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Archive for the ‘Health’ Category

Nov 22,2012

Last night in the House of Lords (in between the debates on the Justice and Security Committee which led to the Government’s proposals on so-called secret courts being savaged) there was a debate on the regulations that set out how the Chair and members of the committee of Healthwatch England are to be appointed as a sub-committee of the Care Quality Commission.

The regulations are controversial because the subservience or apparent subservience of Healthwatch England to the Care Quality Commission undermine the independence of Healthwatch England as the national body representing patients’ interests – particularly as part of its job in the future may be to raise, on behalf of patients, questions about how the Care Quality Commission has carried out its functions.

The Minister’s response was pretty unimpressive – essentially that the initial appointments made to Healthwatch England were so good that there would never be any problems in the future.

You can read the full debate here.

My contribution was as follows:

Lord Harris of Haringey: My Lords, I am pleased to have the opportunity to follow the noble Baroness, Lady Jolly, on this Prayer. She has highlighted the weakness in the Government’s position. I am confident that the people who have set up Healthwatch England are of good will and that they intend and wish it to work; that Anna Bradley will be an excellent person as chair of Healthwatch England; that the outgoing chair of the Care Quality Commission is committed to making it work; and that the chief executive of the Care Quality Commission is committed to making it work. I even believe that Ministers in the Department of Health are committed to making it work.

The problem is that we are provided with a framework of regulation which does not guarantee that in future. One or two appointments down the road, with a new leadership of the Care Quality Commission and, perhaps, with different Ministers at the Department of Health, how will those things be ensured, especially if budgets remain tight and Healthwatch England starts to be effective and makes criticisms which are difficult for Ministers-or, worse still, in this context, for the Care Quality Commission? That is when those problems may arise.

That is why, when the Bill was passing through this House, there was so much concern about the importance of independence for the Healthwatch structure. My concern is that, given that the legislation has passed, this is a wasted opportunity to make it stronger.

One of the lessons that is expected to come from the Mid-Staffs inquiry relates to independence. The report is expected to identify the systemic failure of organisations to focus primarily on the needs of the patients of that hospital. Because each was looking at its own area, nobody was taking the step back to say, “How does this work from the point of view of patients?”. That is where Healthwatch should come in and be influential: to cut through the complicated organisational structures which the Health and Social Care Act has bequeathed to the NHS. That is why the simple issue of how it preserves its independence is so vital.

When the Bill was going through Parliament, the noble Earl held a meeting to discuss how Healthwatch England should work. He made the point that there would be valuable synergies from Healthwatch England being located within the Care Quality Commission. He did not stress, but it was clearly part of the equation, that there would also be some useful cost savings associated with that. The cost savings could be achieved in a whole variety of ways. It would be possible to have an agency agreement whereby some of the back office functions were provided by the Care Quality Commission or any of the plethora of structures that the Health and Social Care Act has bequeathed to the NHS. Similarly, because the duty of co-operation exists, you would hope that those synergies could be activated without the need for the Healthwatch organisation to be subservient to the Care Quality Commission. It would have been possible in these regulations to create a structure which, while preserving the general framework of the Act, would ensure that there was independence.

If we look at the regulations that we have before us, we see a number of flaws. First and foremost, for example, is the size of the Healthwatch England committee. Potentially, this will be a committee of as few as six members. I appreciate that in the initial instance it is larger than that, because people of goodwill are trying to make this structure work. However, in three, four or five years’ time there may not quite be the same atmosphere or there may be a feeling that the wings of Healthwatch England need to be clipped back. In any event, with six to 12 members it is going to be extremely difficult to ensure that there really is the geographical diversity that is necessary; the coverage of all the many major areas of special need that exist as far as health and social care is concerned; and proper recognition of ethnicity and gender within that. Again, the initial membership has provided a reasonable attempt to achieve that diversity, but where is the guarantee of that in the future?

I know there is a feeling that small boards work well. The noble Baroness, Lady Cumberlege, who is not in her place on this occasion, has talked to us glowingly about the value of having small, dynamic boards to run organisations but this is a different sort of organisation. It is supposed to be one that represents the generality of the interests of patients across the whole country and which derives its authority from what is happening in local Healthwatch organisations around the country-the 150-odd local organisations that will exist. It is therefore not appropriate to have a small board in such a case, as it is not the same sort of structure.

Then we have the rather strange arrangements for the appointment process. In the first instance, the chair of Healthwatch England has to get the approval of the chair of the Care Quality Commission before appointments can be made. The future arrangements are that the chair will make the appointments directly but let us be clear: the chair of Healthwatch England is a Secretary of State appointment and has the potential to be the poodle of the Department of Health. I have been in the position of being in charge of the organisation representing patients and I remember successive Secretaries of State, from two parties, making attacks on the organisation because we were being effective and raising issues that were uncomfortable.

Under those circumstances, can we be satisfied with a future arrangement whereby the Secretary of State solely makes the appointment of that individual, who then appoints all the other members of the Healthwatch England committee? In the initial stage, you have a double lock where the chair of the Care Quality Commission gets involved but in future you will have someone who might be appointed as a poodle or to muzzle the watchdog nature of Healthwatch England appointing individuals who are, no doubt, like-minded. That is why the arrangements are strange.

We then have the provision for suspending members, which is set out here. Presumably, the suspension is different from disqualification but the Secretary of State may dispense with the chair of Healthwatch England for a variety of reasons, which includes,

    “failing to carry out those duties”.

Who is going to determine what those duties should be? Essentially, we are being told that the Secretary of State will decide what he or she thinks is appropriate for Healthwatch England to be carrying out. Again, the chair then has similar powers in respect of individual members. I make a specific request of the Minister: that in his reply he spells out absolutely that it will not be appropriate for either the chair or the members of Healthwatch England to be suspended from their membership if they are pursuing their interpretation of what is in the interests of patients and their organisations, and the people that they represent.

Because of the requirement saying that the chair of Healthwatch England must be a member of the board of the Care Quality Commission, we are inevitably creating that subservient relationship. Will the chair of Healthwatch England be subjected to, in essence, the collective responsibility of the members of the board of the Care Quality Commission? There have been recent issues with the membership of that commission’s board, where the chair has taken a different view about what the role of individual members should be. That has led to conflict and serious problems.

Let us pan forward a few years: if the chair of the Care Quality Commission does not like the approach being taken by the chair of Healthwatch England, are they then able to say, “You are not fulfilling your duties as a member of the board of the Care Quality Commission because you are not abiding by the collective responsibility of that board’s members. I am therefore asking the Secretary of State to remove you from office and suspend you because you are not fulfilling your roles”? Even if that does not happen we will have, as my noble friend Lord Collins said earlier, the appearance of potential conflict of interest. Ultimately, how are the public going to have confidence in a structure where it looks to them as though the leadership of Healthwatch England is subservient to the Care Quality Commission, one of those important agencies about whose effectiveness it may have to make criticisms?

We should remind ourselves that the aim of all this is to enhance the collective voice of patients in the NHS. You will succeed in doing that only if the public at large have confidence in the structures that you have created. If you build into them the appearance of subservience and potential conflicts of interest, you are weakening that voice. That cannot in any way be in line with what either your Lordships would expect to see from this, or indeed with what I believe Ministers’ intentions to be as far as Healthwatch England is concerned.”

Nov 21,2012

This morning the Children’s Commissioner published her shocking report “I thought I was the only one. The only one in the world.” on child sexual exploitation in gangs and groups. This authoritative and well-researched document reports that it had identified 2,409 children as having been identified as victims of sexual exploitation by gangs or groups.

And what has been the Government’s response?

To welcome the report and promise action?

Unfortunately not.

Instead, anonymous government spokesmen briefed the media to say that the report was “over-emotional” and “sensationalist”

I raised this in Question Time in the House of Lords this afternoon. The Minister’s response was hardly effusive: the report was “useful to have”.

Here is the exchange:

“Lord Harris of Haringey:
The noble Earl, Lord Listowel, has referred to the Children’s Commissioner’s report which came out today, in particular the dreadful findings about how many children in care have been sexually abused. Will the Minister tell the House the Government’s stance about that report, given that, apparently, people speaking on behalf of the Government to both the BBC Radio 4 “Today” programme and the Sun said that the report was overemotional and were trying to undermine its conclusions?

Lord Hill of Oareford:
The Government’s stance is that the report from the deputy Children’s Commissioner is helpful for the Government to have. We will reflect on the findings that it makes in terms of its recommendations and its estimates about the extent of the problem. I think I am right in saying that the report recognises that making any precise estimate is by nature very difficult, but the more information we have the better. Even before this report, the Government have been seeking to improve the systems for getting accurate reporting from various local agencies and authorities to make sure that we have as accurate a picture as possible to make sure that we do not underestimate or overestimate the problem. Everyone is very aware of the salience of this issue and the important issues that that report gives rise to.”

Almost as though the Government are frightened of the issue.

Nov 6,2012

Earlier today I intervened in the discussion in the House of Lords on the Home Office statement on the historic allegations of child sex abuse in the North Wales police area.

Despite the Minister’s response, I remain concerned.

The exchange was as follows:

Lord Harris of Haringey:My Lords, I am sure that we all welcome the fact that there is to be a new police inquiry into these matters, but I would be grateful for the Minister’s explanation of the thinking behind this being led by Keith Bristow, who is heading up the new National Crime Agency. I have enormous faith in Keith Bristow himself. However, given that the Serious Organised Crime Agency and the yet-to-be-created National Crime Agency are going through a period of enormous flux and confusion while this happens, and the job of the chief executive of an agency that is being set up is usually pretty highly committed to setting up that agency, how will it be possible for him to lead the sort of inquiry that all noble Lords have said they want—very thorough, potentially extremely lengthy and potentially extremely involved? In practice, where will the resources come from? I am not talking about the money but the individual officers. Who is going to co-ordinate that? How is that going to be practically done when the person you are asking to lead the inquiry is supposed to have a more than full-time job setting up a new government agency?

Lord Taylor of Holbeach:I remind the noble Lord that the Statement made it quite clear that it was the chief constable of North Wales Police, Mark Polin, who actually requested Keith Bristow to head up this investigation, and to do so using the resources that are available to him through SOCA and other assets that are available for serious investigations. Indeed, we will face a new world with the National Crime Agency, but that still has to come before your Lordships’ House and I would not presume on that. This is a recognition that the inquiry itself may well cross police boundaries; it may well be a matter that is quite properly addressed by an agency set up to deal with serious organised crime.


Oct 23,2012

During Question Time in the House of Lords this afternoon I intervened to try and get a straight answer from Earl Howe, the Parliamentary Under Secretary for Health, as to how many Accident and Emergency Departments will close in London hospitals over the next four years.  I also wanted to know who would take the strategic decisions for London as a whole and how they were accountable for those decisions.

Needless to say, I didn’t get a proper answer.

This was my exchange with the Minister:

Lord Harris of Haringey:My Lords, how many accident and emergency departments in London does the Minister expect to close in the next four years? If he does not know the answer, can he say who is responsible for that and how they are accountable for making a strategic judgment across London about the level of accident and emergency services?

Earl Howe:The premise behind the noble Lord’s question is that it is automatically worse to have fewer A and E departments in an area. I beg to disagree with that premise. In serious or complex cases, the noble Lord will know that patients need to access exactly the right care, so it is often better and safer for them to travel further to see specialists in major centres than to go to a local hospital. Although it may be closer, it may not have the right specialists, the right equipment or sufficient expertise in treating patients with their condition. The prime example of that has been stroke care in London, where 32 centres were reduced to, I think, eight and there has been a dramatic reduction in the number of deaths following admission.”

My colleague Baroness Janet Whittaker tried again a minute later:

Baroness Whitaker:My Lords, in the noble Earl’s answer to my noble friend Lord Harris, I did not hear an answer to any of his questions about numbers, who makes the decision and who is accountable. Would it be possible to hear that?

Earl Howe:My Lords, I apologise. The Question on the Order Paper relates to north-west London, so I do not have pan-London figures in front of me. The answer to the question is as I gave it in my initial response: those decisions are subject to local determination. That is right, because it is only local commissioners and providers who can assess the situation on the ground properly. As the noble Baroness will be aware, there is a system for escalating decisions—ultimately to the Secretary of State, if necessary, who takes advice from the Independent Reconfiguration Panel in the most extreme cases—but normally, we hope and expect those decisions to be resolved on the ground in the local area.”

So the Minister acknowledged that there would be a series of closures of A&E Departments in London, but couldn’t say how many there would be because he didn’t have the “pan-London figures” in front of him.  And, as all the decisions would be “subject to local determination” presumably as a result of the accumulated, but separate, individual commissioning decisions by local Clinical Commissioning Groups (whose less than satisfactory governance was debated last week), by implication there will be nobody who will take a strategic pan-London view of the level and distribution of Accident and Emergency Services in the capital.

Doesn’t inspire confidence……

Oct 17,2012

My colleague Lord Philip Hunt reported on the Labour Lords Blog that the new governance arrangements for the new Clinical Commissioning Groups (CCGs) through which most local NHS money will be channelled are odd in the extreme, saying:

“A massive £60bn is to be entrusted to them despite very weak accountability and corporate governance structures supporting what are essentially a federation of GPs. Only two lay members will serve on the Board of each CCG so they will always be outnumbered by GPs who will have little or any accountability to the public. This is even more perverse given that the CCGs may make funding decisions which are advantageous to GPs.

Bizarrely, although the regulations we are debating in the Lords allow for a hospital doctor and a registered nurse to be appointed to the CCG Board, those employed by a local hospital are not. This is apparently because it would be a conflict of interest!”

Last night’s debate in the Lords on the Government regulations setting out how CCGs are to operate showed up the sheer absurdity of the arrangements and the normally-sensible Minister, Earl Howe, tied himself in knots trying to explain why certain categories of person were to be excluded from the Boards of CCGs and why it would NOT be a conflict of interest for GPs on the Boards to so arrange local services so that their practices benefitted.

I rather lost my temper when it was suggested by former Tory Health Minister, Baroness Cumberlege, that local councillors should in all cases be excluded from CCG Boards on the grounds that they would be incapable of making difficult decisions affecting their electorates (what does she think local councillors are having to do at the moment given the budget cuts that the Government has imposed on them?).

However, the debate also highlighted the absurdity of the Government’s proposals which would prevent someone being appointed to be a “lay member” of a CCG Board if they were employed by a local authority anywhere in the country; or – even more bizarrely – prevented someone who is a member (not even a governor) of a local NHS Trust, when in some areas every person who uses the local hospital is automatically enrolled as a member of the Trust!

You can read the full debate here and my rant was as follows:

“In this debate we are perhaps being asked to suspend our disbelief that the governance arrangements for the clinical commissioning groups make sense. We are being asked to suspend our belief on the question of whether pigs may fly. However, the extraordinary statement from the noble Baroness, Lady Cumberlege, that somehow locally elected councillors are incapable of making decisions which affect the livelihoods of the populations that elect them is disgraceful.

Baroness Cumberlege: My Lords, I object to that. I said that they have a role on health and well-being boards, which is where the strategy is set out, and that is where the NHS, local authorities, Healthwatch and other organisations come together.

Lord Harris of Haringey: I understand that. My point is that the noble Baroness does not seem to understand that today, all over the country, locally elected councillors are making decisions about closures because they are having to balance the reductions in budgets that this Government are forcing on them and on their local communities. They are making those decisions on behalf of the people whom they represent. Why is it being said that somehow they have a conflict of interest which means that they are incapable of making decisions along with colleagues about health matters?

There are issues of principle here and issues of sheer practicality. The issue of principle concerns conflict of interest. The noble Baroness, Lady Cumberlege, has talked about conflict of interest. Perhaps we will also hear about that from the noble Earl in a minute. However, the biggest conflict of interest will be the fact that the primary care practitioners are key elements of the boards of CCGs’ governing bodies. They are not being excluded; it is just everyone else who is being excluded. Let us be clear about who is being excluded. It is not simply elected members but any employee not just of the local authority in the CCG’s area but of any local authority in the country. Therefore, any person who, under paragraph (4) of Regulation 12, the CCG feels has knowledge about the area and who does not have the misfortune of being an elected councillor but does have the misfortune of being a part-time employee of a neighbouring local authority is exempt.

When the Minister replies, I should like him to explain to us why every single employee of every single local authority in the country is being excluded from participation in CCGs. While he is about it and we are talking about conflicts of interest, we have already heard the point made by my noble friend Lord Hunt of Kings Heath that any person who has been public-spirited enough to decide to become-and frankly it is a fairly meaningless undertaking-a member of a local foundation trust or a local NHS trust is also excluded from membership of a CCG. Again, what is the point of that? It is being said that any person who is public-spirited enough already to have had some engagement with the local NHS is not allowed to sit on the board of the CCG.

This is frankly fatuous. You have ended up with a situation in which you have enshrined one set of conflicts of interest and excluded from the membership of the CCG all sorts of other people who could make a valuable and useful contribution. I am afraid that for the first time in our considerations I agree with 99% of what the noble Baroness, Lady Jolly, said. The 1% with which I disagreed was that we should allow this instrument to go through and review it again in two years’ time. It is so flawed and riddled with poorly thought-out considerations of what would work at local level, and so dismissive of the best judgment of local people to decide who is best to be part of the board, that frankly we should endorse my noble friend’s Motion. I urge the Minister to withdraw the regulations and bring forward revised, more sensible regulations.”


Oct 11,2012

I went along to the so-called “People’s Launch” of Healthwatch this morning.  This followed on from the presumably rather more select official launch of Healthwatch England that happened ten days ago. It took place about three floors underground with a couple of hundred local health activists packed into a low-ceilinged rather-too-small room to hear Norman Lamb MP, the (LibDem) Minister of State for Care Services, and Anna Bradley, the newly-appointed Chair of Healthwatch England, set out their vision of how Healthwatch will work.

What they said was positive and they are clearly keen for Healthwatch England (and, when they are formally established next Spring, for local Healthwatch organisations) to be effective in articulating the voices of the users of health and social care services.

The assiduous reader of this blog (you know who you are) will be aware that I have been critical of the way in which, during the passage of the Health and Social Care Bill through Parliament, the Government watered down the arrangements for Healthwatch and essentially facilitated the privatisation of patient representation and failed to ensure that Healthwatch England was genuinely independent.

Those battles were lost in the House of Lords, when – as always happened on key votes on the Health and Social Care Bill the LibDem peers voted en masse with their Conservative colleagues.

Two further big elephants remain in the room.  The first is the extent to which local Healthwatch organisations will feel ownership of their national organisation, Healthwatch England.  The regulations formalising the governance of Healthwatch England have yet to be confirmed by Parliament and they are being prayed against by the Opposition (the procedure that precipitates a debate and potentially a vote on a statutory instrument) later this month.  Anna Bradley was keen to say (in response to my question) that it should not be a matter of ownership, either by local Healthwatch organisations in respect of the national body or vice versa.  However, with Healthwatch England being formally a sub-committee of the Care Quality Commission it will remain the case that local Healthwatch organisations are going to feel that the national organisation is a top-down construct unless that have a substantial or majority stake in its governance.

The second elephant in the room is the budgets that will be available for local Healthwatch organisations.  The money for these is being passed from the Department of the Health to the Department of Communities and Local Government who will then parcel it out to individual local authorities who are responsible for ensuring that local Healthwatch organisations exist in their areas.  (Incidentally, these are the same local authorities which are responsible for the social care provision that local Healthwatch will be supposed to be monitoring – no potential conflict of interest there then.)

These monies are not going to be ring-fenced and there is no guarantee that all of the money provided will be made available for the local Healthwatch bodies (or even that it will be transparent as to how much was passed to the local council concerned).  Norman Lamb (again in response to a question from me) lauded the principle of localism but was silent about how the Government would ensure that sufficient was passed on locally to deliver the high expectations that he had set in his earlier speech.  He did, hower, report that he had increased the amount of money that is notionally being passed across to Eric Pickles’ Department for local Healthwatch.  I asked him to look at the issue again …..


Jul 2,2012

The Department of Health has recently announced a list of Non-Executive Members of the National Health Service Commissioning Board, the biggest quango in Europe through which most of the money going to the NHS passes.

And – in their wisdom (that’s meant to be irony) they have appointed Mr Naguib Kheraj, the current Vice Chairman of Barclays Bank plc. More significantly he was Finance Director of the Bank until 2007 – so he was in charge of the finances of the Bank when the attempted fixing of the LIBOR market was going on.

Just the sort of person we can have confidence in to oversee the running of our National Health Service.

Only this Government ……


Nahuib Kheraj

Jun 29,2012

I have just finished reading the book by my Lords’ colleague, David Lipsey, “In the Corridors of Power“.  It is a great read: lucid and clear as you would expect from someone with his journalistic pedigree and full of crisp insightful comments on the policy issues of the last forty years with which he has engaged.

His account of working for a trade union in the 1970s and then being one of the first SpAds (long before the term was coined) is hugely enjoyable, as are his portraits of Tony Crosland, Roy Jenkins, Jim Callaghan and the other figures that he has worked with.

The book is also a must read for those who want to understand the realities of being a member of the House of Lords and the limits to what you can achieve.  It is also a concise primer on House of Lords reform, changing the voting system, the finance of social care and many other topics from the funding of the BBC to the politics of greyhound racing.

Buy it and enjoy!


Mar 16,2012

Just over a month ago the Government yet again snubbed the Mayor of London over his proposals for a pilot sobriety scheme, whereby the courts could impose on offenders, whose offences were alcohol-related, a requirement that they be compulsorily tested for alcohol daily for a three months period with a positive test meaning arrest and appearance again in court.

But now – either because they have finally listened to the overwhelming force of arguments coming from all corners of the House of Lords or because they want to provide a helpful headline to the Mayor prior to the Mayoral elections in seven weeks time – the Government has performed an 180° u-turn. They have now tabled an amendment to the Legal Aid, Sentencing and Punishment of Offenders Bill that will enable the courts to impose sobriety orders as part of a suspended or community sentence.

Offenders would have to wear ankle tags that continuously monitor alcohol levels, for up to four months.  The orders would allow alcohol levels to be monitored either by these tags which test sobriety every half hour, or by requiring offenders to attend a police station daily – or at other regular intervals – to be breathalysed.

Of course, the other advantage from the Government’s point of view is that it saves a lengthy debate on a Bill that is already taking much more time to progress through its various stages in the House than expected.  And what is more it avoids the certainty of another defeat for the Government to add to the nine they have already had on the Bill so far in the Lords.

It is really a case of Healey’s Law: when in a hole, stop digging.

Mar 13,2012

In the House of Lords this afternoon, the Labour Leader, Baroness Jan Royall, asked a Private Notice Question of the Department of Health Minister, Earl Howe, about whether the Government would now publish their risk register on the Health and Social Care Bill given that the ruling of the Information Commissioner has now been upheld by the Information Tribunal.

The Government made it clear that they are waiting to see the detailed reasons from the Information Tribunal so that they could decide whether to appeal further.  So the implication is that they will not comply with the ruling before the Bill completes its passage through the House of Lords next Monday.

The exchanges showed seven Labour Peers (Baroness Jan Royall, Lord Charlie Falconer, myself, Lord Dale Campbell-Savours, Lord Bob Hughes, Lord Bruce Grocott, and Lord Maurice Peston) pressing the Government to publish.  There was silence from the Cross-benches, a supportive question from Tory Lord Deben (aka John Gummer) and a nice easy question from LibDem Lord Marks of Henley-on-Thames.

Here are the full exchanges:


Health and Social Care Bill

Private Notice Question

3.07 pm

Asked By

To ask Her Majesty’s Government, in light of the decision of the information tribunal last week, whether they will publish the risk register associated with the Health and Social Care Bill before that Bill completes its Report stage in this House.

Baroness Royall of Blaisdon:My Lords, I beg leave to ask a Question of which I have given private notice.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe):My Lords, the tribunal has agreed that the department should not publish its strategic risk register but has upheld the Information Commissioner’s initial decision notice on the transition risk register. However, we await the full judgment, which will contain the detailed reasoning for the decision. This makes it extremely difficult to make a decision on whether the Government wish to appeal this decision. I hope very much that the tribunal will give its full judgment as soon as possible.

Baroness Royall of Blaisdon:My Lords, the primary purpose of this House is to scrutinise and improve legislation. I know that the Minister would agree with me on that. In the next 10 days, Parliament has to make critical decisions about the future of the National Health Service. Without the information in the risk register or the transitional risk register, Parliament will be less well informed than it otherwise would be. The information tribunal last week instructed the Government to release the transitional risk register immediately, as I understand it, because the Bill is still under consideration. Why are the Government therefore preventing Parliament from having the best possible information on the NHS so that it can make the best possible decisions about the NHS?

Earl Howe:My Lords, many of the risks associated with the Government’s reform programme, as the noble Baroness knows, have already been extensively aired—not least in the impact assessment, in my statement of 28 November last and, indeed, in the whole passage of this Bill—but I fully recognise the concern that we should respond swiftly to the tribunal’s decision. We are making every effort to update noble Lords on our intention as soon as we possibly can. However, as I have always said, this is not a decision for the department alone and any way forward has to be agreed and signed off across Government. I cannot make a decision without agreeing it with my fellow Ministers in other departments and I am sure noble Lords will appreciate that we have only just received the tribunal’s decision.

Lord Falconer of Thoroton:My Lords, I am dismayed by the Minister’s answer. Surely it must be the case that Parliament would be assisted by seeing the objective assessment of what the risks are to the National Health Service from the Bill becoming law. I understand that he is saying that the Government have already said what many of them are, but if that is the case then what is the harm in disclosing the list of risks that the objective assessment by civil servants gives of the introduction of the Bill? Surely Parliament would be assisted by having as much information as possible. It cannot be the fault of the information tribunal that we are getting no answer at all from the Department of Health.

Earl Howe:My Lords, no Government have routinely made risk registers available. This is a matter of principle. It is not just that the issues associated with the Health and Social Care Bill have been extensively aired—as I said, they have been—but it is a point of principle whether a risk register that is integral to the formulation of policy should be published.

The tribunal agreed with our assertion that the strategic risk register should not be published but disagreed when it came to the transition risk register. Our difficulty is that the case that we made for both documents, which are of a similar structure and have similar content, was based on essentially the same arguments, which makes it extremely difficult to make a decision on whether or not to appeal the decision. I hope, as I say, that the tribunal will give its reasons for the judgment as soon as possible so that we can determine the right way forward.

Lord Harris of Haringey:My Lords, surely this is not about the routine publication of risk registers but about the publication of a risk register for a specific Bill in front of your Lordships’ House and Parliament that is causing extreme concern in the country. Why is it not possible on an exceptional basis? I believe that no less a person than Simon Hughes—if such a thing were possible—has advocated to the Government that the risk register should be put into the public domain so that Parliament can look at the implications properly.

Earl Howe:My Lords, I beg to differ with the noble Lord; this is an issue about routine release. I think I am right in saying that the department has received several dozen requests to release the risk register. If this were to become routine, as some people appear to wish it to become, policy formulation in any department would become virtually impossible.

Lord Deben:Does my noble friend agree that a number of the laws passed by the previous Government were also controversial? Can he point to occasions on which the risk register was released in those circumstances?

Earl Howe:I am grateful to my noble friend because I do not believe that there were any. The Opposition sometimes point to the risk register relating to the third runway at Heathrow, but the key difference with that was that it was to do with policy implementation rather than policy formulation. Once you know what you want to do, there are risks associated with rolling a policy out. It is a very different matter when civil servants wish to have safe space to think the unthinkable and then advise Ministers.

Lord Campbell-Savours:Does the Minister intend to delay the Third Reading of the Bill?

Earl Howe:We have a Motion before us in the name of the noble Lord, Lord Owen. That question will be addressed then.

Lord Hughes of Woodside:My Lords, the Minister said that the details of the risks had been well canvassed in this House. If that is the case then in the absence of proper information, with the best will in the world, the discussions must be based on hearsay. That cannot be the right way to go about discussing business.

Earl Howe:My Lords, I think back to numerous debates that we have had in this House, which of course are recorded in Hansard. Many of the risks that I articulated on 28 November last have been gone through by your Lordships almost ad nauseam.

Lord Marks of Henley-on-Thames:What steps have been taken to draw to the attention of the tribunal the urgency of receiving the reasons for this decision, bearing in mind the imminence of Third Reading?

Earl Howe:I have personally seen to it that the tribunal has been made aware of the urgency of releasing its reasons, and it has acknowledged that urgency.

Lord Grocott:Presumably, part of the need for urgency is the Government’s scheduling of the Third Reading of the Bill. I know that we are close to the end of an unprecedentedly long Session of Parliament but it would be an intolerable situation if the information were finally published after the Bill had become an Act and the information were then judged to have been such that many Members who had voted in favour of Third Reading would regret it within weeks. Surely the very least that the Government could do is to postpone the Third Reading debate until the last possible date before the end of the Session.

Earl Howe:My Lords, I am the first to acknowledge the concern among noble Lords to be fully and properly informed about the risks associated with the Health and Social Care Bill. As I say, we have done as much as we can to implement that intent without transgressing what we still see as a point of principle regarding risk registers. My answer to the noble Lord is that I do not believe it is necessary to postpone Third Reading but we clearly have to debate the Motion in the name of the noble Lord, Lord Owen. At that point, the House will decide whether it is content to give the Bill further consideration.

Lord Peston:Can we go back to first principles, which the noble Earl raised? I speak as someone who has been an adviser. Is he saying that officials would not give their honest view of the risks that policies might incur if their advice was made public? If you believe in open government—certainly, if you believe as an official that your duty is to advise Ministers as best you can and, therefore, you will outline the risks—is that not altogether a good thing? It is not a principle that the Government ought to espouse, rather than say that they do not want to go down that path?

Earl Howe:My Lords, civil servants may not wish to put in jeopardy a policy that they are working on by using language that could be—indeed, is certain to be—misinterpreted or sensationalised, or that could cause embarrassment if exposed to the public gaze. Without full candour, risk registers across government would become bland and anodyne. Effectively, they would cease to be of practical value. That is the fear that has been expressed across government.