NHS Risk Register

Andrew George Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

I have just quoted what the Labour Chair of the Public Accounts Committee said on the basis of advice from the National Audit Office, which is precisely in line with data published by the Office for National Statistics. I think I will rest on that.

I want to make it absolutely clear that I appreciate what NHS staff do and the fact that they are delivering improving outcomes. We published 30 indicators of NHS outcomes just two months ago, and 25 of them showed that performance had been maintained or improved. They had not all gone up, but that is why we are focusing on those outcomes, and not just waiting times. However, the average time for which in-patients waited for treatment was 7.7 weeks in December 2011, down from 8.4 weeks at the last election. For out-patient treatment, the average is down from 4.3 weeks at the election to 3.8 weeks now.

[Andrew George (St Ives) (LD)]

rose—

[Mr Lansley]

I know that my hon. Friend will join me in appreciating the success of the NHS in improving waiting times.

[Andrew George]

I do indeed welcome that news, and I do not question what the Secretary of State says about it. However, I am curious about the fact that on one hand the shadow Secretary of State says that it is all going terribly badly but opposes reform of the NHS, and on the other the Secretary of State says that outcomes have never been better but is pressing on with the Bill. Why is he doing so?

[Mr Lansley]

The curious thing, as I know my hon. Friend will appreciate, is that even the Leader of the Opposition says that reform is needed in the NHS because of the challenges that it faces. Of course we can debate what the nature of the reform should be, but the idea that we can simply stand still and that nothing in the NHS needs to change is not the view of NHS staff, patients, the Labour party or the Government. We therefore have to consider what the nature of that reform needs to be, and I believe in patient choice and empowering doctors and nurses on the front line to deliver care. I believe in cutting bureaucracy and removing whole tiers of management to enable that to happen, and in common with my Liberal Democrat friends and colleagues I believe in strengthening democratic local accountability in the NHS and strengthening public health services through local government operations.

The worst possible thing for me to do would be to say, “We need to reform the NHS because it is doing so badly.” I do not believe that, but I do believe we have to root out poor performance. I was shocked to hear the shadow Secretary of State and the right hon. Member for Exeter (Mr Bradshaw), who has disappeared, talking about Stafford hospital. They were the ones who never appreciated the risk of what was happening there. They know that they went through reorganisations without ever addressing the risk. The dreadful things there happened on their watch, so they might at the very least have come here and apologised. The right hon. Member for Exeter came to the Dispatch Box when he was a Minister and said, “Oh, it’s nothing to do with me, it’s all to do with the management of the hospital.”

I believe in foundation trust hospitals, which apparently the Labour party now does not. [Interruption.] The shadow Secretary of State is trying to have it both ways. He is trying to say that he is in favour of foundation trust hospitals, but that if they get into difficulties the best thing is for them to be run by the Secretary of State. He might talk to the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who was the Secretary of State when, in the Maidstone and Tunbridge Wells NHS Trust, dozens, perhaps hundreds of patients died of clostridium difficile infection at the Kent and Sussex hospital. That was an NHS trust, not a foundation trust. The Department of Health and the Secretary of State have no God-given ability to run hospitals directly and do so better than they can be run by the doctors, nurses and managers in charge. The point is that there must be proper accountability, and through HealthWatch, local government and the responsibilities of Monitor we will have a proper accountability structure in the Bill.

--- Later in debate ---

[Andrew George (St Ives) (LD)]

It is a pleasure to follow the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock). In fact, I approach this debate in many of the same ways as the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson). I will not speak for seven minutes on the suggestion that the debate is a sideshow, but if the information were published it would, as the right hon. Gentleman suggested, be unlikely to change a single mind on the issue. That reflects our heated debates and the entrenched positions that people inevitably take. It is the nature of the process of politics—

[John Healey]

rose—

[Andrew George]

I will give way in a moment. I want to make my philosophical point first. In contrast to academia, which begins with a question or inquiry, gathers evidence and comes to a considered opinion, the pity of politics is that we begin with a prejudice and backfill with the evidence that suits our case.

[John Healey]

The hon. Gentleman said that the publication of the transition risk register would not change one mind, but does he not accept that the Information Commissioner, who has read and studied the risk register, is of the view in his decision notice that it would aid public understanding of the reforms and help to reassure the public that all the risks have been properly considered?

[Andrew George]

I agree with the right hon. Gentleman and I have signed the early-day motion supporting the release of the register. The biggest ever reorganisation of the NHS is being undertaken and it is best not to do that in the dark. It is best to have as much information available as possible. I am not suggesting that we are completely in the dark—[Interruption.] I am just saying that it is best to cast as much light as possible upon the information, so that we can have an informed debate, rather than a semi-informed one. He makes a good point about that.

I guess that publication will eventually result from this process, and I do not think it will help the Secretary of State or the Government if it is dragged out rather than conceded. If and when that happens, the Opposition and people who oppose the Bill will inevitably highlight worst-case scenarios and throw them at the Government, and the Government will inevitably look at the best-case scenarios. The nature of political debate will not be improved by this process, but I hope that debate will be better informed.

Much of the debate throughout the course of the Bill’s progress, a process in which I have been involved through the Select Committee and elsewhere, has been about trying to anticipate the effects of the reforms. It would be far better to try to anticipate these things on the basis of the best information given by people who are inside the service and providing that advice. That is why I believe the risk register should be published. The impact assessment perhaps represents the selected highlights of that process. [Interruption.] The Secretary of State may intervene on me, if he wishes to do so.

The underlying core concern—this is in the nature of how we examine these issues—is about whether publishing the risk register will negatively affect the technical delivery of Government policy and services or whether it will affect the political prospects of a party or those in government. The nature of this debate means that we assume that if publication is being resisted, it will have political rather than technical consequences. Obviously, if we thought that the risk register’s publication would have technical consequences for the effective delivery of government—that is the primary point that the Secretary of State is advancing—we would clearly need to think carefully about the release of such information.

[David Rutley (Macclesfield) (Con)]

Will the hon. Gentleman remind the House of the criteria the former Secretary of State used when he rejected publishing the register in 2009?

[Andrew George]

I am grateful for that intervention, because it plays into my next point, which is on my general concern about the nature of Opposition day debates. It is not that I think that Opposition parties should not have the opportunity to debate issues, but such debates tend to over-dramatise the political tribalism of this House. It is in the nature of government that when in government people tend to have to face up to and take unpopular decisions, whereas in opposition they tend to avoid them. Equally, on this issue, those in opposition tend to say that they would be more open, because they look at the matter from a different perspective and take the view that they would have more open government. When people come into government, they tend to err on the side of seeing good technical reasons for why they cannot engage in the process of open government.

[Clive Efford]

rose—

[Andrew George]

I will give way, although I am going to lose time.

[Clive Efford]

I shall be brief. This transition risk register refers specifically to the Bill, about which there is widespread concern. The register is unprecedented in that regard so, with due respect to the hon. Gentleman, his argument really does not hold.

[Andrew George]

I am cantering around the issues. I have signed the early-day motion, so I judge that disclosure is better than non-disclosure. However, I wish to make a further point about the kid psychology of this whole thing. We all tend to want what we cannot have and if we obsess about this issue, we might take our eyes off the ball of what the debate ought to be about. That brings us back to the point made by the former Secretary of State.

I ask the Minister who is winding up: when has the disclosure of such documents actually harmed Government public services? If we were given examples of where disclosure of information has actually harmed the delivery of effective government, we could begin to mount a case for trying to define the lines of where and when such documents should be published. On the basis of the debate so far, I am not sure that we have demonstrated that if we were given the new toy in this political playground—the publication of the risk register—it would necessarily improve the quality of the debate.

Of course, the main show, rather than the sideshow, is the Bill itself. I am concerned that if the risk register were to be published soon, and we were to have information that would perhaps help to change people’s minds and enable a more informed debate, it would not be possible to come to a considered conclusion that it would be best to withdraw the Bill because of the nature of the prism of the Westminster village. Given the virility contest in which such decisions are taken, the climbdown needed for a Secretary of State to withdraw a Bill such as this would be catastrophic both for himself and for the Government. So we end up continuing on with something that I believe could be catastrophic for the NHS—I have put my views in the public domain on many occasions on this issue.

The right hon. Member for Leigh (Andy Burnham) may want to win over Liberal Democrats, but describing us as “spineless” will not necessarily get many of us into the Lobby with him. If he does not want to contaminate his party with people he believes are so infected with such a disabling condition, I am not sure that it will help.