Risks? What risks?
Andrew Lansley and the Department of Health (DoH) have been fighting to prevent the publication of an internal analysis carried out by the DoH into the potential risks associated with implementing his reforms. The struggle has lasted over a year since the first requests for information were made, and is still ongoing. The DoH is appealing against a decision by the Information Commissioner, Christopher Graham, ordering it to disclose the report.
The document, known as a Strategic Risk Register, could be highly sensitive as it evaluates the potential risks of the government’s proposed NHS reforms, covering financial risk as well as patient safety.
However, due to the department’s appeal, it may not be released before the Bill is passed in Parliament. This would deny the House of Lords the chance to read a highly influential report before they have their last opportunity to make major amendments to the legislation.
This has led to urgent calls from MPs, professional health bodies, and unions – demanding that the risk register be published before the Report Stage has finished, so that the Lords can properly assess the risks posed by the legislation before amending it.
The issue has become so prominent that the shadow health secretary, Andy Burnham, has tabled a debate and vote in the House of Commons on the 22nd February calling for the risk register to be made public.
Before that, the Labour MP Grahame Morris began an Early Day Motion on the 30th January calling for the risk register to be released before the Bill reaches report stage in the House of Lords. The motion had already gathered 50 signatures after its first week.
The British Medical Association, Royal College of Nursing, and Academy of Medical Royal Colleges made a joint appeal in January for the DoH to publish the risk register, and Unison – which represents hundreds of thousands of health workers – added its voice to the calls for publication.
Damaging assessment
There are some possible indications for why Mr Lansley is so reluctant to publish the reports, as some leaked elements of the risk register are said to paint a damning picture of the affect his reforms will have on the health service. The Green Benches blog by Dr Eoin Clarke carries segments which are said to have come from the risk register, and his assessment is
'The chief warning in the report is that Lansley's reforms will spark a surge in health care costs and that the NHS will become unaffordable as private profiteers siphon off money for their own benefit. The report specifically warns that GPs have no experience or skills to manage costs effectively.'
The issue of costs is also raised in the NHS London’s Risk Assessment, which was published on its website, and warned that the reforms could lead to the financial ‘failure’ of some NHS organisations, worse care for patients, and threats to maternity services, children's safety and public health.
Interestingly, these are the kinds of regional assessments which were sent to the Department of Health to make up Strategic Risk Register, which the department is unwilling to publish. Certainly, if that report came to similar conclusions, Andrew Lansley’s reluctance would be understandable.
Battle for publication
This battle over publication is due the DoH’s failure to comply with two separate Freedom of Information (FOI) requests, one by the Labour MP John Healy, and the other by the London Evening Standard, which asked whether any risk assessment of the proposed health reforms had been carried out by the department.
The department did not respond, and therefore on the 2nd November 2011 the Information Commissioner ordered Andrew Lansley to disclose the risk register. It is unusual for such reports to be made public, but in ordering disclosure, Christopher Graham stated that
'the factors are finely balanced in this case, but the considerable public interest in disclosure means that the information should be disclosed’.
The request by the Evening Standard had been sat on by the department for twelve months, since it was made in November 2010, until the DoH was ordered to comply. The department’s argument against complying with the FOI request was that the register’s publication would jeopardise its ability to manage the transition and modernisation of the NHS, which would be detrimental to the totality of the policy, thereby risking the implementation of government policy and taxpayers’ money.’
Andrew Lansley subsequently appealed against the decision, and therefore the matter was put before the Information Tribunal, where on the 13 January 2012 the appeal was allowed to proceed. The hearing has been brought forward to the 5 and 6 of March – which is at the end of the Health and Social Care Bill’s progress through Report Stage in the House of Lords, which will began on the 8 February and will last until March.
Clearly this does not allow the Lords much time to digest the contents of the Strategic Risk Register - if they see it at all - which is why calls for it to be published quickly have grown from all sides.
