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Guest editorial Monday 12 March 2012: Liberating the Risk Register - it's all about 'freedom, fairness and responsibility'

Publish Date/Time: 
03/12/2012 - 19:58

Today's guest editorial comes from health policy and strategy consultant Joe Farrington-Douglas, former health policy special advisor to shadow health secretary John Healey MP.

On Friday, the Courts dismissed the Government's attempt to keep the NHS reform risk register secret, but the Department of Health has already said it will delay its response until after the Health Bill has been passed by Parliament.

It is time for the Prime Minister and Deputy Prime Minister to overrule the Health Secretary and live up to the rhetoric on the NHS and on openness.


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Risk has been at the heart of concerns about the Government's NHS plans from the start.

In the summer and autumn of 2010, before the media spotted the political storm brewing, health staff and NHS experts began to sound the alarm about the Government's big gamble with our health service.

But in its haste and hubris the risks were ignored, concerns were hidden and implementation was accelerated with scant lip-service to engagement, consultation and Parliamentary debate.

Register my risk!
It was at this point that John Healey made his request for the Government to publish its own assessment of the risks - to expose the dangers and to put pressure on them to think again about the scale, cost and likely damage to patient care.

15 months later, the Information Rights Tribunal has upheld this request, and ordered the risks to be revealed. At this eleventh hour, this ruling should be honoured to allow Parliament and voters to make up their minds before it is too late.

With the ink still wet on the Coalition Agreement promising no top-down reorganisation of the NHS, within two months David Cameron and Nick Clegg put their names to 'Equity And Excellence: Liberating The NHS', the White Paper initiating upheaval of all aspects of the health service.

The plan broke with the incremental Labour reforms by overturning commissioning, provision and regulation structures simultaneously. Their changes were without mandate, but they were also without evidence - of the capacity of GPs to do complex strategic commissioning; of the implications of commercial competition law for local health economies; or the of impact of private cherry-picking on NHS hospitals.

While many of the Royal Colleges and other experts and stakeholders welcomed the White Paper's warm words about quality, staff empowerment and patient choice, it was only when they saw the detail that the scale of the risks began to be understood.

Worse still, the bureaucratic reshuffle comes at the same time as the NHS was being asked to make unprecedented efficiency savings. Even the NHS Chief Executive Sir David Nicholson, asked to stay on the bridge to steer the NHS through these troubled times, conceded that the risks of not achieving the savings were made greater by the administrative distraction of reorganisation.

Both the Public Accounts Committee and Health Select Committees of the House of Commons have echoed this concern.

In autumn 2010, and ever since, the Government has been warned about these risks. But all along, they have ignored these warnings and pressed full steam ahead.

The Government's response to concerns about GP capacity to do commissioning was to accelerate implementation across 90 percent of the country in three months. As competition fears were raised, another £1 billion worth of services were pushed out to any qualified provider.

As the November 2010 Command Paper promised, "some will oppose our plans, but the Government will maintain constancy of purpose in adhering to our vision and plans". Since then, despite the pause and a cascade of complex and contradictory amendments, "some" has become almost all, as Labour's isolated opposition in Autumn 2010 grown into a growing chorus of concern and almost unanimous professional call to drop the Bill today.

Whipping Parliament (without even charging extra), with GOD on our side
That is why we are in the extraordinary position today of a Government in defiance of the Courts, whipping Parliament to nod through blindly a Bill that sends the NHS into chaos.

GOD himself; AKA the former Cabinet Secretary Lord Gus O'Donnell, was made to issue a threat about the effect on civil servant's honesty if risk registers are routinely published.

Yet surely a well-run Government would have nothing to fear from the Information tribunal's ruling? It would no more set a precedent any more than the release of the Heathrow expansion risk register did in 2008.

Indeed the Government's own policy ion communicating risk seems to strongly support the case for release.

Last week's was an extraordinary judgement based on an extraordinary case study of poor policy-making, implementation-planning and communication by a Government that refused to listen, ignored consultation and was cavalier about risks.

The Tribunal was told last week by the Department of Health that no assessment was made about the risks of the reorganisation until late October 2010, three months after the White Paper and after the Bill had already been largely written.

The one-sided, evidence cherry-picking impact assessments published with the Bill were written off as not fit-for-purpose by the Government's own Regulatory Policy Committee.

Far from interfering with the timely consideration of policy risks and options, publication of the risk register is likely show civil servants scrambling to mitigate their Ministers' recklessness - or desperately trying to persuade politicians to change course.

Prime Minister David Cameron and Deputy Prime Minister Nick Clegg promised to protect the NHS. They promised open Government. Before the guillotine finally comes down on Parliament's consideration of their reckless Health Bill, it is time to deliver.