17:12 - The House divided: - Ayes: 328 / Noes: 246 - Question accordingly agreed to.
The Secretary of State for Health (Mr Andrew Lansley)
Your generosity of spirit is legendary, Mr Speaker, and you were characteristically generous in accepting the submission of the right hon. Member for Leigh (Andy Burnham) that there was an emergency warranting this debate. I regret that he has let you down. It turns out there was no emergency, there was no argument, and there was no point.
Ostensibly, the debate is to consider the Department of Health’s transition risk register. The House considered that on 22 February, and by a majority of 53 the House decided that it did not support the publication of the risk register. We further considered that matter in the debate on 13 March. I think that the views of this House should be respected.
Yesterday, in another place, Lord Owen proposed an amendment, the purpose of which was to delay consideration of Third Reading in the House of Lords until the publication of “reasons” by the first-tier tribunal and the Government’s response. That amendment was defeated by a majority of 115. I remind the House that the Government do not command a majority in the House of Lords. That proposal was defeated by a substantial majority on the balance of the argument.
I will not repeat what I said in the debate on 22 February, but let me just add three things. First, as my noble Friend Lord Howe told the House of Lords yesterday, the risks and other impacts of the Bill were fully disclosed, not least in the impact assessments—a 200-page document—published alongside the Bill; in the NHS operating frameworks; in transition letters from the NHS chief executive and others; and in the full description of the risk headings that Lord Howe set out to the House of Lords on 28 November. I regret to say that it sounds to me that no Labour Members—with, I suspect, the exception of the right hon. Members for Wentworth and Dearne (John Healey) and for Leigh (Andy Burnham)—have taken the trouble to read the debates in the House of Lords.
Secondly, as my hon. Friend the Member for Banbury (Tony Baldry) made clear, Lord Wilson of Dinton, a former Cabinet Secretary, told the House of Lords yesterday that he has deep concerns about the Information Commissioner’s decision and its negative impact on the safe space within which officials give frank advice and act as a “devil’s advocate” to Ministers.
John Healey
The right hon. Gentleman argues that one of the principal reasons why the Government have not accepted the decision to disclose the risk register is that information about risks has been disclosed to the public already. The Information Commissioner considered that. Will the right hon. Gentleman recognise that, in his legal decision, the Information Commissioner said that he did not accept the argument that the Government advanced, and that he considers that
“disclosure would go somewhat further in helping the public to better understand the risks associated with the modernisation of the NHS than any information that has previously been published”?
Mr Lansley
The right hon. Gentleman knows perfectly well that in the debate on 22 February we made it clear that we felt that our appeal to the tribunal was justified, and indeed it was, because we won at appeal on the question of the publication of the strategic risk register. The Government’s objection and my objection to the publication of the risk register is precisely that risk registers are not written for publication. They are written in that safe space within which officials give advice to Ministers.
Mr Lansley
No.
Risk registers do not represent a balanced view. They are not a prediction of the future. They set out a worst-case scenario to challenge decision making. My hon. Friend the Member for Totnes (Dr Wollaston) captured the understanding of what a risk register is very well. The point is that we have looked precisely at the balanced view in the impact assessment, which captures where the risks and the benefits of the Bill lie. However, publication of the risk register, as my right hon. Friend the Member for Charnwood (Mr Dorrell) made perfectly clear, would prejudice the frankness and integrity of the decision-making processes of government and the Government are opposed to their publication.
As I mentioned, we won on appeal in relation to the strategic risk register, but not on the transition risk register. In the absence of the reasons for those decisions by the tribunal, and given the nature of the overlap between the strategic risk register and the transition risk register, I cannot comment further on that, or indeed on what our response will be to the tribunal’s decisions.
Duncan Hames (Chippenham) (LD)
The Secretary of State consistently makes the distinction between policy development issues and operational matters in respect of risk registers and other plans that have been published. Once this Bill has become law and the NHS becomes engaged in the operational matter of implementing his reforms to the health service, will he then encourage NHS trusts to publish, in due course, the risk mitigation plans that they might have, in order to reassure the communities they serve?
Mr Lansley
As the House has noted, risk registers designed for publication form part of the papers prepared for the boards of trusts. Of course, the legislation further strengthens the openness of foundation trust boards, for example, in respect of meeting in public and publishing their documents. But, as my right hon. Friend the Member for Charnwood rightly pointed out, there is an enormous difference between the frank expression of officials’ worse-case scenarios to Ministers in order to challenge decision making—as I say, it was anticipated that that was not intended for publication—and the preparation of risk registers by NHS bodies and trusts, which are designed for publication. Indeed, the national risk register is also designed for publication on that basis. As I said, those in the House of Lords yesterday agreed, by a substantial majority when voting on an amendment, that not only had the consideration of the Bill received unprecedented scrutiny, but that they also had the information they required.
Thirdly, let me just remind the House that the right hon. Member for Leigh, as a Minister, refused to publish the Department’s risk register. He said:
“Whilst we are conscious that there will be public interest in the contents of the Strategic Risk Register being made freely available, we have also taken into account the public interest in preserving the ability of officials to engage in the discussions of policy options and risks without apprehension that suggested courses of action may be held up to public or media scrutiny before they have been fully developed or evaluated. We also take into account the fact that ministers and their officials need space in which to develop their thinking and explore options, and that this disclosure may deter them from being as candid in the future, which will lead to poorer quality advice and poorer decision-making. Having regard to all these factors, we have determined that the balance of public interest strongly favours withholding the information.”
I could not have put it better myself, because that is precisely the point. He talks about the difference between the strategic risk register and the transition risk register, but the one requested was a risk register at the point at which policy was being formulated, and there is a substantial overlap between the strategic risk register and the transition risk register.
The right hon. Gentleman did one thing when he was a Minister and he argues the opposite now. The same thing seems to be happening in so many other fields. When he was a Minister he said that he was in favour of clinical commissioning, and practice-based commissioning was in the Labour manifesto in 2005. In 2006, he said that his ambition was to introduce
“practice-based commissioning. That change will put power in the hands of local GPs to drive improvements in their area”.—[Official Report, 16 May 2006; Vol. 446, c. 861.]
Now he wants to block a Bill whose purpose is to give clinicians—doctors and nurses across the NHS—the power to commission and design services in their area. We just do not know the position. Once more, we heard nothing positive from him about what Labour would offer the health service; all we heard was a denigration of the performance of the NHS and a determination to block the Bill. We are still hearing from him about what Labour Members are opposed to; we just do not hear about anything he is in favour of.
The curious thing is that last Tuesday, on an Opposition day debate, I said, “We are hearing from Labour Members and Labour activists all over the country about their opposition to £20 billion of cuts.” Hon. Members will remember, because this happened only a week ago, that the right hon. Gentleman was shouting at me from the Labour Front Bench, “No, no, no. We are in favour of that.” I said to him, “Look, it is in the manifesto”, because Labour’s manifesto said that
“we will deliver up to £20 billion of efficiencies in the frontline NHS”.
Yesterday, the right hon. Gentleman turned up with his hon. Friends at the Department of Health to deliver a petition from Wigan and Leigh. It said:
“We the undersigned are opposed to the Government’s Health and Social Care Bill and £20 billion of ‘unmandated’ cuts in NHS funding”.
He sat there last Tuesday saying, “No, we are in favour of £20 billion of efficiencies”, yet he is wandering all around the country with his hon. Friends saying, “No, it is £20 billion of cuts.” Frankly, Mr Speaker, if I recall correctly, that is what you would have me describe as an erroneous view.
The NHS across the country is a service that not only will use reform positively but is using reform positively now. We are seeing the reforms being implemented. On 1 April, clinical commissioning groups will take responsibility for more than £60 billion-worth of delegated responsibility for commissioning. I am tired of hearing the right hon. Gentleman denigrate NHS performance when what we have, since the election, is the lowest ever number of patients being admitted to mixed-sex wards, with numbers down 95%; the lowest ever number of patients waiting more than six months for treatment, with numbers down from 100,000-plus to 70,000; the lowest ever number of patients waiting more than a year for treatment, with numbers down from more than 18,000 to below 6,000; and the lowest ever number of patients waiting more than 18 weeks from referral to treatment. In May 2010, that figure was 209,000 but the latest figure is down to 182,000. Also, fewer people than ever are acquiring infections in hospital, with methicillin-resistant Staphylococcus aureus down 36% and clostridium difficile down 25%.
I have searched in vain for a point to this debate. I think that the only point was so that the right hon. Gentleman and his friends could put out a press release about having 24 hours to save the NHS—I think I have heard that one before. The Labour party is never knowingly over-clichéd. Only the Daily Mirror bothered to notice the press release, putting it on page 6; if it had really thought that this was about saving the NHS, it might at least have put in on page 1. No, the truth is that this is political opportunism dressed up as principle. This is a debate for no purpose and the only effect of this one and a half hour debate is to delay the consideration by this House of the amendments made in another place. Given the full and constructive character of the debate in the Lords over 25 days, I think it is a disservice to the other place that this House’s time has been wasted on having this debate. The Labour party has shown that it is interested not in what is in the Bill, but only in the political opportunity of opposing it. We are interested not only in what is in the Bill but in the opportunity it presents—not for the sake of the Opposition’s politics but for the NHS to improve and strengthen in the future.