthermore, corporate and individual capacity and capability might be diminished by uncertainties arising from transition. Those are all rated as high risk.

I believe that we are already starting to see some of those issues arising in the north-west and nationally. The Health Select Committee recently dealt with some of those issues in its report on public expenditure. The Foundation Trust Network had told the Committee that

“in the short to medium term there is significant disruption in relationships as experienced people leave the NHS or are redeployed.”

It also said:

“With the financial pressures on commissioners, combined with the changes in personnel and disruption of historic relationships, there is growing evidence that commissioners are making unsophisticated attempts to reduce costs.”

Based on all the evidence we heard, the Select Committee concluded:

“The reorganisation process continues to complicate the push for efficiency gains…we heard that it more often creates disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings.”

I can provide a local example. Salford primary care trust was running an effective service of active case management for people with long-term conditions, but it ended that a few months ago. That is a counter-productive change—the sort of change being made by NHS bodies as they rush to meet the pressures of making savings and reorganisation. I know that ending that service was to the detriment of my constituents and other Salford people living with long-term conditions. I have raised the issue in debates with the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is in his place on the Front Bench.

The Bill brings competition into the NHS at a level that I believe is unhealthy and unwanted. What are the potential risks to patients of a massive increase in the use of private clinics, private surgery and other private treatments? Much is said about choice, but what about the risks? We know that tens of thousands of women with PIP breast implants are sick with anxiety; they understand the risks of using private surgeons who then refuse to follow their duty of care to their patients. These are women who fear that they might have industrial-grade silicon leaking into their bodies, giving them immune system problems. They are finding that their surgeons are either untraceable or do not want to know about their problems with the implants.

Dr Sarah Wollaston (Totnes) (Con): Does the hon. Lady accept that GPs will not be commissioning private breast surgery?

Barbara Keeley: In fact, there is a link, or a crossover, with the NHS. I have received letters from women who have had breast cancer and whose breast augmentation

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has been carried out in the private sector. I think that the hon. Lady attended the Select Committee meeting at which the issue was discussed, so she should understand the risks.

Many private clinics that were keen enough to sell surgery now want to charge their past patients just for a scan to check an implant. Women who have undergone surgery in those clinics have told me that the videos and brochures selling the surgery made no mention of the risks, or even of the fact that implants last only up to 10 years and that they would have to repeat the surgery every 10 years of their lives in order to keep replacing them. That was never mentioned.

Some clinics have gone into administration. My right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) described what happens in such instances. The new owners—if there are new owners—tend not to want to know anything about the problems of past patients. Questions of capacity are involved. The largest private medical company undertaking implants dealt with some 14,000 of the 40,000 patients who were given PIP breast implants, and thus could be seen immediately to be liable for 14,000 removal and replacement operations. However, it now says that it has the capacity to deal with only 4,000 operations of this type per year. Having created a problem, that group of private clinics is now saying that it does not have the capacity to solve it. The Committee was worried about the capacity of the NHS to deal with it, but the capacity of the private clinics who sold all those operations is much smaller.

The problem of PIP implants is on a huge scale, and I still believe that far too little is being done to help the women who are sick with anxiety about their implants. As I have said, the private clinics and surgeons do not want to deal with the problems, cannot deal with them because they do not have the necessary capacity, or deal with them only if the patient pays again, often when she cannot afford to do so. As we have seen, the Secretary of State has no power to compel private clinics or private surgeons to meet what we say are the moral obligations and their duty of care to former patients.

We also, sadly, have a regulator for devices such as implants—the Medicines and Healthcare products Regulatory Agency—which seemed to be incapable of conveying to the 40,000 patients with PIP implants the message that the product was faulty and could be toxic, thus causing 21 months of delay before the patients even knew about the new risk to them. Much surgery, including much private surgery, involves various medical devices and implants, and that situation is not acceptable. Given that we have seen such regulatory failure in the case of one sort of implant, I want to know what risk is posed by private surgery involving other devices. It is possible that in future we will see further scandals involving replacement knees and hips.

We need to know what risks, at national level, are inherent in the proposals in the Health and Social Care Bill, particularly the competition proposals. We need to know that in the House, as the Bill progresses, and we need to know it more widely. I support the motion.

4.32 pm

George Hollingbery (Meon Valley) (Con): I want to begin by challenging something that was said by the shadow Secretary of State, the right hon. Member for

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Leigh (Andy Burnham), when he opened the debate. He has also shouted it several times from a sedentary position, and indeed he intervened on my hon. Friend the Member for Dartford (Gareth Johnson) a moment ago to make the same point. He keeps saying “It is a different register”.

Let me quote, at some length, what the right hon. Gentleman said earlier: “This led my predecessor”—the right hon. Member for Wentworth and Dearne (John Healey)—“to initiate a freedom of information request for the transition risk register. I wish to point out that my right hon. Friend did not request the full departmental risk register, which was subject to a similar request in 2009”, which was, indeed, released by the right hon. Gentleman. The right hon. Member for Leigh went on: “There are three crucial differences between the situation and the subject of today's debate. They would do well to listen because the Prime Minister got his facts wrong at Prime Minister's Question Time. The first important difference is that this relates to a different document. This debate is about the transition risk register, not the strategic risk register”.

I may have misinterpreted this, because it is not my key area, but let me refer briefly to the decision notice issued by the Information Commissioner. Paragraph 16 about the “Scope of the request” states:

“At the internal review stage the public authority referred to two separate risk registers which it said were relevant to the request and held by the department – the ‘risk register centred on the Health and Care Bill’ and the ‘strategic risk register'… For the avoidance of doubt, the Commissioner wishes to state that he agrees with the public authority…and that it is the strategic risk register which should properly be seen as falling within the scope of the request.”

In short, the document that is requested now, and the one that the right hon. Member for Leigh refused to release in 2009 are, as adjudged by the Information Commissioner, exactly the same document. The right hon. Gentleman may wish to refer to that later, and I am entirely happy for him to do so. If I have got it wrong, I am happy to be corrected.

John Healey: I am grateful to the hon. Gentleman for giving way because, uncharacteristically, I think that he has got it wrong. The Information Commissioner’s notice considered two different freedom of information requests: one for the transition risk register from me, and one for the strategic departmental register from a journalist from the E vening Standard. The decision notice was a decision on both those registers. My right hon. Friend the Member for Leigh (Andy Burnham) is absolutely right: in our motion and the debate, we are talking about a different document—different in nature—from the one to which he referred and the one which was relevant in 2009.

George Hollingbery: I am grateful to the right hon. Gentleman for clearing up part of this, but I think that the decision that was made by the Information Commissioner was on the strategic risk register and its release. No doubt we can discuss that later, but I am grateful to him for his intervention and for clearing that up.

More generally, we must consider whether the Bill has been properly assessed both in the House and outside by many people. There are 443 pages of closely worded analysis on the impact of the Bill, and the

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impact assessments cover every possible aspect imaginable, including risk management and the risks associated with the new Bill. That information has been in the public domain for many months, and I do not honestly believe that there is anything to be gained by issuing further risk registers that may scare a number of people about the things that they have to consider. The risk register would add very little. The answer, basically, is that it is an expedient hook on which to hang a debate: to raise again in the House a topic that has been raised a great many times—quite rightly, in many ways, as many amendments have been made to the Bill. However, the quality of speeches from the Opposition demonstrates to me at least that the point of the debate was not to discuss the risk register but to use it as a hook on which to hang a particular viewpoint.

It is well known that when the right hon. Member for Leigh was Secretary of State he refused to release the risk register. I have examined that, and I was going to quote him further at length, but the House has heard that quote several times today, so I will not trouble hon. Members with it again. The argument that he made then was a sensible one, and it remains sensible now. Do we really believe that it is good for the Government to make public all their plans for the management of every conceivable risk that they might encounter? Some of those risks will scare people rigid, and I do not honestly believe that that is the right use for the strategic risk register.

Charlotte Leslie: Does my hon. Friend agree that the Opposition should be careful about what they wish for in setting a precedent of publishing every single risk register? It may seem unlikely at the moment, but one day, they might be in government.

George Hollingbery: That is a fair point. As we have heard again today, Tony Blair says that he very much regrets parts of the Freedom of Information Act. We have all come to regret parts of the Act, and setting such a precedent could be awkward for the Opposition. When, inevitably, they return to power, they will find that equally difficult to manage.

If officials are inhibited in any way from having full and frank discussions with Ministers on challenging issues for the Government, that is a retrograde step, and we cannot afford to take it. I have no argument with the Information Commissioner, as it is his job to make assessments based on rational arguments made to him in the light of documents under review and, as he explained in his judgment, on the timing of the initial request. It is germane, however, to point out that in paragraph 29, the judgment discusses exactly the issues to which I have referred, and cites

“the ‘safe space’ and ‘chilling effect’ arguments which are well understood and have been considered in a number of cases before the Information Tribunal.”

In paragraph 35 the commissioner makes his judgment and states:

“The Commissioner finds that the factors are finely balanced in this case”.

It was not an open and shut case; he had to make a fine judgment. The Information Commissioner himself clearly found that a difficult decision to make.

As I have said, it is entirely right and proper that the Information Commissioner should make his judgment as he sees fit. That is what he is there for, but for my

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part, I believe that that is a dangerous precedent to set. We have to wait for the result of the Government’s appeal and any further iterations of the statutory process before we receive the final answer. I recognise the shadow Secretary of State’s challenge, asking why the Secretary of State would not simply acquiesce and open up the information to all. The simple answer is that there are very good reasons for not doing so, and I have just talked about those.

What of the Opposition’s plans for the national health service? Will the shadow Secretary of State publish the likely contents of the NHS risk register for and the relevant impact assessments of his own plans for the service? That might be tricky because, other than the fact that they want to cut the NHS budget, we have absolutely no idea of the Opposition’s plans, and, as far as I can tell, neither do they. I trawled the party’s website today and I could find literally nothing about Labour’s plans for the future of the NHS; as is the case in a great many policy areas for the Labour party, confusion seems to reign on the Labour Benches. At a time when there is an exponential increase in demand on NHS services and a huge increase in available treatments, and when money is in very short supply for the Government, the Opposition’s response, judging by today’s debate, is nothing, except what seems to me to be naked opportunism.

I shall offer a final thought. Perhaps political parties should also be forced to publish impact assessments and maintain risk registers on their internal musings at election time, in the interests of transparency. Had Labour had to do that in 1997, it would have been extraordinarily unlikely that the party would ever have been elected.

4.41 pm

John Healey (Wentworth and Dearne) (Lab): It is good to follow the hon. Member for Meon Valley (George Hollingbery), although he is wrong to say that this debate is simply a device for having a bigger debate. The motion is very simple and I had hoped that it would command wide support across this House, because this is not about being for or against the NHS Bill, or about being for or against the NHS reorganisation. The matter before us is whether we are for or against good government and the proper accountability of government to the public and to Parliament. A more open Government—a Government required to be more accountable—must raise their game and are more likely to be a better Government.

The Prime Minister said as much in the first month after the last election. He said that

“we’re going to rip off that cloak of”—


“secrecy and extend transparency as far and as wide as possible. By bringing information out into the open, you’ll be able to hold government and public services to account.”

Not for the first time, people are looking to the Prime Minister now to honour the promises he made, especially on the NHS. I have to say that 15 months after I made the original freedom of information request and 13 months after the Government introduced the NHS Bill, they are now dragging out the refusal to comply with the Information Commissioner in a way that prevents the

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public from getting a better understanding of the plans and prevents Parliament from doing our proper job of legislating well and legislating wisely.

George Hollingbery rose

John Healey: I will give way to the hon. Gentleman, as I have followed his speech.

George Hollingbery: I wonder whether the right hon. Gentleman could provide the House with a single example of where, in the transition of a Bill, a risk register of this sort has been used to inform the House’s debate. He may well be able to do so, and I would be grateful if he could.

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.

Ben Gummer rose

John Healey: I will not give way again; I have given way twice. The hon. Gentleman has spoken and has not been here for the whole debate.

Risk has been at the heart of the concern about the NHS reforms right from the outset. When I led an Opposition day debate from the Dispatch Box in November 2010, I described the reorganisation as

“high cost and high risk; it is untested and unnecessary.”—[Official Report, 17 November 2010; Vol. 518, c. 908.]

The lack of evidence and lack of confidence in how well the Government were prepared to manage the risks was the major cause of the growing concern among the public and professionals and in Parliament in the late

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autumn of 2010 and the winter of 2011. That alarm has only grown. It was first expressed by the all-party Select Committee report of December 2010, and reiterated in its January 2011 report, which concluded:

“The Nicholson challenge was already a high-risk strategy and the White Paper increased the level of risk considerably without setting out a credible plan for mitigating that risk.”

Not only is this reorganisation unprecedented and therefore exceptional; the NHS as an institution is exceptional. We all need the NHS. We trust it when we are most fearful, and we utterly depend on it when we are most vulnerable. That is why it matters so much to people, and why there is an unprecedented and exceptional level of public interest in any changes to the NHS and especially any risks to the NHS. The plans are unprecedented in their nature, their scale, their pace and their timing. That means that there is exceptional concern over the risks associated with their implementation. That is why there is an exceptional case for releasing this transition risk register. The Information Commissioner has had the benefit of assessing the risk register, and he has stated:

“There is a very strong public interest in disclosure of the information, given the significant change to the structure of the health service”.

There are two other factors that reinforce the case for, and the public interest in, the publication of the transition risk register. First, the story of this reform is a masterclass in poor policy making. It has been misjudged and mishandled from the outset. Good policy making normally involves policy consultation, followed by legislation and implementation. The Government have turned that on its head. First, we had implementation ahead of any legislation, followed by a forced pause to consult on the policies when they encountered so much resistance. That all adds to the risks and to the public interest in and the case for the disclosure of the risk register.

The Department of Health has a poor track record on risk assessment, on the use of evidence in policy making and on policy delivery. When the Cabinet Secretary did his first capability review of the Department, he concluded:

“Management of risk across the delivery chain is weak. There is no formal linkage between risk registers and mitigation strategies held by the Department and those in the delivery chain.”

Two years later, when the capability review was repeated, many of the same problems still applied, and the Department was again flagged in the review as at an amber state of concern—[ Interruption. ] Yes, that was under the previous Government. My point is that the Department of Health has a poor track record on planning and dealing with management risk, which is why it is so important to publish the risk register.

Clearly, in a short debate such as this, we cannot nail all the arguments that the Government are trying to put up. Suffice it to say that the Information Commissioner has heard them and has judged that the register should be released. The arguments will be tested in court on 5 and 6 March at the Information Tribunal and I shall give evidence to that tribunal. All I am asking for—and all the motion is asking for—is what the Government have promised. Today, on the Treasury website, one can see the Government’s principles for risk management:

“Government will make available its assessments of risks that affect the public, how it has reached its decisions, and how it will handle the risk.”

That is what we are asking for.

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4.50 pm

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

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£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

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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

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. A lot of Members still want to speak and time pressure is on. I shall have to reduce the limit to five minutes, and people will have to restrain themselves from making interventions. Those who continue to intervene must recognise that they might end up being dropped down the list accordingly.

4.58 pm

Diana Johnson (Kingston upon Hull North) (Lab): I want to start by praising the tenacity of my right hon. Friend the Member for Wentworth and Dearne (John Healey) in pursuing this issue, which is another unfortunate aspect of the Health and Social Care Bill. From its start until today, this botched Bill has been an unmitigated disaster. The Secretary of State has said many times, “No decision about me without me,” but when we listen to the arguments being put forward by Government Members we see that that is not what is happening. They are saying that patients cannot be given information or told what is in the risk register. That is all very poor. Also, when Parliament has so little business to deal with on the Floor of the House we ought to have proper pre-legislative scrutiny of major Bills such as this one. There was no opportunity at the outset to look carefully at each clause, but that might have been a much better way of dealing with this and coming up with something that all Members of the House could get behind.

I am also concerned that the only voices to which the Government seem to be listening in this whole debate are the private health care providers. When we see that £8.3 million has gone into Tory coffers and £540,000 has gone into the Lib Dem coffers from private health care providers, we wonder why we are hurtling at such a breakneck speed towards a free-market NHS.

I agree with the Secretary of State when he said:

“Where the NHS embraces a culture of transparency, of learning from its mistakes and constantly striving for higher performance, it is a world-beater.”

I fail to understand the argument that he makes about why the risk register cannot be produced to allow Parliament to scrutinise properly the Bill that is before it. It is disappointing that we need to have this debate today.

I am struck by the tone that the Liberal Democrats are taking. I understand that 15 Members signed the early-day motion that mirrors the motion before the House, and I know the Liberal Democrats have always championed transparency and information being made available to the public, so I hope that those 15 Liberal Democrats will join the Opposition and vote for the motion. I know that at the general election in 2010 the Liberal Democrats were not arguing for a top-down reorganisation of the NHS. As I recall, what they wanted was elected representation on PCT boards. The person who stood against me in Hull argued that to save the NHS, the next Government must end the break-neck pace of NHS reforms. That was what he stood on in 2010, yet the party that he stood for is now arguing in

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the House of Commons for reforms of the NHS at break-neck speed. Just as we have seen with tuition fees, armed forces pay, VAT and police numbers, there is likely to be another Lib Dem betrayal on this subject as well.

I shall focus on my major concerns about what might be in the risk register. I am extremely concerned about poorly performing doctors and how that will be dealt with. I know that PCTs, especially my own PCT in Hull, were taking positive action to deal with such doctors, and I am worried that with the chaos that will be created by the new structure, we will not be able to tackle those GPs. I am also concerned about Haxby Group, which has GP practices in my constituency. We have heard from my right hon. Friend the Member for Leigh (Andy Burnham) about what was happening in York. At present the PCT can keep an eye on what is happening with Haxby in Hull, but as I understand it, in future there will be five different NHS regulators involved in controlling the position that Haxby takes on offering private health care to its patients.

I am concerned about medical education. Hull and York medical school is in my constituency. How will we get a planned approach to medical education for the future? How does fit with the NHS Bill? I am also concerned about social care. The acute trust in my constituency has the fourth highest number of bed-blockers. How will we deal with that under the new structure? Finally, on health inequalities, the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton), has said that northerners are “boozed-up smokers who are addicted to unprotected sex”. That is a paraphrase, but I am worried that the good work that the primary care trust has done through collaboration and co-operation on health inequalities will be lost because of the Bill.

5.2 pm

Henry Smith (Crawley) (Con): I am grateful to have the opportunity to take part in the debate. As I have said in the House before, every right hon. and hon. Member feels passionately about the NHS. We have legitimate disagreements about the best way forward for the national health service, but we all know that it is something that each and every one of our constituents, almost without exception, and each and every member of our families, cares about. We have all relied on our health service at one time or another. It is therefore understandable that debates about the future direction of the NHS should arouse the sort of passion articulated earlier today.

It is important in the debate to reiterate what my right hon. Friend the Secretary of State said, which has been repeated by other hon. Members—that as a result of the Health and Social Care Bill, the national health service will remain free, regardless of the ability to pay, and universally available to all citizens of this country. When we discuss improvements to the health service, it is outcomes that we need to focus on.

I believe that the biggest risk to the NHS—which, as the shadow Secretary of State has said, is one of this country’s most respected institutions—is allowing it to continue with inertia and carry on as it has done in the past. At best that is a sentimental and quaint way of looking at the future of our health service. At worst it is dishonest and dangerous for the future health care of each and every one of our constituents.

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Certainly, the experience in my constituency shows that the health service desperately needs change, and that without it we risk the quality of care. In 2001 maternity services were removed from Crawley hospital, and in 2005 we lost our accident and emergency department. The risks that have been experienced since those events have increased immeasurably, but since we have started to move towards the provisions of the Health and Social Care Bill we have seen considerable improvements. Waiting times have reduced for my constituents. Local GPs and clinicians very much support the provisions of the Bill and have already joined together in a GP commissioning consortium. The elected local authorities, which are a welcome addition to local health debates, are engaged, which is great for improving future health care provision and ensuring the involvement not only of patients and clinicians but of elected councillors. Only last week I was delighted to open a new digital mammography unit at Crawley hospital and a new day unit being expanded there, so already there are improvements.

In my concluding remarks I want to talk about the inconsistency we have heard from the Labour party on the release of the risk register. As we have heard, the right hon. Member for Leigh (Andy Burnham), the former Health Secretary, and his predecessor in that job, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), rejected making the risk register available on a total of three occasions. The argument that things are now different is just nonsense; the only thing that is different is that Labour are now in opposition. They are using precious time in this place to call for the release of a risk register that, as my hon. Friend the Member for Kingswood (Chris Skidmore) has said, is now over a year old and no longer relevant, because we have moved on with—

Madam Deputy Speaker (Dawn Primarolo): Order. I call Hugh Bayley.

5.8 pm

Hugh Bayley (York Central) (Lab): I believe that the Government should publish the risk register relating to the Health and Social Care Bill, and I wrote to the Secretary of State last year to urge him to do so. I received a reply from a junior Minister in the Lords that gave the arguments that were advanced to the Information Commissioner about why it would be dangerous, including the suggestion that civil servants would pull their punches if their risk assessments were made public. The commissioner rejected those arguments, but even after he made his decision they were still being advanced by the Government, and we heard them advanced once again in the Chamber today.

The Government have got themselves into an utterly impossible position. Dozens of constituents have written to me, and I have been told by people with very high posts in the NHS, including senior clinicians, senior mangers and professors of health policy, that the Government ought to publish the register. Underneath this all is a growing belief that the only reason the Government can possibly have for not publishing the register is that it would be politically embarrassing for them to do so.[ Interruption. ] The Minister shakes his head, but the hon. Member for Southport (John Pugh) drew an interesting parallel. When the former

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Speaker in the previous Parliament sought to overturn the Information Commissioner’s decision that the information on MPs’ expenses should be published, I tabled a motion stating that we should publish the figures for second-home allowances. This was before

The Daily Telegraph

exposed what it did, and, had the House published at that stage there would have been a public outcry, but there would not have been the loss of public trust in this House, which came when we were seen to be hiding the data and seeking to overturn a reasonable decision, made by the Information Commissioner, that it should be made public.

The Government have got themselves into precisely that position because if, after the tribunal, they are told that the information has to be published, the embarrassment that they know they will face, they will face, but they will face it against a background of public cynicism that would not have existed if they had published in the first place. If, however, they win their case and the information on the register is not published, the public will still believe that the Government have something to hide, so my advice to them is, “You’re in a hole, stop digging and publish.”

The Secretary of State said in his speech to the House that all the information that is relevant to the debate about the Bill is in the impact assessment so there is no need to publish the risk register. But if all that we—and the public—need to know about the Bill has already been published, the Government have nothing to lose by publishing the risk register.

If we look at the impact assessment, we see that from time to time the Government have redacted certain figures, so if one or two things, for some particular reason, had to be kept secret, they would still be able to publish 99.99% of the risk register, and they would satisfy this House and public opinion and build greater confidence.

There is public fear because there are inevitably risks to increasing competition in the provision of NHS services. Increasing competition is not in itself a bad thing. The Labour Government increased competition between acute London hospitals in coronary care and achieved better coronary care outcomes, but when we contract to private providers we inevitably create risk. I should not need to tell Government Members that risk is what private companies take, and that it is given as a justification for making profit and reward, but if risk applies to profit it can and does apply to the quality of patient care.

Several Government Members have said that they want to drive up the quality of patient care and to drive down the cost of care, but they will do so only if they publish comparable data on outcomes and cost for every supplier of service to the NHS. The Government need to commit to do that and to include it in the Bill; otherwise, members of the public will fear that the consequence of the reforms, forcing competition on the NHS, will mean that some care standards will fall, which is what happens when we have unregulated—

Madam Deputy Speaker (Dawn Primarolo): Order. I call Ben Gummer.

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5.13 pm

Ben Gummer (Ipswich) (Con): Your predecessor in the Chair, Madam Deputy Speaker, noted that this has been an intemperate debate, and so it has, reflecting a wider debate about the NHS that has become increasingly intemperate with every day that has passed. The reason is in large part the terrible myths, put about by the Opposition and their co-agitators in the health care unions, which we have heard again perpetuated in the leadership, and in the sponsor and proposer of the motion today.

As any demagogue will know, it is always difficult to present a travesty of the truth in a calm and reasonable voice, and that is precisely why the manner in which the Opposition have conducted this debate, and the entire debate about the NHS, belies the fact that they are interested not in a calm and reasonable debate, but merely in smearing the Government and in bringing into disrepute this long-needed reform of the NHS.

The inconsistency of the Opposition’s position is evident even in the motion, which asks for the Government to respect the decision of the Information Commissioner, yet that is based on an Act, the Freedom of Information Act, which the previous Government brought in, and on which I have to say the Conservative party was wrong. This is not just about the decision of the Information Commissioner; the Act describes a process that must be respected in its entirety. We are in the middle of a quasi-judicial tribunal, and it would have been right and respectful to the spirit of the Act if the Opposition had waited until the decision-making process was complete before making this point. Far from dragging it out, as the former shadow Health Secretary, the right hon. Member for Wentworth and Dearne (John Healey), claimed earlier, and as the current shadow Health Secretary says from a sedentary position, the Government have brought forward the tribunal date to expedite it. That is entirely consistent with the Government’s track record on transparency.

Yesterday, in the Justice Committee, we took evidence from Maurice Frankel, who is well known to Labour Members as a champion of freedom of information. He said that we as a Government are doing reasonably well, and that we are certainly ahead of Australia, Canada, the United States and Sweden. When the hon. Member for Kingston upon Hull East (Karl Turner), for whom I have great respect, asked how FOI in England and Wales compares with that in similar jurisdictions, Professor Hazell of the UCL constitution unit said that we compare very well and have a rather more generous regime than in Australia and Canada. We are now improving on that as a Government.

Karl Turner: Would the hon. Gentleman say that the question was put in relation to this particular issue? He is rather suggesting that it was, but it certainly was not.

Ben Gummer: The hon. Gentleman is entirely correct. I am trying to put in the round the position of this Government on freedom of information—that is, respecting the Act brought in by the previous Government in going through the necessary process, and in the meantime showing greater transparency in their dealings with the public than any previous Government. One need not look only at the transparency inherent in departmental business plans and departmental spending above £5,000.

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The risk registers quoted by the shadow Secretary of State, which he revealed with a flourish as though he were some latter-day Carl Bernstein, came from the websites of local PCTs and were revealed as a result of transparency initiatives by this Government. In their motion and in their attack on the Government, the Opposition have shown inconsistency that reveals their true intent.

The shadow Secretary of State repeatedly called into question the Government’s motivation for not releasing the risk register. Their motivation is precisely the same as that which drove him to refuse to release a risk register in 2009. In turn, I question his motivation for calling this debate and picking a fight on this matter. It is not, as the motion might suggest, to inform the public debate, but to fuel the misinformation campaign that has been the basis of the Opposition’s attack on the NHS reforms; to take out of context statements from a document that, by its very nature, considers risks rather than benefits; and to use that in an effort to undermine a programme of reform that has the support of increasing numbers of health care professionals in my constituency to whom I have spoken, and is showing real results.

Jonathan Ashworth (Leicester South) (Lab): Will the hon. Gentleman give way?

Ben Gummer: I will not, if the hon. Gentleman does not mind.

That is not responsible opposition; it is dangerous opposition. The Leader of the Opposition goes around lecturing everyone about responsible capitalism, but he might like to start at home and have a look at responsible opposition. In undermining the ability of the machinery of government to operate correctly, the Opposition undermine not only this Government’s, but successive Governments’, ability to make decisions on our constituents’ behalf. Wiser colleagues of the shadow Secretary of State might rue the day that they wanted all risk analysis by Departments to be made public, thereby unbalancing our debates. That would have made impossible even the timorous reforms of Tony Blair in academies and in foundation trusts.

Let me inform the shadow Secretary of State of the effects that these health reforms are already having in my constituency. We have better care for the elderly that stops them going into hospital and allows them to be treated at home, and a drugs budget that is being kept under control for the very first time. He turned down a heart unit in my local hospital; we are now having it built at a cost of £5 million. The reforms will deliver real benefits to my constituents in Ipswich, and I wish that his constituents could have received them too.

5.19 pm

Jim Shannon (Strangford) (DUP): As a Northern Ireland MP, I will give a Northern Irish perspective. The need for the publication of the risk register is clear in my mind and in the minds of my constituents. My constituents tell me that they have concerns over the reform of the NHS and how it will affect them. It is therefore important for the risk register to be made public.

When one inquires into what a risk register entails, one is pointed to the guidance in the NHS paper,

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“Making it Happen: A Guide for Risk Managers on How to Populate a Risk Register”. A telling paragraph states:

“Managing risk effectively and embedding internal control into the processes by which objectives are pursued is extremely important for the NHS. The external driver in the form of a Statement on Internal Control, places a public disclosure obligation on individual boards of directors. That responsibility includes ensuring that the system of internal control is effective in managing risks. The production of a ‘live’ Risk Register is considered to be an integral element of good risk management practice by the Controls Assurance Team and NHS Litigation Authority and is a key feature of the Australian/New Zealand Risk Management Standard. It is hoped that this document will help NHS organisations progress this agenda.”

What has changed in that need to ensure that good risk management practice is carried out by the NHS for the benefit of the organisation? Why is this risk register not being published so that front-line NHS workers can understand the risks and give their input?

I want to give an ordinary perspective on this matter. One of the major hospitals in Northern Ireland, the Ulster hospital, is on the border of my constituency. Its catchment area includes some 200,000 potential patients. It is a fantastic hospital with friendly and helpful staff, from the porters up to the consultants. I have been in contact with a large number of its staff who have concerns over this matter. They are clamouring for openness and transparency. People from my constituency work in that hospital every day in their various roles. They want to ensure that they are part of any decision-making process, because they know that their experience and expertise should be considered in any debate. They are not being given such an opportunity at this time.

I and many Members on the Opposition Benches—and, I suspect, some Government Members—believe that there must be transparency so that people know whether the savings are worth the risk. Our health service is a priority. For many people it literally means the difference between life and death. It is essential that those on the front-line of the service are aware in advance of what the changes could bring so that they can prepare for them.

I have been contacted by the British Medical Association and many other bodies that have asked me to speak on their behalf and on the behalf of doctors, midwives and staff in the NHS. The letter from the BMA, which I am sure all Members have received, bears repeating:

“Health professionals are already seeing fairly chaotic and complex implementation of the reforms ‘on the ground’ which has already begun within the NHS. The challenges and potential risks identified with this process should be contained within the register. Furthermore, the staff currently trying to balance the implementation of the reforms with the drive to find £20 billion of efficiency would benefit greatly from the Government’s view of the risks associated with this difficult twin challenge.”

That must be put on the record in this House, as it has been by many Members today, to bring clarity on this matter. The opinions of those who are working on the ground must at least be considered, but they cannot give a full opinion without possessing the full facts.

I am not someone who believes that every aspect of public service should be disclosed. Defence matters clearly should not be disclosed, because it would put the lives of soldiers at risk. As a Northern Ireland MP, I know that from the time of the troubles up to the present day, there have been security matters that cannot

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be disclosed and that should be kept secret. However, it is my opinion that the reverse could happen if we do not release the risk register. I believe that not releasing it could cause danger and harm. I therefore support the disclosure of the risk register.

The NHS, although far from perfect, is something that we can have pride in because of the dedication of those who work in our hospitals: the doctors who take on extra shifts to ensure that every patient has access to care, the nurses who stay for an extra 10 minutes or more to finish changing people’s dressings, the auxiliary workers who ensure that the elderly patients eat all of their dinner, the porters who transport patients slowly enough so that they are not hurt, and the cleaning staff who work later than necessary to ensure that the wards are clean. Those people are part of the NHS, have knowledge of the NHS and have an interest in the NHS. My constituents tell me that they want the publication of the NHS risk register. I urge Members to consider that very carefully. The publication of the risk register is a single issue. I ask Members to support it tonight.

5.24 pm

Mr Marcus Jones (Nuneaton) (Con): I rise as a Member who is completely and utterly committed to, and supportive of, our NHS, and completely committed to transparency and openness in government. In that vein, I applaud the Government’s recent moves to extend transparency in the Department of Health, with probably more information being provided than ever before. There is more information on IT projects and departmental spending, to name but two of the many examples of the progress that the Department is making. A similar exercise is going on across government, which I applaud.

Although it can be a ghastly system to administer, I also fully support how the Independent Parliamentary Standards Authority expenses regime is made public. I probably will not get too many cheers for saying that, but I am completely and utterly committed to transparency.

However, we have to recognise that there are often situations in which all risk scenarios are discussed, including doomsday scenarios. We need to consider carefully whether to put all that information directly into the public domain, for fear of the panic and problems that it may cause. For example, if Members saw a copy of the Treasury’s risk register and the wrong information were put out, suggesting an increase in interest rates, growth problems, problems with the banking system and the austerity measures that may be needed in a doomsday scenario, that information would be in the public domain within seconds. It would probably mean the markets going into freefall, and we would all be rushing to the nearest cash machine to take our money out, if we had any left. No Government have released such information in the past, for obvious reasons. The doomsday scenarios that we have to consider are real risks, but they rarely occur.

There is no doubt that the risk register covering the Health and Social Care Bill will include certain such scenarios, and the Government’s approach is critical to developing policy not just on health care but across the piece. That was certainly the Labour party’s view when it was in government and when the shadow Secretary of

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State was in charge at the Department of Health. Under his stewardship, a very similar request to see the risk register was refused, and section 36 of the Freedom of Information Act was cited as the reason.


Madam Deputy Speaker (Dawn Primarolo): Order. Let us not have shouting across the Chamber. We need to hear the Member who is speaking. If other Members disagree with what is being said, that is what the debate is for.

Mr Jones: The same practice was followed by the shadow Secretary of State’s predecessor as Health Secretary, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson).

Glyn Davies (Montgomeryshire) (Con): Does my hon. Friend agree that the Opposition know perfectly well that what they are asking for is unreasonable, and that the case that he is making is absolutely sound? They are seeking to discredit the Government rather than support the NHS, and they are taking a completely irresponsible position.

Mr Jones: I absolutely agree. The points that they are making today are just as confused and incoherent as the rest of their policies. They seem to just cut and paste their policy with some frequency to suit the bandwagon that they wish to jump on at a particular point.

Karl Turner: Will the hon. Gentleman give way?

Mr Jones: I will continue, if I may.

The motion is something of a red herring, in that it does nothing to meet my constituents’ concerns about the delivery of health care. When I speak to them, it is quite obvious that they want choice about where they are treated and access to high-quality health services that can be provided locally. They want less management and bureaucracy in the NHS and more money to go to the front line.

My constituents certainly do not want to go back to the PCT-type commissioning that we had under the previous Government, because Nuneaton was completely disadvantaged under that system. Nuneaton is one of the most disadvantaged areas of Warwickshire and has one of the worst health inequalities. Despite that, NHS Warwickshire did not support Nuneaton and health funding dissipated elsewhere in the county. The huge PFI scheme in Coventry drained the life out of the Warwickshire health economy and caused a threat to constant service reorganisation, which could have caused the loss of A and E and maternity, and other women and children’s services, in the George Eliot hospital in Nuneaton.

We need to battle and fight against the problems that we encountered under the PCT, but at least under the new system, the local GP commissioning consortia are helping. They want to work with the George Eliot hospital and are making efforts to support and maintain those services in Nuneaton.

5.30 pm

Siobhain McDonagh (Mitcham and Morden) (Lab): I wish to share with the House a cautionary tale and to suggest that the publication of the risk register might be in the best interests of all hon. Members and all parties, because it will allow us to stand back and look at the consequences of the changes.

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The London experience—certainly the south London experience—is that the changes will lead to a wholesale closure of general hospitals in urban settings because they confuse the roles of providers and commissioners of services. I am in a fortunate position. After 13 years of argument, one of the last acts of the previous Labour Government was to agree to spend £219 million on the rebuilding of St Helier hospital. Thankfully, the current Government agreed those plans—it was one of only three capital programmes of its size in the country.

St George’s hospital in Tooting, which is known to many, was to merge with St Helier to make St Helier large enough to become a foundation hospital. After those years of argument, the programme was going well until St George’s hospital looked at the GP commissioning plans in my area, which suggested that they would reduce services at St Helier hospital by £40 million over the next five years. St George’s, the only hospital interested in merging with St Helier, backed away immediately, because it knew it could not make the figures stack up.

We now have a £219 million capital programme for a hospital that, as it stands, is completely unviable. I should not be admitting that to the Government because they might think that they do not want to spend that money. I want them to spend it, but I want them to spend it on a viable hospital, because the demand and the need are there.

I can understand why GPs, who are private practitioners, want to provide more services. My argument is in favour of the consumer—the patient. Patients might not want to get up every morning to try and make a GP appointment and not get in that day. They might not want or be able to take a day out of their working lives or sustain the consequences of doing so to get a GP appointment. They might not want to wait a fortnight for a blood test, as I am doing. They might choose to go to their local hospital for that service. I believe it is the right of NHS patients to make those choices, but they are the choices that we will deny to people if the Health and Social Care Bill is passed, because it imposes a 19th century health model on the 21st century. Our experience in London is that walk-in clinics provide for many, but not for everybody, better services than GPs.

We have heard about the relationship between the patient and the GP. In south-west London, people are grateful to see any doctor when they go to the GP service. That relationship does not exist. I appreciate that the experience of people in market towns outside London might be entirely different, but from a London perspective, the changes will have an enormous impact on patients, including the most disadvantaged patients who live in our capital city. As a consequence, enormous numbers of hospitals in suburban areas will face reductions and closure. MPs of all parties must consider whether that is what they want. It is beginning to happen. On a BBC regional programme recently, the medical director of NHS North West London said, quite openly, “Yes, we will see the closure of many hospitals.” Is that what we want? Are we prepared to support that? Is it in the best interests of our constituents? I do not believe so.

5.35 pm

Jeremy Lefroy (Stafford) (Con): The subject of this debate is risk within the NHS, specifically that associated with the Health and Social Care Bill. I want to address

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the matter with specific reference to Stafford hospital. My constituents, whether patients, relatives, loved-ones or NHS members of staff, have been through a great deal over the past few years. There is tremendous support for a quality acute hospital and the services that it provides in Stafford, including full-time emergency care, which it currently does not provide. The existence of that support is evidenced by a petition signed by 20,000 people. Those people need to know that the Bill will not hinder but support their ambition. I would like to show why it will support it.

The other great legislative influence on the future provision of NHS care in the coming years will be the report from the Robert Francis public inquiry into all the aspects of the troubles that surrounded the hospital. I am glad that the Secretary of State ordered that inquiry. He deserves credit for doing so. Indeed, his predecessor as Secretary of State, the right hon. Member for Leigh (Andy Burnham), also deserves credit for ordering the previous inquiry, which drew many valuable conclusions. Since those came to light, they have had a great impact on the Health and Social Care Bill. I will give three examples.

First, the Bill places a duty on the Care Quality Commission—the successor to the Healthcare Commission—and Monitor to work together closely. As Francis said, the absence of that duty was one reason for the troubles at Stafford and why the trust got the authorisation that it should not have got. Secondly, clause 2 places a duty on the Secretary of State to improve and promote quality throughout the NHS, which is vital. Thirdly, the Bill will strengthen local accountability for health services.

Francis will report soon—possibly while we are still considering the Bill—and as the right hon. Member for Exeter (Mr Bradshaw) said, we have to ensure that as many of those recommendations as possible are addressed in the Bill or very soon afterwards, perhaps in other legislation. A senior member of the Royal College of Physicians described the report to me as undoubtedly the most important review of the NHS in the past two decades, so it is vital that its recommendations are carried through.

In Stafford, we have seen at first hand the risks within the NHS. These risks, and their consequences, predate the Bill. The greatest risks that any health care system has to address are the safety of patients, the quality of care and the financial sustainability of services. The three are inextricably linked.

Mr Marcus Jones: Does my hon. Friend agree that part of the problem with Stafford hospital is the same as the problem at the George Eliot hospital in Nuneaton, Warwickshire? A PFI hospital built in close proximity has been a huge drain on the local health economy and has starved smaller district general hospitals of resources.

Jeremy Lefroy: I want to come to that point, although I should point out that people are grateful for the new hospitals built under PFI. I would not take anything away from that. It is the financial arrangements around them that have caused problems in some cases.

Much more work needs to be done on tackling the risk of harm to patients and ensuring patient safety. Local accountability, which the Bill strengthens, is

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important. Clinical commissioning groups will not commission services for their patients if they do not have confidence in them, but they have a responsibility to work with those providers so that confidence can be restored—they should not just ditch them. Transparency in the reporting on and reaction to adverse and serious incidents is improving, but under the Bill, with the health and wellbeing boards, HealthWatch and the CCGs, there will be groups taking a direct interest in what is happening in their local area.

Since the troubles at Mid-Staffordshire, all parties have focused on quality of care. I welcome the improvements at Stafford. There is still much more to do, but the staff have done a tremendous job moving things forward. However, there is a serious problem nationally, as was highlighted by the recent CQC report commissioned by the Secretary of State. We would all agree that it is not acceptable that elderly and vulnerable people are left unattended when they need help in hospital. We still get such cases, even today. That is why the Health and Social Care Bill’s requirement for the Secretary of State to improve the quality of services is so welcome. Making that a requirement will not in itself solve the problem, but it will ensure that the Secretary of State has a legal duty to deal with problems in the quality of care.

Then there is the question of financial risk. In Stafford, we face the problem at first hand, with a £20 million deficit this year. I am grateful to the Government for supporting us in that, and for their support in so many other places. However, we face great challenges, along with many other small acute trusts across the country, and we would under any Government. Let me make it clear: acute district general hospitals are an essential part of the health economy of this country, wherever they are. For the sake of towns and smaller cities across the country, we must, as a Parliament, find a model for them that works. Clause 25 of the Bill enhances local involvement in the commissioning of services. That will help the process, but it will need to be a robust process. When the consultations that are envisaged take place, they must be real, and they will be real: CCGs live in the communities for which they will be commissioning and they should know more than anybody about what their patients need.

The final risk cannot be legislated for, and no risk register will ever deal with it. If compassion for patients is lacking—if they are seen as numbers, not as people; if the elderly and vulnerable are considered a burden and somehow less important than the young and fit—we will have failed, however well funded our services are, however strong and shiny our new hospitals are, and however complete our risk register is. However, I am confident that we will not fail.

Several hon. Members rose

Madam Deputy Speaker (Dawn Primarolo): Order. There are still 17 speakers who wish to participate in this debate and we have under an hour to go. May I ask Members not necessarily to take the full five minutes if they can possibly avoid it? [ Interruption. ] You can all sit down while I am speaking. May I also ask those who have already spoken to observe a self-denying ordinance and not intervene? They have had their chance.

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5.42 pm

Catherine McKinnell (Newcastle upon Tyne North) (Lab): My inbox and postbag, like those of my colleagues, have been flooded with e-mails and letters calling for the publication of the risk register. Without it, MPs will be voting on changes to the NHS without knowing the full facts. I am overwhelmed, although not surprised, by the concerns of my constituents. I want to use today as an opportunity to express those concerns.

One key issue that I feel has not received enough attention to date is the level of risk posed to children by the proposed NHS reforms. Concerns about that have been expressed by more than 150 paediatricians, who have called on the Government to scrap the Health and Social Care Bill. First, they quite rightly question the Government’s assertion that this top-down reorganisation is even necessary. More importantly, however, they say:

“We believe that the bill will undermine choice, quality, safety, equity, and integration of care for children and their families.”

My colleagues have already described the shameful saga of the release of the risk register, so I will not go any further into that. However, we should be grateful for the interim insight given by NHS London’s assessment of the risks of reorganisation, which makes for grim reading. By virtue of the fact that the Government are refusing to publish the risk register, I can only be concerned about what the national picture must be. In addition to the risk of all patients receiving “sub-optimal care”, the London assessment refers to the risks to safeguarding children, the “dilution of expertise”, and

“weaknesses in information sharing systems and processes,”

and says:

“The consequences of this may be preventable harm to children”.

There is clearly a fundamental problem with the reforms when it comes to child protection. In order to safeguard children effectively from abuse and neglect, various agencies need to communicate and work together. However, the result of the NHS reforms will be to substitute co-operation for competition, to the detriment of good safeguarding and, ultimately, to the children whom it is supposed to protect. Each month we see a higher incidence of children being neglected by their parents and taken into care. In that context, and against the backdrop of significant cuts to children’s services, the Government should not be focusing their energies on unnecessary reorganisation that could increase risks to an already vulnerable group.

The Government’s policy is completely confused in this area. The Department for Education is aware of the need and expresses support for providing early help to vulnerable children and families. We should be focusing on training midwives to identify vulnerable families before a child is born, getting them the support they need if they are at risk. The NHS London risk report, however, has expressed grave concerns about the capacity of maternity services and the capability of the work force—as a direct result of the proposed reforms. Similarly, general practitioners—a first port of call for many families—have a key role to play in identifying and reporting risks of abuse. This is hampered where, as shown in the London risk report, the reforms will render their performance variable and, in some cases, poor.

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In the words of the 154 paediatricians who wrote to The Lancetlast week, the safeguarding of children

“will become even more difficult when services are put out to competitive tender and organisations compete instead of co-operate. Children who are vulnerable, neglected or abused will inevitably slip through the net…The bill will be detrimental to the goal of integrating care for the most vulnerable children across health, education, social care and the criminal justice systems in order to deliver good outcomes”.

It defies belief that the Government are insisting on pursuing reforms that have been assessed as potentially and needlessly resulting in harm to children. How, faced with that, can the Government continue with this folly?

Even in the face of the public’s reaction to the Bill, we have seen more than 150,000 signatures on the “Drop the Bill” petition, while hundreds of my own constituents have contacted me on this issue. My constituents and others up and down the country highlight the Government’s lack of transparency and accountability on this matter. The Information Commissioner has said that there is a strong public interest in disclosure of the information. An important point is being made about the risk register, which reveals that the Government have abandoned principles of proper governance on this matter.

Time and again we have heard the Government promising openness and transparency in government and in the NHS—the Prime Minister, the Deputy Prime Minister, the Health Secretary and others have extolled those virtues—but as the refusal to publish the register shows, those statements are nothing but platitudes. How can the Government claim transparency when they kept key critics of the Bill out of their meeting on Monday? It is a joke. The Government must publish the risk register, allowing proper and informed debate. We owe it to the people of this country who treasure our NHS—and we owe it especially to our vulnerable children.

5.47 pm

Steve Brine (Winchester) (Con): I have sat in my place for a long time, and I must say that I find today’s debate deeply troubling in many respects. It is troubling because I dread to think what some people watching our debate must think. It is troubling because, as many of my hon. Friends have said, we are once again not really discussing the principles of the Health and Social Care Bill or what it will mean on the ground in constituencies such as mine. It is troubling, above all, because this Opposition day debate—I note it has fallen rather flat yet again—is not about the NHS. As my hon. Friend the Member for Kingswood (Chris Skidmore) said, it is about politics and about the latest, almost embarrassing, bandwagon rolling out of what used to be new Labour. Today’s Opposition day debate was clearly a Trojan horse for other issues; Labour has been successful in that respect. As has already been said this afternoon—and I suspect that it will be said again—the last Labour Government never routinely released risk registers. I enjoyed the analysis of my hon. Friend the Member for Kingswood, who demolished Labour’s argument earlier.

I am a member of the Justice Select Committee and Members will be aware that this week we began an inquiry into the Freedom of Information Act. The key things I want to understand from that inquiry are whether the shadow Health Secretary was right to refuse freedom of information requests during his

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time, and what some of the key people involved in the political birth of this Act think of it now. As luck would have it, I have some primary source material, so let us reflect on it.

There is a longer quote, but I will not spoil someone else’s thunder. I will cite what Tony Blair said in his autobiography:

“Freedom of Information. Three harmless words…I quake at the imbecility of it.”

Now, far be it for me to disagree with a former Prime Minister, but that is putting it a little strongly, in my opinion. I do not share his views, but they are, by any standards, astonishingly candid words. He went on:

“I used to say…to any civil servant who would listen: Where was Sir Humphrey when I needed him? We had legislated in the first throes of power. How could you, knowing what you know have allowed us to do such a thing so utterly undermining of sensible government?”

Well, Mr Blair should not have been so hard on himself. He built in safeguards to protect against the very undermining of sensible government—the sensible government that so concerns him now—and I believe that that is the issue we are discussing today.

Were the last Government, and the present coalition Government, right to refuse FOI risk register requests? Let me turn to the wise words of the former Cabinet Secretary Gus O’Donnell, who, when, speaking to the BBC earlier this month, said:

“The problem we face with the way FOI is working is it’s driving stuff underground or into non-FOI-able routes, as the jargon has it. You just don't know when you write something down whether that is eventually going to be decided by a tribunal of people who may have never worked in government whether or not that should be released.”

When asked if he could provide an example of the way in which the Freedom of Information Act was preventing proper discussion between Ministers and civil servants, he cited—yes, you guessed it—the topical example of the calls being made for the publication of Government risk registers, and the dangers, as he saw them, that it would have for contingency planning in the case of a nuclear Iran, when the Government might consider options which, if made public, would undoubtedly provoke an overreaction on the part of the media and the public. It could be said that today’s call from the Opposition is deeply irresponsible.

Is the coalition arguing for secret government, or is this yet another example of the devil having the best tunes, and of our not allowing the facts to get in the way of the myth? The present Government are committed to transparency, and are publishing more information than has ever been published before to help patients to make the right choices about their care. That is at the heart of the Health and Social Care Bill. Governments of all political stripes have recognised that risk registers are specific policy tools that present risks in “worst-case scenario” terms. Releasing such documents would damage the ability of Ministers to receive accurate advice, it would mislead public debate, and be detrimental to the public interest.

Many Members have referred to myths surrounding the Bill, and I have no time to go into some of them now, but let me just say that the myth that annoys and upsets me most as a new Member is that perpetuated by Opposition Members that only they care about the

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national health service, that only they have ever used the national health service, and that Government Members have no idea about it. Let me, in the words of the Prime Minister, bust that myth. I care deeply about the national health service, and—in the words of the Deputy Prime Minister himself—if I thought for one minute that the Bill would damage the national health service or lead to its privatisation, I would not be supporting the Government, let alone the Bill.

5.51 pm

Mr David Anderson (Blaydon) (Lab): I apologise for my earlier absence. I was speaking in a debate in Westminster Hall.

Today’s debate is not just about reform of the health service; it is about democracy, accountability and transparency. For long periods during the last Parliament, the Labour Government were challenged by Members then sitting on the Opposition Benches to initiate an inquiry into what had happened in Iraq. Those Members were right to challenge the Government over what they had done. Ultimately, after the troops had come home safe and sound, the inquiry took place, and we await the results. The Government were wrong to resist the calls for an inquiry at that time, and we should have got it right.

Similarly, as was pointed out earlier, the expenses debacle showed that Parliament as a whole had got it wrong in trying to hide information from the public. The public did not forgive us for that. One of the main reasons Members such as me are sitting on the Opposition Benches today and not over there is the fact that the public did not trust us because of the way in which we had mishandled that debate—and out of that debate came the position of the coalition in regard to transparency.

On 21 May, the Prime Minister said:

“Greater transparency across Government is at the heart of our shared commitment to enable the public to hold politicians and public bodies to account.”

The coalition agreement said:

“The Government believes that we need to throw open the doors of public bodies, to enable the public to hold politicians and public bodies to account.”

In December last year, the Deputy Prime Minister said:

“The third characteristic of an open society is the sharing of knowledge and information. In a closed society the elite think that, for the masses, ignorance is bliss. But in an open society there is no monopoly of wisdom. So transparency is vital.”

Why, then, are we having this debate? If transparency is so vital, why is the risk register not being published? The Government parties are aware of the strength of feeling in the country. The findings of a YouGov poll, published two days ago, showed that 68% of people in the country wanted the register to be released; that 80% of Liberal Democrat voters—that will be only a small sample, of course, because the Liberal Democrats do not have many supporters—wanted it to be released; and that 62% of Conservative voters wanted it to be released.

So what is this about? The hon. Member for Southport (John Pugh), who is sadly not in the Chamber now—although he has been present for most

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of the debate, unlike his colleagues—got it right when he said, according to the

Liverpool Daily Post

last week:

“If the Conservatives had gone to the country at the last election and said ‘we want a market-based health system’ they would have lost the election badly.”

That is the truth. This is a smokescreen: it is about detoxifying the Tory brand on the NHS. To give credit where it is due, the public relations master, the Prime Minister, got it absolutely right: he sold the people of this country the PR view that everything would be okay, and said that the NHS would be safe in his hands. He sold the people of this country a pup. It was a PR stunt backed by the coalition partners, who must wake up and realise that they have a responsibility in the House to put that right. There is absolutely no mandate for this piece of work. They told the people of this country that there would be no top-down reorganisation, but that is what is going on.

The coalition partners told the people of this country that the previous Government had failed on the NHS, despite the fact that 1 million people are treated every 36 hours; despite the fact that people across the country are living much, much longer than they were 20 to 25 years ago; despite the fact that satisfaction was at an all-time high; and despite the fact that we had persuaded the people of this country that it was worth saving the health service and putting in three times the amount of money that was paid into it previously. The myth that productivity did not go up under the previous Government was blown away by reports in recent weeks, so at every level, the Government have been proved wrong.

What do the Government do when they are challenged? They begin to blame the trade unions. I want to tell the House something about the trade unions. By and large, the vast majority of people in them are front-line health-service staff, including full-time officials in the unions which I am proud to belong to: in Unison, the deputy general secretary is a theatre orderly. The head of the health section was a nurse for many years; the head of nursing was always a nurse. In the Royal College of Nursing, people have to be nurses to get a job. The important people, who make trade union policy, are hands-on people who, day in, day out, and night in, night out, go into hospitals and other places where care is delivered, so they know exactly when we get it wrong.

The Government got it wrong on something else. From 1992 onwards, the unions advised the last but one Government and my Government that they had got it wrong on the private finance initiative. Last year, it was proved by a national audit that PFI had been a disaster. If the then Government had listened to the unions in 1992, we would not be here, but the option now for the people in the bunker is not to discuss the matter with the trade unions. That is a disgrace, and we should all support the motion today.

5.57 pm

John Glen (Salisbury) (Con): I welcome the opportunity to participate in this debate. I want to begin by echoing the views of many Members and put on record my affection and respect for the NHS and everyone who works in it. Contrary to the way in which the debate has been framed, it is not an honest attempt to examine the

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Government’s intentions for the future of the NHS. It is an opportunistic attempt to use the word “risk” in the context of health to mount a scare campaign. Releasing the risk register is not the key to improving the quality of debate on the Bill. A risk register is routine in all Government Departments, and it allows civil servants to assess measures fully and without fear, and to set out properly, with full candour, their observations when Ministers discuss policy intentions and they give advice.

I want Ministers to receive quality advice. I do not want decisions to be based on advice that is not candid or full, but that will be the consequence of this politically motivated debate if the motion is carried. Is that really the precedent that we wish to set? It would be helpful if many more of us acknowledged that we are not experts on the intricacies of the internal workings of the NHS. If we were deluged with masses of technical comments and hypothetical situations, that would not inform the House or the general public. It would probably alarm the most vulnerable and lead to a complete loss of confidence in the NHS.

The real issue with which the whole House should be concerned is what this legislation is really about: putting this country’s beloved NHS on a sustainable footing for the future. As I said at the outset, I believe in the NHS and I love the NHS, but it is totally wrong to say that money alone is the answer. Politicians need to level with the British public. We are putting more money into the NHS—we ring-fenced the budget, contrary to Labour’s approach—but competition is not a disease. Even in the NHS, it is a legitimate way to drive up standards. The Bill means that providers compete on quality, not on price. The Bill provides a framework for competition to drive up quality according to need, regardless of the ability to pay. Some 75% of clinical commissioning groups attest that they are willing to continue to work constructively on this legislation.

It must be recognised that spending on the NHS accounts for £1 of every £7 spent by the Government—we are spending £100,000 million each year—so the idea that we can reliably and consistently reduce bureaucracy without legislation is unrealistic. By establishing clinical commissioning groups, we will save £4.5 billion by the end of this Parliament. It takes courage on the part of this Secretary of State and his Ministers to face up to this vicious campaign of vilification, misrepresentation and smear. The biggest risk faced by the NHS today lies in not facing up to the challenge of getting more resources to the front line as more people expect and need more from the NHS for much longer. That is the real risk, not the publication of a technical document to which few inside or outside this House could do justice.

6.1 pm

Seema Malhotra (Feltham and Heston) (Lab/Co-op): Many right hon. and hon. Members have talked about the importance of the NHS and the need to safeguard its future. I am proud of Labour’s record on the NHS, from its creation in 1948 to what happened under the previous Labour Government, when 119 hospitals were built, hospital waiting times were at a record low and satisfaction with the NHS was at a record high.

In the past few days I have received nearly 50 letters from residents in my constituency asking me to vote

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for the release of the NHS risk register; that is more letters than for any other campaign in my two months as a Member. This is obviously a matter of great importance to my constituents and to the wider public. They believe, as I do, that transparency about the proposed NHS changes is an issue of national importance.

I wish to share with the House some comments from the many letters that I have received. Nick from Hanworth says that he is

“worried that MPs will be voting on the changes to the NHS without knowing the full facts.”

Valarie from Feltham thinks:

“It is vital that MPs have the full facts about the risks to the health service before they have to vote”.

Kiran from Hounslow says that

“as the NHS is such a significant part of our lives, we the public have a right to know what the government is planning and why it is being so secretive.”

My constituents have also written passionately about the NHS, and what it does for them and their families. Alfred writes that

“getting the NHS was one of the greatest things that happened for health in this country...our NHS is the envy of many nations.”

Last night I replied to each constituent telling them that I share their concerns and those of health professionals, staff and patients, and will be voting for the release of the risk register. Under this Government we have already seen 3,500 nursing jobs cut across the country. That, and other measures, have brought about a decline in the performance in the NHS. Since the previous election, 9% more patients are waiting longer than 18 weeks for their treatment, and accident and emergency waiting time figures published last week show that the NHS missed the target of seeing 95% of patients within four hours for the seventh week in a row.

It is interesting that the first question that I asked in Parliament, on 10 January, was on the impact on waiting times of the NHS reorganisation. The Minister replied that I had raised an extremely important point, but he did not answer my question. Taxpayers who fund the NHS deserve detailed answers about what would happen to the health service if the Government’s proposals were implemented. Good change management has always involved the sharing of risks, so that they can be better understood and mitigated. Surely, when the issue at stake is the future of a national institution that this country holds so dear, it is more important than ever that good change practices should be adhered to, and that the transition risk register should be open to scrutiny. The Health Secretary’s refusal to release the risk register prompts the question: what are he and the Government trying to hide?

My constituents deserve better than this. They deserve the shorter waiting lists that they were getting under Labour, not the longer ones that they are now experiencing. They deserve more front-line staff, not fewer. They also deserve openness and clarity from the Government, not the present situation in which the risks to their NHS are being kept secret.

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6.6 pm

Mel Stride (Central Devon) (Con): During my short time as a Member of the House, I have heard many speeches by Opposition Members. While I have often disagreed with what they said, I have found myself respecting them because their speeches have been based on conviction and, sometimes, on the lofty ideal of the pursuit of the truth. In today’s debate, however, I have heard little other than naked political opportunism. It is the kind of opportunism that we see when Labour continually suggests that we are in favour of the privatisation of the health service and, by extension, that we are willing to attack the notion of health care being free at the point of delivery and universally available, irrespective of the ability to pay. That is not only disingenuous; it is a cruel deception, particularly on the elderly and the vulnerable, many of whom live in my constituency, who get very frightened as a consequence.

I am afraid that I see exactly the same game at play in this debate. Opposition Members know that risk registers think the unthinkable. They know that the game plans worked out in them are worst-case scenarios, and that if the information were to be made public, it is likely that it would be misinterpreted. They know that that would probably lead to Ministers and officials not having candid and meaningful discussions about the matters at hand. They also know that we have published a comprehensive impact assessment that ran to 436 pages, and that it was updated as recently as last September. They know that it is conceivable that exposing certain risks to the public domain could make them more likely, rather than less likely, to happen. They also know that if they get what they want, it could set a precedent not only for the Department of Health but for all Departments and for all future Governments.

How do we know that the Opposition know all those things? It is because they, as the previous Government, did exactly the same things that we are attempting to do when they were faced with broadly the same situations. I know that the shadow Secretary of State will quibble with the words “strategic” and “transition”, but I listened carefully to the point made by my hon. Friend the Member for Meon Valley (George Hollingbery) that we might be talking about exactly the same strategic register. The reality is that Labour adopted that position then, but it is not prepared to do so now.

Opposition Members also know that our record on the health service has been good. We should be proud of that record. In contrast to the increasing health inequalities and the decreasing efficiency of health care that occurred under the previous Government, we have seen decreasing in-patient and out-patient waiting times and a 95% reduction in mixed-sex wards. We are the party, after all, that went into the election and honoured our commitment to increase expenditure on the health service in the years to come. We are the only party in this House that was prepared to do that.

In conclusion, I believe that it is unfortunate that we have had to commit so much parliamentary time in the Chamber to this issue. Surely the most important issue we face is not the risk register but getting the health service ready for the 21st century. On that point, I hope that the Government continue to show the courage to take the brickbats, the knocks and the game-playing that the Opposition throw at us, to stand up for the health service, to reform it and to ensure that it is there to deliver for millions of people in the years to come.

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6.10 pm

Roberta Blackman-Woods (City of Durham) (Lab): I, like my hon. Friend the Member for Easington (Grahame M. Morris), want to begin by paying tribute to the staff of the NHS. I regularly go out with the emergency services and they do a truly amazing job on our behalf in what are becoming much more difficult circumstances. I also want to pay tribute to 38 Degrees and other campaigning organisations, including the British Medical Association and the Royal College of Nursing, for what they have done to give the public more information about these reforms. I do not think that that absolves the Government of their responsibility to publish the risk register, but it is important to put on record the work that those groups have done.

I also want to pay tribute to Anne Hutton and her husband, Neil, two of my constituents who are leading the campaign against the Health and Social Care Bill in Durham. Their street stalls in Durham marketplace are becoming legendary, and I have joined them on a number of occasions. It is clear from the people who visit the stall that the more people know about the Bill, the less they like it. That is probably why the Government will not publish the register: people do not like the opening up of more of the NHS to the private sector, they are worried about fragmentation not only in commissioning but in delivery, and they want answers from the Government that they are clearly not giving.

The second issue that people raise is that they simply cannot understand why the Government are wasting money on a top-down reorganisation of the health service when we are living in such difficult economic times and the NHS is being starved of the resources it needs to meet need locally.

The third issue is that there is absolutely no mandate for either political party in the coalition to undertake such a reorganisation. Unlike those on the Government Front Bench, I have been out and about, talking to people about the reforms. That has included attending consultation events held by shadow GP consortia. The lack of information on the risk of moving to new commissioning arrangements has been a key feature of these discussions, however, as has been the likely negative impact on health outcomes of the fragmentation of services. People are getting increasingly angry that they are being asked to give an opinion on GP consortia and new commissioning arrangements without having access to information that will help them make an informed decision.

It will not have gone unnoticed by my constituents—many have written to me, just as many have written to other hon. Members—that Ministers on the Government Front Bench have today sought only to rubbish Labour’s excellent record on the NHS, rather than explaining why they will not publish the register. I am sorry that the hon. Member for Winchester (Steve Brine) is not in his place, because I wanted to take him to task. I think he insulted those of my constituents who have written to me by saying that they were simply jumping on a bandwagon. Many of them have real concerns about the Bill. Those concerns should be addressed, rather than the people who write to MPs being rubbished.

I am pleased that the parties in government have raised the issue of Labour’s record, which I shall address in the short time remaining. We are proud of our

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record. We employed about 90,000 additional nurses and 40,000 extra doctors, and we built more than 100 additional hospitals. That is a good record. In my area we have a new hospital. In 2006, 94% of people were having their operations done in less than 13 weeks, but that waiting time is going up, with 90% now having them done in 18 weeks. Unfortunately, all that very necessary input into the NHS did not reduce health inequalities enough, but we did hit the target for the north-east of reducing health inequalities by 10%. I am really concerned that by not publishing the register we simply will not know how these reforms will exacerbate health inequalities.

Madam Deputy Speaker (Dawn Primarolo): Order.

6.15 pm

Penny Mordaunt (Portsmouth North) (Con): I once found myself in the happy circumstance of being in conversation with the former BBC director-general, Greg Dyke, who expounded on the lengths he had to go to in order to change the culture at the Beeb. He told me that one had to have a vision and show leadership, and that one could not be afraid to challenge the status quo. He then described how he was idly playing with the top drawer of his finance director’s desk while waiting for him to return to a meeting—he reassured me that this was absent-minded fumbling rather than a covert management technique—when the drawer happened to slide open to reveal a notepad emblazoned with the legend “Things that could go wrong!” Mr Dyke told me that he was puzzled at how differently that man’s mind worked from his own, but he knew that his ambitions for the corporation were more likely to be successful because his colleague—by himself, unlikely to set the world on fire—was thinking through the possibilities and consequences of his plans.

Vision, leadership and a preparedness to change are vital to improving the NHS, but reform plans must be subject to scrutiny and revision. This Government have welcomed debate on NHS reform because our motivation is to improve health care. We have not embarked upon this reform for its own sake. What a shame that some do not wish to debate, but rather to carp and criticise without offering anything constructive. It is a matter of regret that this debate is about the risk register. That decision should be in the hands of the tribunal. The commissioner has made a judgment and the Government have appealed, as anyone in their position would be entitled to do. I understand that the decision is being fast-tracked at the Government’s request. Good. That is the process, and I will be content with the outcome.