Government Policy on Health

Commons Urgent Question

The following Answer to an Urgent Question was given in the House of Commons on Monday 9 September.

“Unlike our predecessors, this Government cannot get enough of experts. We work with a wide range of stakeholders in developing policy, because that goes to the heart of our approach to mission-driven government. But I think the shadow Secretary of State was referring specifically to the right honourable Alan Milburn, so let me address him specifically. I walked into the Department of Health and Social Care on 5 July to be confronted with the worst crisis in the history of the National Health Service: waiting lists at 7.6 million, more than a million patients a month waiting four weeks for a GP appointment—if they could get one at all—the junior doctors still in dispute and on strike, and dental deserts across huge parts of our country, where people cannot get an NHS dentist for love nor money.

This Government are honest about the scale of the crisis and serious about fixing it, which means that we need the best available advice—it is all hands on deck to fix the mess that the previous Government left. If a single patient waited longer for treatment than they needed because I had failed to ask for the most expert advice around, I would consider that a betrayal of patients’ interests. I decide whom I hear from in meetings, I decide whose advice I seek, and I decide what to share with them. I also welcome challenge and alternative perspectives and experience.

The right honourable Alan Milburn is a former Member of this House, a member of the Privy Council and a former Health Secretary. He does not have a pass to the department and, at every departmental meeting he has attended, he has been present at the request of Ministers. During Alan’s time in office, he gave patients the choice over where they are treated and who treats them, as well as making sure that the NHS was properly transparent, so that all patients were able to make an informed choice—a basic right that we expect in all other walks of life but which only the wealthy and well connected were able to exercise in healthcare until Alan changed it. He gave patients access to the fastest, most effective treatment available on NHS terms, so that faster treatment was no longer just for those who could afford private healthcare. He made the tough reforms that drove better performance across the NHS and, along with every other Labour Health Secretary, delivered the shortest waiting times and the highest patient satisfaction in the history of the NHS. That is his record and Labour’s record, and it is the kind of experience that I want around the table as we write the reform agenda that will lift the NHS out of the worst crisis in its history, get it back on its feet, and make it fit for the future once again”.

My Lords, the Minister will know that there have been concerns over Labour’s appointment of donors and party apparatchiks with little or no experience to senior Civil Service positions, which have led the Civil Service regulator to launch a review into Labour appointments.

I accept that this case is different. We understand that the Secretary of State is new to the role and inexperienced. We also know that Alan Milburn brings a huge wealth of experience in healthcare both in government and from personal consultancy, advising one of the largest providers of residential care for older people. I have also seen reports that he is a senior adviser on health for a major consultancy firm. I want to be clear, this is valuable experience and I applaud the Government for seeking such experience in the same way that noble Lords welcomed the appointment of the noble Lord, Lord Robertson, to review defence capabilities.

However, I am sure the Minister will also recognise the issue of real or perceived conflicts of interest—something that Labour Peers rightly questioned Ministers on when we were in government. So, in that spirit, I will ask the Minister a few questions about how the Government can look at potential perceived conflicts of interest and how they will be managed. Given Mr Milburn’s consultancy interests, can the Minister tell us what his formal role is? Is it a paid role and, if so, how much does he earn? Which meetings does he attend? Does he attend meetings without Ministers being present? Are notes taken for these meetings? How do the department and the Government ensure that he does not have access to commercially sensitive documents that could be of interest to his clients?

If the Minister cannot answer all these questions, I ask her to write to me and other noble Lords with answers and place a copy in the Library. Let me be clear, I completely understand why the Secretary of State appointed Mr Milburn—due to his experience in government and the private sector. It is valuable experience, from which a new Government could learn. I hope the Minister will accept my questions in the spirit of ensuring that the conflicts of interest are managed and there is real accountability, so that the Government can get the best out of Mr Milburn in his new role.

Before the Minister responds, I make it clear that these should be questions, not speeches.

My Lords, to set out some key points in respect of the right honourable Alan Milburn, he has no formal role in the department. Therefore, the conflicts of interest the noble Lord referred to do not even arise. The main thing I would like to set out is that it is very important to make a distinction between the areas of business and meetings in the department about generating ideas and policy discussion—it is those in which Mr Milburn has been involved, at the request of the Secretary of State—and the very different meetings about taking government decisions. If I might summarise it for your Lordships’ House: Ministers decide, advisers advise.

My Lords, I declare a certain puzzlement at this Question. I recall, when the Conservatives were in office, reading regularly on the front page of the Times that donors had been talking to the Prime Minister or various Cabinet Ministers about government policy and expressing strong views on which direction they should take in various areas. As an academic, I am also well aware of the extent to which expertise comes into government through informal channels.

On one now famous occasion, which was not reported at the time, a number of experts on the Soviet Union whom I knew well were invited by Margaret Thatcher to an informal seminar in No. 10 to advise on whether the Foreign Office or Margaret Thatcher’s advisers were correct in their attitude to the Soviet Union. A number of the academics suggested that the Third Secretary of the Communist Party, then a man called Gorbachev, was a good person to get to know. Mrs Thatcher took their advice rather than that of her advisers and it had a remarkably positive impact on British foreign policy. Do the Government accept that all informal contact with outside experts is desirable and that it is a good thing, where possible, that it should be reported?

It is right that people from outside government come into departments to lend their expertise and share their views and that Ministers make decisions without those people involved. That was the line I was trying to draw. The Secretary of State for Health is very fortunate to be able to turn to every living former Labour Health Secretary, from the right honourable Alan Milburn through to my noble friend Lord Reid, Andy Burnham and many others, because all of them have offered to roll their sleeves up and assist us. Perhaps I could remind your Lordships’ House that, between them, they delivered the shortest waiting times and highest patient satisfaction in the history of the National Health Service. I hope that we will be able to do justice to their experience.

My Lords, does the Minister agree that this is very different, because the Minister is taking advice from people with huge experience, and it is open and above board? This is unlike when Boris Johnson was Prime Minister, and his wife Carrie Johnson apparently made a number of decisions, including the appointment of Ministers. Was that not something we ought to be worried about, rather than this open and sensible arrangement we have now?

My noble friend makes an important distinction, and I would certainly share that view. It is worth reminding your Lordships’ House that ministerial meetings that are attended by third parties are declared in a quarterly transparency publication in the established way. Of course, this will be done. I can tell your Lordships’ House that I had a meeting with the right honourable Alan Milburn, and it was very useful.

My Lords, I should declare an interest because I was on the Times Health Commission. We took evidence from a wide range of people, including the person mentioned. Can the Minister provide assurances that, whenever people are consulted, they are routinely asked to declare their interests; that any declaration of interest is repeated not only at the first meeting but whenever other people are present so that it is well known; that the consultation goes widely; and that there is no overreliance on a small number of people? We at the Times Health Commission found that, by consulting widely, we were able to hear very conflicting views, which was helpful and formative.

I thank the noble Baroness for sharing her experience of consulting widely. It is certainly entirely legitimate for government departments to do just that. However, those who do not have a formal role are not required to declare interests; it is different for those who have a formal role. Requiring them to do so would mean, for example, us sending forms in advance to Cancer Research UK before it comes in to talk to us about cancer and to assist us. Would we want that? We would not. Of course, where there is a formal role, we absolutely do that.

It is probably worth saying that a particularly high-profile invitation went from the Secretary of State to the noble Lord, Lord Darzi. He will report shortly on the true state of the National Health Service. He does not have a specific role in the department but he has been invited by the Secretary of State to assist; I believe that he will assist both your Lordships’ House and the other place.

My Lords, when the Green Party consults on health policy, among the organisations it consults are the Socialist Health Association, Keep Our NHS Public and 999 Call for the NHS—all organisations that are greatly concerned about the continuing privatisation of the NHS. Can the Minister tell me whether the Secretary of State or she herself have had meetings with any of those three organisations since coming into government?

I cannot answer that, I am afraid. I would be very happy to look at it for the noble Baroness.

Although I understand completely the role of advisers—obviously Alan Milburn is a very reputable adviser—where is the line? My concern is that, when an adviser has a pass, has been in meetings without Ministers present and has perhaps directed civil servants in those meetings, a line has perhaps been crossed. I would welcome assurances from the Minister that this has not occurred and that there have not been any meetings where Alan Milburn has been there without Ministers—in effect, directing policy with no formal role.

The right honourable Alan Milburn has not been directing policy; he also has no pass. I hope that is helpful to the noble Lord.