I beg to move,
That this House
has considered the matter of whether the House should defer consideration of Lords Amendments to the Health and Social Care Bill until after disclosure of the NHS transitional risk register.
My right hon. Friends and I are grateful for your agreement to give the House this opportunity, Mr Speaker. On this of all days we should be celebrating what a much-valued social institution has done to bind our nation together throughout the 60 years of Her Majesty’s reign. Instead, we gather to dismantle it. A health service that is judged by international experts to be one of, if not the, best health service in the world is about to be inexplicably and unjustifiably broken apart by an ideological Bill ending 63 years of NHS history.
This is a difficult day, but what makes it all the harder to stomach for people watching is the manner in which things are happening. People outside will struggle to understand how Members of this House could make such momentous decisions without having carefully considered all the facts and all the evidence. The truth is that Members will go through the Lobby tonight without knowing the full implications of what it means for the NHS in their constituencies. How do they begin to justify that to their constituents, to patients who depend on the NHS and to staff who devote their lives to it? We have argued from the beginning that the Government’s decision to combine an unprecedented financial challenge in the NHS with the biggest ever top-down reorganisation has exposed the NHS to greater risk, and the truth is that we are beginning to see the effects of that. In our constituencies, they have already dismantled the existing structures of the NHS before the new ones are in place, leading to a loss of grip just when it was most needed. So we are seeing A and E waits getting longer, staff shortages leading towards A and E closures, and patients in our surgeries beginning to complain of treatments being restricted or of longer waits.
We have also heard from the health professions—from GPs, nurses, midwives and physios—who one by one have made clear their considered professional judgment that, on the balance of risks, it would be safer to abandon the Bill than to proceed with the upheaval of reorganisation. Ministers by their actions are putting the NHS at greater risk, but even today this House does not know the assessment that was given to Ministers or the precise nature and scale of those risks.
I do not plan to give way because I want other Members to have the chance to contribute to the debate.
Ministers want the House to back the gamble they are taking with the NHS without having the courtesy to tell it the odds. The Information Commissioner thinks we should see the risk register and so does the Information Rights Tribunal, which brought forward its ruling so that it could influence our proceedings. If the NHS starts to struggle because of all the change being thrown at it and if services in some parts of the country start to fail, how will Members of the House respond when people come to our surgeries and ask whether we did everything we could to anticipate the dangers? We will remind them of the truth—that Government Members put politics before the national health service and signed up to a reckless reorganisation without knowing all the facts.
No, because we brought down NHS waiting lists to their lowest ever levels and we left patient satisfaction at its highest ever level. Those same waiting lists are going up under the right hon. Gentleman’s Government and he should be ashamed of that. He will not publish the information about the risk to waiting times because he is frightened of putting it before the House and the public, but we will remind them of the truth.
The Government proclaimed that they were going to be the most open and transparent Government in history. Today, it still says on the Treasury website in a statement of 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. It will also do so where the development of new policies poses a potential risk to the public.”
May I suggest that the Government take down that misleading statement of policy? Their actions have left it in tatters, together with the grand claims of openness and transparency. The tribunal, they will say today, has not given us its reasons. Ministers will try to argue that the public and Parliament’s right to know about the impact of their policy decisions is outweighed by the public interest in the preservation of a safe space for policy advice.
Those arguments were considered, first, by the Information Commissioner, and subsequently by the Information Rights Tribunal. They found the opposite to be the case: that the public interest lay in full disclosure. But it does not matter; Ministers are simply re-running the arguments of a case that they have lost. They have no leave to reopen the substance of that argument, but they are not the only arguments that they have lost.
In an attempt to rescue the Bill last year, the Prime Minister made a number of claims for it. They cover issues that we know are in the local and regional risk registers which have been published. First, he said the Bill was needed as the NHS does not
“deliver the patient-centred, responsive care we all want to see”.
He cited heart services and claimed that someone in this country is twice as likely to die from a heart attack as someone in France. That was before new research in January reported a 50% fall in heart attack deaths in the past decade.
Then the Prime Minister said that cancer services were failing people, compared with other countries. That was before new research in November 2011 which showed that the NHS in the past decade achieved the biggest drop in cancer deaths of any comparable health system in the world. Thirdly, the Prime Minister and all the Ministers on the Government Front Bench have routinely trotted out the same script for years—that NHS productivity has declined in the past decade. That was before new research on NHS productivity from Professor Nick Black published in February in
The Lancet showed that, far from falling, NHS productivity increased in the past decade at the same time as the NHS achieved patient satisfaction.
One by one the Government’s arguments for the Bill have fallen apart. They have comprehensively lost the argument. They have convinced nobody and now they are running scared, resorting to the only remaining option of ramming the Bill through Parliament before they are required in law to publish the real assessment of their policies.
I am sure my right hon. Friend will join me in wishing well 11-year-old Bailey Stark in my constituency as he and his family cope with his condition that means that he is unable to swallow. His mother is worried sick about the changes in the health service, which might mean that he will not get the treatment he requires in Newcastle. Does my right hon. Friend agree that that risk is all the more reason for publishing all risks, as we should know the truth about what is happening to our NHS? [Interruption.]
Members shout “Scaremongering” from the Government Benches, but the Government will not publish the evidence to back up their claims. We have read the local and regional risk registers which warn precisely of the case that my hon. Friend mentions—of damage to the continuity of care, risks to patient safety, longer waits for cancer patients, risks to child safeguarding. Those are the facts in the regional risk registers and they are the facts that Ministers are trying to withhold from the public.
Does the right hon. Gentleman share my surprise and sadness that the Liberal Democrats, who were once the defenders of freedom of information, are now trooping through the Lobby in support of a dangerous Bill shrouded and protected by the restriction of information?
I am grateful to the hon. Lady for her point. The Liberal Democrats once derided the Freedom of Information Act as too weak. Today they cower behind it, trying to use any scrap of protection they can find within it to prevent the publication of the information that patients and the public deserve to have. That says everything that people need to know about today’s Liberal Democrat party.
I will not give way. I will now bring my remarks to a close.
We are clear that the risks in the Bill arise not just from the organisational turbulence that the Secretary of State is inflicting on the NHS, but from the specific policies in the Bill. Today we table a package of amendments in a last-ditch attempt to provide the necessary safeguards that the Liberal Democrats failed to secure in another place—
They are safeguards in light of the huge potential for the conflict of interests in the award of contracts under the “any qualified provider” provisions, which will not be addressed by a simple register of interests, and safeguards on a stronger local HealthWatch—the Government have watered that down since the Bill left this House of Commons. There are safeguards too—
I am grateful to the right hon. Gentleman. Will he just clarify one issue of principle for the House? Are Labour Front Benchers now arguing that every Government Department should publish its strategic risk register? If not, can he justify his proposition that the Department of Health should do so uniquely?
I refer the right hon. Gentleman to the Information Commissioner’s ruling on the decision about a third runway at Heathrow. That is the precedent his Government should be following, but instead they have chosen to defy the commissioner. It was the Labour party that published the decision on a third runway at Heathrow, and I refer him to the ruling from the Information Rights Tribunal, which made a clear distinction between the strategic risk register, which covers all the uncontrollable risks that any Department will face, and the transition risk register, which deals specifically with the effects of Ministers’ decisions, in this case on the NHS. There is a real difference between the two. The tribunal said that the transition register should be published. His Government should respect the law and publish today.
We will table amendments to provide safeguards today, but in future it will not just be the cover-up of the risk register that we will have to worry about—that is just a taste of things to come in the new NHS. Members will have to get used to the words “commercial confidentiality” when inquiring about local services, because that is what they will find in the NHS that Ministers are creating. Let us look at the risks inherent in the proposed relaxation of the private patient income cap. One risk assessment that Ministers have published—the revised impact assessment—states that
“there is a risk that private patients may be prioritised above NHS patients, resulting in a growth in waiting times for NHS patients.”
That is all they have told us, but that alone is reason enough to oppose the Bill.
The only hope I can give people worried about the future of the NHS is that this might be the end of the Bill, but it is just the beginning of our campaign. The NHS will find a way of working around these changes and will not deteriorate overnight. We will be working to mitigate the worst effects of the Bill. This is the eleventh hour; our only hope would be a change of heart from the Liberal Democrats. We will call a vote on this motion and ask people to vote against it to show that we have not had enough time to debate these important issues.
I respect those Liberal Democrat Members who have had the courage to defy their orange book leadership, and I respect their grass-roots members who did the same at their spring conference, but the truth is that from today the Liberal Democrats will be remembered not only for tuition fees, but as the party that stole people’s votes in May 2012 in order to secure jobs for themselves and sell out the national health service. They could have stood up to the Prime Minister and enforced the coalition agreement, but they chose not to do so.
That brings us back to where we started: a Bill that nobody voted for, rammed through this place tonight in the teeth of near-universal professional opposition and in defiance of a major legal ruling; a Bill about which no Member of this House can look their constituents in the eye and say they have a mandate to support. Tonight Government Members will inflict this Bill on the NHS without knowing the potential damage it can do to the health service in their constituencies. They have made their choice; I have made ours. Although on a day like today it is hard for me to give any encouragement to people worried about what the Government are doing, I can at least say this: we will repeal this legislation at the first opportunity and restore the N in NHS. We have given this fight everything that we had. All I can say is that our fight will go on to protect and restore the Labour party’s finest achievement.
Order. The Secretary of State has indicated that he wishes to speak later in the debate—[ Interruption. ] Order. That is his absolute prerogative. In view of the level of interest in the debate, it will be helpful for the House to know at this point that a five-minute limit on Back-Bench speeches is to be imposed immediately. I call Dr Daniel Poulter.
He was in, on the list and at the top. If he does not wish to speak, so be it.
I start by apologising to the House for making what I suspect may sound like a slightly portentous speech. It is not meant to sound portentous, but if it does I apologise.
Because of the fluxion of time, there are not many of us on the Government Benches who are former Ministers, but there is, irrespective of the topic, an important point that needs to be made in the context of today’s debate. I urge every right hon. and hon. Member, before they vote at the end of this debate, to get a copy of House of Lords Hansard for yesterday’s debate, where this matter was debated. There are, in that Lords Hansard, two speeches that hon. Members would do well to read: those of Lord Wilson of Dinton and Lord Armstrong of Ilminster, both former heads of the civil service.
Lord Wilson was head of the civil service during the time of a Labour Government, and both he and Lord Armstrong made it very clear in their speeches yesterday that to release the risk register would be extremely bad news for the relationship between the civil service and Ministers generally. Irrespective of this issue, irrespective of the topic, if risk registers were to be released, officials would needlessly be politicised and thus be concerned about the advice that they gave to Ministers. Ministers would then find themselves being given verbal advice, fewer people would be involved and that would not help the machinery of government.
I will give way to the right hon. Lady.
Lord Wilson made it clear in his comments:
“Every day in government, Ministers consider policy issues and depend on the Civil Service for advice. Anyone who has been a Minister understands the private space in which civil servants give their best advice.” —[Hansard, House of Lords, 19 March 2012; Vol. 736, c. 643.]
It seems to me that this debate is really very much about a matter of principle: the relationship between civil servants and Ministers.
I understand the Opposition wishing to make some political points, but many of them, including the right hon. Lady to whom I am about to give way, have recently been Ministers, so I am sure they understand that point, and it does not behove the House, in its desire to make a political point, to seek to undermine a long-standing relationship between Ministers and officials.
Why therefore has the strategic health authority in London felt able to publish its risk register? There are 18 areas of risk, and those that were red are, after mitigation factors, still red, so we learn something very important. That is why we should have the risk register under discussion published.
I understand that point, but they are very different registers. The register to which the right hon. Lady refers is meant to be publicised. The two are of an entirely different nature, and that is a point which has been explained to the House by my right hon. and hon. Friends on the Treasury Bench on a number of occasions.
We are discussing departmental risk registers and the advice that civil servants give to Ministers. All I am saying is that right hon. and hon. colleagues, before they vote on the matter, should at least take care to consider the advice of former heads of the civil service on the effect that publication would have on the relationship between civil servants and Ministers.
All I am saying to my hon. Friend is that this is a debate about the relationship between civil servants and Ministers, a relationship that has worked very well and very effectively in this country.
Here we have heads of the civil service advising Parliament that this move, which the Opposition would seek to force upon us, is not in the best interests of the relationship between civil servants and Ministers and is not in the best interests of the good running of government.
Do I take it that the hon. Gentleman has concluded his speech?
The national health service is probably the most precious institution in this country. It is vital to millions of our fellow citizens—its hospitals treated nearly 10 million people last year—and so no one should take risks with it. The Prime Minister decided to take such risks, he told a private meeting of Conservatives, because the NHS was in an “invisible crisis”. Well, all I can say to the Prime Minister is that it is invisible because there is not one. The NHS is not in crisis; it is doing remarkably well, and it needs to continue to improve. The Prime Minister also said that he was willing to “take a hit” in this regard. No Labour Member cares very much whether he does or not: what we are bothered about is that we do not want the national health service to take a hit; we do not want its precious, hard-working staff to take a hit; and we do not want its patients to take a hit.
Government Members—or those in the majority party—call themselves conservatives, but actually they are a party of chancers. Real conservatives recognise that the outcome of change is unpredictable, that the process of change can be troublesome, and that there are often unexpected consequences of change, and they therefore need specially convincing that there is a good case for the change. Clearly, the Government have not made such a case.
The Government have not made such a case for change. They have not convinced the 1 million-odd people in the national health service that these changes are needed, and if they cannot convince the people on whom the service is going to depend, they are taking a real chance with its future.
The Prime Minister attributes his commitment to competition, including outside competition, to some of the most worthless and shallow research that has ever been conducted at the London School of Economics—and that puts it in a pretty extreme category. The researchers said that they identified that hospitals they claimed competed with one another had achieved a 7% improvement in the period for which patients awaiting an operation had to wait once they got into hospital. A 7% improvement is a period of something less than an hour. Then, without any justification whatever, they generalised from the particular and said that the hospitals they claimed competed with one other were 7% more efficient right across the board. It is on that basis that the Prime Minister says that he wants to introduce competition into our national health service.
Across the board, we see the Government taking unjustified risks with our national health service. If they are not prepared to disclose to the rest of us what risks they have been advised they are bringing about, they are both cowardly and stupid. I do not think that the people of this country will ever forgive them for their reckless, chancy, dodgy, second-hand-car-salesman approach to the national health service.
It is a sure sign of a deranged mind when one starts to repeat oneself. I have said previously that the Bill is a huge mistake, that not releasing the risk register merely creates further alarm, and that abandoning the Bill could be the safer option. I have also said that the Secretary of State’s intentions are noble and that the Opposition’s objections are—in part, at any rate—considered and compelling. However, I have clearly failed to persuade many of my parliamentary colleagues to share that point of view, as last night’s voting showed.
I am grateful to the hon. Gentleman for giving way. He says that he has been opposed to the Bill from the outset. As he knows, I served on the Public Bill Committee with him. Why did he not vote against it? He had ample opportunity to make the Government drop the Bill.
If the hon. Gentleman checks Hansard carefully, he will find that there were occasions when I did. We must all agree, whether sadly or happily, that the vote in the Lords last night was conclusive, even if some, like Baroness Williams, were voting for legislation that they said they did not particularly like. That is in part because of the modifying genius—I put it as strongly as that—of Earl Howe.
There are risks attached to the legislation. The risks that I face are small in comparison with those faced by the Secretary of State. I risk being found out for having fears that are misplaced. I risk having my forebodings exposed. He risks a great deal more than that. The House does not need a risk register to find out what those risks are. If he proceeds rapidly at a time of huge upheaval in the NHS, he will actually promote that upheaval. If he goes ahead, he will be doing so at a time of austerity, in the teeth of wholesale professional opposition and in a climate of genuine legal uncertainty, with legislation that has, in part, been cobbled together. We will soon find out what has been scaremongering and what is plain scary. Crucial to mitigating the risks will be the pace and the extent of enactment and implementation. There will be a mopping-up phase. It will be crucial for the Government to woo back professional opinion. The risk register would have told us, to some extent, how easy or difficult that will be.
Already we hear that the Government are struggling with the central plank of the legislation: GP commissioning. We wait with interest to see the regulations on that. It is hard to see how GPs can commission basic out-of-hospital services in primary care, which is a central thrust of the Government’s legislation, and not be seen, as small businesses or associations of undertakings, to be benefiting themselves with public money. In the legislation, we have made the biggest provider the biggest commissioner as well. GPs will have no problem commissioning hospital services without any legal obstacle, but they will lack the expertise to do so. That is what primary care trusts found when they did the commissioning. The risk is that we will end up with GPs not being able to commission what they do understand, and being asked to commission what they do not understand. We therefore await the regulations with considerable interest.
I suggest that although Cabinet members have been banging the table today, they may well be banging their heads against the wall in the years to come.
This afternoon, the House is being asked to agree to the longest ever NHS legislation and to back the biggest ever reorganisation of the NHS. We are being asked to accept that from Ministers who have lost twice in law and still keep secret the risks that they are running with our NHS. This is a legal and constitutional argument; it is not a political argument. This is not about being in favour of or against the Health and Social Care Bill; it is about the public’s right to know the nature and scale of the risks that the Government are running with their NHS, and it is about their elected Parliament’s right to know about those risks when it is asked to legislate—as we are being asked to do—on their behalf. We are elected to the House to legislate by the people, for the people.
Nothing is more precious to people than our NHS. We all need the NHS. We depend on it utterly when we are at our most vulnerable and fearful. The NHS in England employs more than 1.4 million people, treats 3 million patients each week and provides each of us, throughout our lives, with some of the best health care in the world, free at the point of need. That is why it matters so much, and that is why people mind so much about the plans for the NHS.
The NHS, as an institution, is exceptional, and the public interest in anything that puts it at risk is exceptional, too. The current reform plans are exceptional in their nature, scale, timing and speed, and concern about the risks to the NHS is exceptional. That was expressed by all NHS experts, professional groups and patients in the consultation on the White Paper, and it was expressed by the Health Committee in its reports in December 2010 and January 2011. Risk was, is and will continue to be at the heart of the concerns about the biggest ever internal NHS reorganisation. That is why I made my original FOI request for the transition risk register in November 2010. That is why I refused to accept the Department’s refusal to release it. That is why I went to court this month to help to argue the case against the Government’s appeal.
Good government demands that Ministers get the best and fullest policy advice from officials, and it requires some safe space in which to make major policy decisions, but I am not asking for the release of policy advice. Risk registers are management, not ministerial, documents. They do not contain policy advice or accounts of policy discussions. They derive from major policy decisions, and the White Paper of July 2010 set out the main policy decisions three and a half months before the first transition risk register was compiled.
Nor am I asking for the release of information that will bring to a halt the Government system of risk management. It did not do so in 2008 when we were forced to release the risk register for the runway at Heathrow. Nor am I asking for the routine disclosure of risk registers. I am asking for the non-routine disclosure of this risk register because of the exceptional case and the balance of public interest that is in favour of disclosure and not in favour of withholding, just as the Information Commissioner and now the Information Tribunal—both of whom have had the benefit of having seen this risk register—have decided.
We are at the very end of the 11th hour of this Bill’s 14-month forced passage through this House. Beyond today, the Government must decide whether they will respect the law and release the risk register. This is part of the reason why the Government have lost the support of NHS staff and lost the confidence of NHS patients, and have now lost the trust of the British public.
It is a great honour to take part once again in a debate on the Health and Social Care Bill. I first made a contribution to these debates in 2010 and, as John Healey said, since then there have been 14 months of detailed and careful consideration of the Bill’s provisions. That says a lot. There has been criticism both in this debate and previously that the Bill is ill-considered and has been rushed through, but given the consideration of it that there has been over such a long period, and with so much public involvement and comment, that is clearly not the case.
The right hon. Gentleman also said that our NHS is truly a precious institution for each and every one of us—our own family members as well as all our constituents—and I agree. People rely on the health service and hold it very dear, and it is therefore right for passionate feelings to be expressed about its future both in this Chamber and outside. I contend that because we have a changing demographic and magnificent advances in medical technology, the way our national health service is run cannot stay still.
No one on the Opposition Benches has argued that the NHS does not need to continue to improve. That is not what we are discussing; we are discussing the risk register. Does the hon. Gentleman believe that the Government should abide by the tribunal’s decision, or does he believe they should continue to ignore that lawfully made decision?
I think the biggest risk to the national health service is if we do not reform it and move it forward. It needs reform to stay relevant to the needs of all our constituents. I find the Opposition’s position strange—I would put it down to political opportunism, but I am happy to take another intervention if Opposition Members want to state their case—given what happened with the three requests made when Andy Burnham was Secretary of State and under his predecessor.
I believe I do understand the difference between the different types of risk register, but if we simply stand still and have inertia in our health service, it will become less relevant.
Frank Dobson accused members of my party of being chancers. I prefer to consider us as reformers, and only if we embrace reform will we be able to provide a better NHS.
One reform that I imagine the hon. Gentleman will welcome is the Chancellor’s proposal, which we gather we will learn about tomorrow, that every taxpayer can find out where their taxes go. As the taxpayers have paid for the compiling of the risk register, why should they and we not be able to read it?
I am a great supporter of transparency across all our public services, and the people of this country thirst for transparency about how their hard-earned money is spent.
The Health and Social Care Bill provides for the democratisation of the national health service. The experience of the NHS in my constituency over the past decade was the sad loss of the maternity department at Crawley hospital, followed four years later by the closure of its accident and emergency department. One reason why those two units and others were transferred from my constituents’ local hospital was that decisions about the national health service were made nowhere near where they took effect.
The Bill will allow local clinicians, in conjunction with their patients—and, I might add, with democratically elected local government—to have a much greater say in how the NHS is delivered and greater scrutiny of it. We will have a far more responsive health service. It has been almost decades since health decisions in Crawley were made by clinicians, patients and elected councillors. By repatriating many decisions, we will have a more transparent and responsive health service.
It was a great privilege to be able to open the new digital mammography unit at Crawley hospital a few weeks ago. That is a classic example of a health service that develops in line with technology and with the changing needs of our population. I am confident that the Bill will give local clinicians, patients and democratically elected local representatives the tools to provide a far safer and more relevant national health service to the people of my constituency and constituencies up and down the country.
In conclusion, after 14 months of careful consideration of the Bill, it is time we get on with the reform of the national health service, which goes hand in hand with the increased investment in it that the Government have guaranteed at least to the end of this Parliament. I might add that that is in stark contrast to what is happening in Wales, where Labour is in control of the NHS and where budgets have been cut. The people of Wales are feeling the result. I want to resist that happening to patients in England and therefore believe that it is time to get on and pass this legislation for the good of our NHS.
This debate is about contempt—for the Information Commissioner, for the tribunal, for the people who signed the e-petition, for the public who have contacted hon. Members in their hundreds of thousands and for the principle of transparency. For years, we had lectures from the Conservatives and Liberal Democrats when they were in opposition, when they said that sunlight was the best light.
We should not be surprised, because the whole debate on this legislation has been about contempt, starting with the contempt for democracy. The Government have no mandate, no support and no truth—the Conservatives promised no top-down reorganisation. The Conservatives and Liberal Democrats were not straight with the people, but why not? I hate to disagree with my right hon. Friend John Healey, but this debate is political. The Conservative party has always opposed the national health service, because it is the living example that collectivism works. Conservatives oppose the NHS because they are against collective provision.
“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.”
The Conservatives knew that, which is why they covered it up.
The Government have shown contempt for the House, because even before they reached for the pause button, changes were taking place. Before we have even agreed the legislation, they have all but abolished 151 primary care trusts, with tens of thousands of people being made redundant. They are being replaced by 279 clinical commissioning groups, and strategic health authorities have been set up.
The new national commissioning board, which has not yet been agreed in law, has already got a chief executive, a finance director and seven board members, recruited at salaries of up to £170,000. That is before we have even passed the legislation. If that is not contempt, what is?
Worst of all is the Government’s contempt for the people to whom we look to deliver our services. The Government say, “We know best,” but anybody who was in the Chamber last week to hear the Government’s contempt for the work of Dr Chand, who did his best to ensure that the House looked again at the Bill, will know how the Government feel about health workers in this country.
Who are these people who know so much better than the doctors, nurses, general practitioners, consultants, radiographers, occupational therapists and porters? What is their background? There are researchers, a teacher, and a sales and business manager. In the Lords there are former Army people, journalists, lobbyists, MEPs and researchers, and people who worked at Tory HQ. Do they all know so much better than the people to whom we and the people we represent turn every day of the year to take care of us?
Who is against the Bill? Almost everybody, including the British Medical Association, the Royal College of Nursing, the Royal College of Midwives, the Royal College of Radiologists, the Royal College of Physiotherapists, and the Royal College of Paediatricians and Child Health, the Faculty of Public Health and the GPs. I could be here all night going through the list, but the Conservatives and Liberal Democrats know it.
There was one small omission from my hon. Friend’s list of the many opponents of the Bill: the agent of Simon Hughes, who is also deputy leader of the Liberal Democrats. Mr Gary Glover, on his Twitter account, said:
“Lib Dems have accomplished almost nothing on the NHS Bill.”
Surely the truth is that Lib Dems could accomplish rather a lot, because they could help us to defeat the Bill tonight.
My hon. Friend is absolutely right. As an eternal optimist, I continue to hope against hope that the Lib Dems will see the light tonight, but my guess is that they probably will not. They have shown contempt even for the democracy within their own party. They claim to be determined to be bound by the democratic decisions of their own party. They have not been. They have ignored their party. When they came to Gateshead two weeks ago, they said they would stand up to the Bill, but they have not. It is the double-talk and spin that we are all used to.
Two days ago, I visited my general practitioner, and on his practice nurse’s wall was a poem by Michael Rosen, the children’s poet laureate, who, in 2009, wrote a poem called “These Are The Hands”. It read:
“These are the hands
That touch us first
Feel your head
Find the pulse
And make your bed.
These are the hands
That tap your back
Test the skin
Hold your arm
Wheel the bin
Change the bulb
Fix the drip
Pour the jug
Replace your hip.
These are the hands
That fill the bath
Mop the floor
Flick the switch
Soothe the sore
Burn the swabs
Give us a jab
Throw out sharps
Design the lab.
And these are the hands
That stop the leaks
Empty the pan
Wipe the pipes
Carry the can
Clamp the veins
Make the cast
Log the dose
And touch us last.”
These are the people we should have been listening to. These are the people who have been ignored constantly by the Government parties. And these are the people who will never ever forgive them for what they are doing tonight. When the election comes, they will be thrown out where they belong.
Later this evening, the House will consider—yet again, many of us would say—the Health and Social Care Bill, but the issue for consideration now is whether the Government should publish the transitional risk register on the Bill. The right hon. Member for Wentworth and Dearne was explicit that he was not arguing that all strategic risk registers should be published, and acknowledged the argument that there needed to be private space in which civil servants could give advice to Ministers secure in the knowledge that it would remain private, because there was an important interest of good government that that discipline and space should exist. That is an argument that he explicitly accepted and of which I am a strong supporter.
My hon. Friend the Member for Banbury reminded the House that only yesterday two retired former heads of the civil service told peers in the other place of the importance of the principle that Ministers must be able to receive advice from civil servants on policy issues, including the risks associated with them, without that advice later becoming public. The issue that the right hon. Member for Wentworth and Dearne did not cover but which is important is that there needs to be confidence within the civil service about which side of the line advice will fall. If civil servants can give advice to Ministers believing that it will remain confidential and if, after the advice is given, the line is moved and the advice falls to be published, we run the risk that across Whitehall the space that he advocates will, in truth, not exist, because there will not be the confidence that the advice will not later fall to be published.
The right hon. Gentleman is talking about advice. It has been made clear that this is not advice but a management assessment of risks relating to the Bill and the reorganisation. It is not about policy or advice, which is why it is important that it is released.
It is an interesting debate whether a risk register about a transition related to a policy is advice about policy or advice about management. The issue is that there is doubt. If the Government surrender this line without arguing the case to its conclusion, there is space for doubt about whether these risk registers will remain confidential in the future or whether they will be published. The important principle is certainty.
I will give way to my hon. Friend in a moment.
The important principle—it is always an important principle in the law—is certainty: the certainty that people can be clear whether the advice or the register that is being given to a Minister will remain confidential or whether it will be published. My concern is that this motion is seeking to move that line retrospectively, in a way that two distinguished former heads of the home civil service clearly believe would prejudice the space that the right hon. Member for Wentworth and Dearne said was important.
The right hon. Gentleman is making an argument for blanket secrecy. However, this is less about his view or even mine; rather, the point is that the Information Commissioner and the judge, along with his two wing members on the tribunal, all of whom have seen and studied the risk register, have determined that, in their legal judgment, the balance of interest lies in publishing and not withholding it. Those are the facts of this case.
The right hon. Gentleman is correct, but he does not go to the end of the process, because the reasons for that decision have not yet been published. The House is therefore being asked to make a decision on the basis of a judgment that has not yet been published, which cannot be right.
My right hon. Friend has argued the case on behalf of retired senior civil servants and Government Front Benchers. However, as the Chair of the Select Committee on Health, and therefore as someone who is deeply interested in effective scrutiny, does he not agree that if the Committee, of which I am a member, wishes properly to understand the potential impact of fragmentation, the conflicted nature of clinical commissioning groups, and so on, we need to find a way of getting behind the declaratory reassurances from the Front Bench?
Of course I agree with the proposition in the way that my hon. Friend puts it. However, the proposition before the House is a rather more precise one: that a register drawn up in the expectation that it would remain private should retrospectively be put into the public space. The proposition that I am advancing to the House is that that is an area where we should proceed with care. We should embrace the principle that when advice is given to Ministers, it should be clear to those giving it whether it is being given confidentially or whether it will later be given over for publication. That is the simple principle that I wanted to set out.
I have got out of my sick bed to be here today, because this is a vital debate, and I am grateful for the opportunity to participate in it. I often feel that these debates are a bit like the siege of Stalingrad: we are rolling back the forces of oppression. I content myself, with my cough and sore throat, that at least the red army was victorious on that occasion.
In response to the point that Tony Baldry and Mr Dorrell, who chairs the Health Committee, made about the ruling by the Information Commissioner, I think we should reflect on the fact that it was indeed a ruling. It was not advice that he was giving. Mr Christopher Graham has some expertise in this field, and although the detailed reasons have not been published, the arguments that were made by my right hon. Friend John Healey and the co-applicants from the Evening Standard—that it was in the public interest to publish the risk register—were obviously accepted.
If I may, I would like to remind the House of what the Information Commissioner said, which was upheld on appeal. Mr Graham said:
“Disclosure would significantly aid public understanding of risks related to the proposed reforms and it would also inform participation in the debate about the reforms”.
Earlier on, Government Members were shouting “Frit!” at Labour Members. I really did not understand what that meant—I am just a simple working-class lad from Easington—but I now understand that it means “You’re afraid”. However, if the Government have complete confidence in the direction of their reforms, surely it is they who are afraid, because they should have the confidence to publish the document.
It is beyond doubt that the Information Commissioner considered all these matters before reaching his decision. Does my hon. Friend agree that, if the risk assessment had supported the Government’s case, the Government would have got it out like a shot? That they have not done so exposes the fact that they are playing fast and loose with one of the nation’s most treasured institutions, and that they are trying to hide that.
Absolutely; good point, well made. If the Government had nothing to hide and were not concerned, they would have published the contents of the risk register. We have had a flavour of the contents of the other risk registers that have been compiled at strategic and other levels, and I believe that the Government are concerned about them.
“I’ll not sit here and tell you that the risks have not gone up. They have. The risks of delivering the totality of the productivity savings,”— that is, the Nicholson challenge; the £20 billion—
“the efficiency savings that we need over the next four years have gone up because of the big changes that are going on in the NHS as whole.”
It is clear that local and national risk registers, as well as the strategic risk registers to which we have had access, have highlighted serious concerns with patient safety, increased costs, the break-up of care pathways—which we have seen on Health Select Committee visits—as well as competition harming integration, about which the Committee was very concerned, and the specific risks during the transition stage.
Will my hon. Friend also confirm that, in that session on
Absolutely; I completely agree with my right hon. Friend. These are huge structural changes to a beloved organisation, and it is in the public interest that we know precisely what is in the transition risk register.
A little while ago, I tabled early-day motion 2659, which called on the Health Secretary
so that we could have proper scrutiny in the Lords and in the House of Commons. We have not seen what is in the transition risk register, but we are aware of the existence of other risk registers. While the Health Secretary has been fighting tooth and nail to prevent the publication of the transition risk register and, in the process, hiding the risks to the NHS in England, other NHS bodies and clinical groups have been compiling their own risk registers into the impact of the Health and Social Care Bill.
One such body is the Faculty of Public Health, the body for specialists in public health, which is a joint faculty of the three Royal Colleges of Physicians of the
United Kingdom. I am grateful to Professor Clare Bambra, from the north-east, and Professor John Ashton, from the north-west, for providing this information. In a letter to
The Independent newspaper, Professor Lindsey Davies, the president of the Faculty of Public Health, outlined his concerns about the pressure that clinicians were now under from their employers for criticising the Government’s plans to reform the NHS. He wrote:
“Public health professionals have the right and duty to speak out on issues which they perceive as threatening the health of the population they serve”.
The bunker mentality of the Health Secretary, and his determination to silence clinical and public opposition, have astounded the country as a whole.
In response to the Department of Health’s refusal to publish its own strategic risk assessment of the impact of the Bill, the Faculty of Public Health has undertaken its own study, in which it has highlighted a number of significant risks, not least the potential for a postcode lottery. It states:
“Clinical Commissioning Group flexibility to determine services will lead to an increase in geographical variation in service provision.”
It identifies the possibility of costs being pushed up, and states that the
“development of more overt market mechanisms, and the greater role for the independent sector in the provision of healthcare is likely to increase the overall cost of providing healthcare.”
It also raises concerns about issues of quality as a consequence of the reforms. If the transition risk register indicates that, we should know about it.
The delaying tactics employed by the Secretary of State are, to my mind, holding Parliament in contempt. He should publish and employ no further delaying tactics. Reports that Tory-Lib Dem Cabinet members banged their Cabinet table in delight and glee at the prospect of the health Bill finally being rammed through and becoming law at the end of today leave a very sour taste in the mouth. I urge all Members to support this motion and get the risk register published.
I inform the House that there is a slight discrepancy between the clock time shown on the annunciator screen and that shown on the digital display panels on either side of the Chamber. For the avoidance of doubt, this debate began at 3.44 pm and has to end at or before 5.14 pm. For the purposes of deciding when we reach the end time, the Chair will use the time on the Chamber digital display panels. I hope that that is helpful. Given the level of interest in the debate, the time limit for Back Benchers will be reduced to three minutes with immediate effect.
I have just been reading a kind of risk register—the risk register for Ibuprofen—and I have been reading it in the British National Formulary, which is kind of recipe book and technical how-to-do manual for doctors and nurses. When I read it, I see that it is scary stuff. If I take this medicine, I might develop a fatal skin reaction, I might bleed to death from a stomach ulcer, I might develop kidney failure, I might collapse with pancreatitis, hepatitis and all sorts of things. Why on earth did I take this medicine—this potentially dangerous Ibuprofen?
Listening to Labour and seeing the extreme shroud waving that has been going on is, frankly, enough to give anyone a headache. I took the Ibuprofen because of what I read in the impact assessment. The impact assessment presents a sensible, balanced portrayal of the realistic risks and benefits, and warns me of many points of which I need to take heed. It is far more likely that I am going to develop indigestion from taking Ibuprofen than that I am going to collapse from a fatal skin reaction.
I am not trying to trivialise the issue; believe me, I understand how vital the NHS is to all our constituents and to patients. My view is that the transition risk register has been elevated to a status far out of proportion to what it merits. I completely understand the points made by Lord Wilson and Lord Armstrong—very experienced civil servants who tell us that they would feel constrained in giving full and frank advice. However, we have seen how any detail can be taken out of all proportion in this House; we are all partly responsible for that. As I said, some of the shroud waving over this Bill has been disgraceful, and I know of patients who have been genuinely frightened by it. I would be prepared to see the risk register published, but I accept the point of my right hon. Friend Mr Dorrell that it has to be done on the basis of a clear understanding.
I am listening carefully to what the hon. Lady is saying. I remember, however, a comment that she made to The Guardian, I believe, at the start of this process, when she said that this Bill was like throwing a hand grenade into the NHS. What has changed?
There we go—a deliberate misrepresentation. After I made those comments, I wrote to senior colleagues and told them that what I had said was completely different. I was deliberately misquoted on that statement and have been consistently misquoted by Labour Members. They should go back and look at the original.
I feel that it would be reasonable to present all the risks, but it would be crucial for Members of all parties to recognise that we are talking about a lasting change. We would also need to see a change in how risks are extrapolated out of all proportion to what they represent and an end to the deliberate frightening of patients into believing that they will have to pay for health care, which has been a consistent feature of how this Bill has been misrepresented by Labour Members.
In the context of her medicinal anecdote, does the hon. Lady not accept that members of the public at least have the right to read the little inserts in books of pills before they take them? Should we not have the same right to read the risk register?
The equivalent of that is actually the impact assessment. However, as I have said, I would be prepared to allow the publication of the register, because, in this internet age, the misrepresentation of the Bill, and the extrapolation out of all proportion to the risks, has been a complete disgrace.
Does the hon. Lady recall saying that the absence of an intermediary body between small GP commissioning and the National Commissioning Board was a serious flaw in the legislation? Clearly that flaw is still there.
I believe that by the time of the next election, our patients will still be going to see GPs. They will still be being referred to the hospitals of their choice, that referral will still be free at the point of use, and it will still be based on their needs and not on their ability to pay. The only thing that will be missing will be an apology from the Labour party.
I am pleased to follow Dr Wollaston, for whom I have great respect. I am glad that she recognises that the risk register should be published, and I greatly regret the fact that her Whips did not allow her on to the Bill Committee, where her views might have had more influence. However, I think that the coalition insults those of us who oppose the Bill by suggesting that we would mistake a worst-case scenario for a prediction. I think that opponents of the Bill know what a risk looks like, and I think that we could be trusted with the risk register. We want to be able to study the Bill with the benefit of that information, and to be able to represent our constituents properly on it.
This is a very sad day for our health service. Although the Bill returns to the Commons today following a tangle of more than 1,000 amendments, the Government have done little to alter its direction, which remains fixed on the ideology of driving commercialisation into almost every corner of the NHS. [Hon. Members: “Have you read it?” ] Yes, I have.
The risks were made plain at the weekend. Dramatic warnings by leading doctors featured in an assessment by the Faculty of Public Health, which was mentioned by Grahame M. Morris. It has also read the Bill, and it represents more than 3,000 public health specialists in the NHS as well as local councils and academia. It says that the Bill poses
“significant risks… to patients and the general public”.
It goes on to say that the Bill could well damage people’s health and experience of care—[Interruption.]—and adds:
“It is likely that the most vulnerable who already suffer the worst health outcomes will be disadvantaged as a result of the enactment of the Bill.”
Let me repeat that. Members may not have been able to hear it over all their heckling. The poorest,
“the most vulnerable who already suffer the worst health outcomes will be disadvantaged as a result of the enactment of the Bill.”
That is precisely the point. That is why an extraordinarily wide cross-section of people are deeply concerned about the commercialisation that the Bill brings. Yet despite their concern, and despite two rulings demanding the release of the risk register, the Government maintain their arrogant dismissal and refuse to make the register public. Why? Because they know that were they to make it public, we would know what they already know, which is that it drives a nail into the coffin of the Bill. The Bill is hugely damaging, and that refusal to come clean speaks volumes.
So many parts of the Bill are still hugely flawed. The 49% private income cap and the fact that more and more beds will be used for the private sector will massively undermine our NHS. That is why so many constituents are writing to us: they are deeply concerned. However, this is not the end of the road, because the campaigning will continue throughout the country.
Your generosity of spirit is legendary, Mr Speaker, and you were characteristically generous in accepting the submission of 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 matter of the Department of Health’s transition risk register. The House considered that on
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
Secondly, as my hon. Friend 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.
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”?
The right hon. Gentleman knows perfectly well that in the debate on
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 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 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.
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?
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”.—[Hansard, 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
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.
In the past few minutes, we have seen a perfect demonstration at the Dispatch Box of why the right hon. Gentleman has spent 20 months trying to sell this Bill to the country but has comprehensively failed to do so. He had nothing to say in response to the speeches of Opposition Members and he did not respond with appropriate seriousness to the points that we have put to the House, namely that it should not put through far-reaching changes to this country’s most valued institution without knowing all the facts. Not one Member can go through the Lobby and say that they know all the facts about what this Bill will do. Instead, what we have heard from the Secretary of State, Tony Baldry, Mr Dorrell and Dr Wollaston is a rerun of the arguments that were heard in detail by the Information Commissioner and the Information Rights Tribunal. I have news for them all—and, indeed, for Anna Soubry—they lost. Those arguments have been heard, a ruling has been made and the Government should surely respect the law, and of all people, the hon. Member for Broxtowe should respect the law.
The Secretary of State said there was a very simple point—that the Government have a responsibility to respect the law. They are the Government who told us they would be the most open and transparent Government in history. What total nonsense. Our point is simple: he is passing a Bill with far-reaching implications for the NHS in England in defiance of a legal ruling that he should publish all the information about his Bill. He made three points that were simply wrong. He said that the transition risk register deals with the worst-case scenario. It does not. It deals with the likelihood of a range of events and the impact of those events, and gives a judgment about whether or not they can be mitigated and the likelihood of mitigation. Has he read his own risk register?
The Secretary of State made a point about the strategic and transition risk registers. Has he read the ruling from the Information Commissioner and has he understood the implications of what the Information Rights Tribunal said? They said that the Government should not publish the strategic risk register because it deals with uncontrollable risks that are outside the control of Ministers, but that the Minister should publish the transition risk register because that is what he is inflicting on the national health service.
Let us not forget that the Secretary of State has chosen to inflict the biggest ever top-down reorganisation on the national health service at this moment of greatest financial challenge. That was his decision. His right hon. Friend the Prime Minister ruled that out. He said that there would be no top-down reorganisation. The coalition agreement ruled it out, but the Secretary of State brought it forward. It was his decision and if he wants this Parliament to endorse his plan, he should have the courtesy of putting before Members all the information that he has seen, but he is not prepared to do that.
Why will the Secretary of State not publish this information? What has he got to hide? Is it the fact that it would prove that all the people who are lined up in opposition to his Bill are right—the doctors, the nurses, the midwives, the physios? Is it possible that they are right in their judgment that the Bill will cause more harm than good? Would not the pitiful levels of support that he still has for the Bill be wiped out by the publication of the risk register?
The Secretary of State made no argument today at the Dispatch Box. The Government are doing what they are doing in total defiance of the law, in the teeth of professional opposition. They do not have the permission of the people of this country to put the NHS through the biggest ever reorganisation in its history. They promised in their manifesto that they would not do it. The Prime Minister promised us that he would protect the NHS and there would be no top-down reorganisation, but the Government have introduced the biggest ever top-down reorganisation. They are making a catastrophic political mistake by doing so. We will remind them every day of the damage they have done to our national health service.