Being aware of the risk, how can the government carry on regardless?


 

NHS campaigner Jos Bell presents an eyewitness sketch of the House of Commons debate on the NHS Risk Register, which took place this week

On Thursday, a BMJ report (£) was released which showed the NHS performs remarkably well in comparison to those which cover a similar demograph – and that the Lansley upheaval will interfere in a counter-productive and unnecessary way.

Andrew-Lansley-greedy-tosserThis week, I and three people of my acquaintance have all experienced excellent hospital care – all of it specialist, some of it highly complex and life saving. One person I know well has not. Thus my NHS circle of the week presents a quality ratio of 1:4.

Now, re-wind 24 hours to the setting of the chamber of the House of Commons.

Speaker Bercow invites Andy Burnham to address the House on the matter of the health and social care bill transitional risk register, which Andrew Lansley has been repeatedly asked to release.

The shadow health secretary said:

“We are living in extraordinary times for our democracy and for the NHS…

“From the moment the white paper was published, the NHS began to change… just when it’s needed most, as the Nicholson challenge is biting, there is confusion and drift as there is a huge loss of experienced staff…

“They inherited possibly the best health service in the world and in just 20 months have reduced it to a demoralised, destabilised organisation full of people fearful for their future…

“The scale of the re-organisation means that the release of the risk register is urgently needed.”

The government is clearly not minded to pay any attention to the Information Commissioner, who has made it plain that the public interest would be best served by the release of the document – specifically because of the potential enormity of the impact of the bill:

“The Commissioner finds that there is very strong public interest in disclosure of the information, given the significant change to the structure of the health service the government’s policies on the modernisation will bring.”

For the purposes of straight-talking debate, Burnham centred on three key issues:

“– What exactly are the risks?

“– How serious are they?

“– The public right to know.”

Fourteen Lib Dems had signed Easington MP Grahame Morris’s EDM requesting the debate; predictably, they were not all present.

This by turns bad tempered, impassioned and on occasion oddly disconnected debate on the failure of the government to release the health and social care bill risk register, did not achieve the result desired by the opposition and a small number of disquieted Lib Dems (the vote was eventually lost by 53, with only four Lib Dems actually voting with the opposition).

But it was useful in revealing more truths into the behaviour of David Cameron and the Department of Health, as well as providing an opportunity to discuss the reason so many are actively campaigning against the bill; namely, risk and rampant untruths.

The reduction in health inequalities may be a stated aim in the bill, as health minister Simon Burns was keen to remind us all, but the measures needed to enable this to happen are not only absent, they are compromised by other clauses contained in the document. A risk to children is surely something to be addressed? Not if the government has any say in the matter, it seems.

Surely in the midst of this, every child still matters? One hundred and fifty child health experts say inequalities will widen and there will be preventable child deaths as a result of the measures in the bill. Is the government listening? Does it care? Sadly the evidence is to the contrary. On Thursday the Royal College of Paediatricians voted to ask for the bill to be withdrawn with a majority of 79 per cent.

Oh yes, and 1.3 million diabetics have not had their recommended annual checks; walk-in centres have been closed in Ashfield; and hospital waiting lists are being ‘doctored’ by throwing off patients who teeter over the 18-week wait.

All serve to emphasise the worrying evidence, driven home by Andy Burnham, that an increasing number of previously stable trusts are self-assessing a range of services at extreme risk levels – scoring 16 and above on the assessment.

Far from being interested in serious discussion, the government response was to alternate pre-primed MPs, saying that on the one hand the request for a Risk Register reveal was unnecessary because the requested document was supposedly out of date (November 10th) and on the other it was so scary that the poor ’ickle public should needs be protected from it.

PFI contractual issues and IT fails were flung out at every given opportunity. For further back-up, the primed ones kept intervening to say its revelation would set a precedent – never before in the history of Parliament, etc. etc. etc.

At which point an angry John Pugh (Liberal Democrat, Southport) popped up to say he already had another one readily available on the internet – namely the emergency management RR 2012 – altogether more terrifying than anything that could be in the H&SC transition register (or at least, one would hope so).

Burnham and his predecessor John Healey (Labour, Wentworth and Dearne) doggedly persisted in demonstrating that the requested register was specific to the bill and not the strategic document which the government benches continually pretended was the object of discussion – thus no precedent would be set, particularly as the Freedom of Information Act allowed for consideration of each case on specific merit.

Burnham also related the chief executive of the NHS confirming to the public accounts committee:

“I’ll not sit here and tell you that the risks have not gone up. They have.”

So – being aware of the risk, how can the government carry on regardless?

With MPs standing up en masse with arms outstretched for interventions, question after question was rebuffed in such a fashion as to accuse the opposition of apparently trivialising the debate by having the temerity to focus on the RR – whereas in truth it was the government benches who continually trivialised the session by refusing to acknowledge even one key point or the pressing need to attend to real patient experiences.

Reality was met with guffaws and vitriol – Anna Soubry (Conservative, Broxtowe) finding herself roundly chastised on two occasions from the Speaker’s chair. For all the interest she has in the needs of the sick, she really should stick to carrying bags as advised by the deputy speaker.

Exactly how the voluntary sector feels about Harriett Baldwin (Conservative, West Worcestershire) bouncing chief executive of the Association of Chief Executives of Voluntary Organisations (ACEVO), Stephen Bubb, across the chamber as free marketeer and localism champion-in-chief, remains to be seen.

A fired up Burnham stripped the government artifice bare “without so much as a fig leaf of a principled argument”, which was certainly true of the Burns apparel when he maintained that disclosure will jeopardise the success of his own policy.

His quack-psychology was rooted in the notion that if the risks were revealed they would become a self-fulfilling prophecy – trying to persuade us all that the scary stuff is currently all in our scaremongering imaginings. These were the tactics of a Burns Witch Project.

Far from sending out messages or reassurance, it created a feeling of, as opposing speakers said more than once, ‘exactly what have they got to hide?’ The more they deny and avoid and abuse the more guilty they appear.

Once upon a time John Selwyn Gummer tried to make his daughter eat a burger to prove how it couldn’t possibly carry CJD; now her brother Ben Gummer (Conservative, Ipswich) stands in the chamber and tries to force feed us the health and social care bill as harmless and beneficent.

Time and again we had to listen to the worn out shibboleth of pretence that this is the supposed great bureaucracy dismantle – when in reality, as Valerie Vaz (Labour, Walsall South) said, the new infrastructure has everything in it “but a partridge in a pear tree”. Not only is it more complex and vast but it has also been built upon the unwarranted expenditure of mass redundancies and re-hiring.

Former health secretary Alan Johnson (Labour, Kingston upon Hull West and Hessle) hit Lansley full square:

Nobody has ever coveted the position of Health Secretary for so long and then failed in it so quickly. The publication of the transition risk register will, I am sure, make his position even more untenable.”

As for his devised pronouncements about the reducing pressure on hospitals – this indeed is the voice from ‘the bunker of untruth’.

The reality is:

• Between December 2010 and December 2011, a 13 per cent increase in the number of people waiting longer than 18 weeks, and a 105 per cent increase in people waiting longer than a year;

• The number of patients waiting more than six weeks for their diagnostic tests has more than doubled, and the number waiting more than 13 weeks has more than trebled.

The changes directly resulting from the health and social care bill are already affecting real people with real families. Moreover it also became apparent that in LaLa world there are no plans to mitigate known risks. Risks? What risks?

The seven hours of agitated warnings and scornful fob offs surely proved one thing – that one side of the House is desperate to save the NHS whilst the other sees the NHS as something of a political poker game where reality rarely features.

That the bill will inversely impact on safety and quality with more chance of repeats of  the North Staffs and Winterbourne View scandals, there is now little doubt amongst the professional groups.

The Robert Francis QC report on Mid Staffs is due imminently – and Burnham asked why it is that Lansley is ignoring the opportunity to include the recommendations of the report he himself has commissioned by determinedly ploughing on before the full report is released.

Burns and Lansley both obfusticated their way through the debate on the matters of life and death, Burns eventually taking his ill temper out on his briefing sheet and the despatch box after a storming closing speech from shadow minister for care and older people Liz Kendall.

When pressed time and again on their eventual intention to reveal the register should the Tribunal find against them, it became obvious they would seemingly rather sew the offending document into their trousers than reveal it to the world – even if that meant we will all chant the ‘pants on fire’ song as they sit on it, singing the ‘LaLa song’ whilst the flames of the NHS fry to a Burns crisp and patients queue in fields strewn with discarded medical equipment.

Mr Cameron should know better, but as Mr Burnham said:

“The prime minister has made a catastrophic error of judgement in letting this go through unchecked. Leaving staff with two hands tied behind their back, they’ve taken away the maps and the safety equipment – and all without permission”.

See also:

Just as we dismantle our NHS, India is trying to build theirs – David Taylor, February 23rd 2012

How the coalition is breaking the NHS – Alex Hern, February 15th 2012

My open letter to the PM about the NHS bill – Dr Kailash Chand OBE, February 14th 2012

NHS productivity gain is just the latest evidence that socialised medicine brings down costs – Daniel Elton, February 13th 2012

The Financial Times comes out against the NHS bill – Alex Hern, February 9th 2012

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