NHS Risk Register

Debate between Ben Gummer and John Healey

Wednesday 22nd February 2012 Commons Chamber

[John Healey]

I do not think that the Minister was listening to the point that I just made: on the Freedom of Information Act, the decisions that Ministers make—I hope—as we did, and the decisions that the Information Commissioner would make on a challenge, depend on the specific information and, in this case, the risk register at stake. This case is unprecedented and exceptional and the Information Commissioner has come to this view because we are faced with such huge upheaval. It involves the biggest reorganisation and the longest legislation, at a time of the tightest financial squeeze for 50 years. Furthermore, this reorganisation was explicitly ruled out in the Conservative manifesto and in the coalition agreement. That is why, less than two months later, the huge upheaval of the White Paper was so unexpected, and why the NHS and the civil service were so unprepared for what they are now being forced to implement.

[Ben Gummer]

rose—

[John Healey]

I will not give way again; I have given way twice. The hon. Gentleman has spoken and has not been here for the whole debate.

Risk has been at the heart of the concern about the NHS reforms right from the outset. When I led an Opposition day debate from the Dispatch Box in November 2010, I described the reorganisation as

“high cost and high risk; it is untested and unnecessary.”—[Official Report, 17 November 2010; Vol. 518, c. 908.]

The lack of evidence and lack of confidence in how well the Government were prepared to manage the risks was the major cause of the growing concern among the public and professionals and in Parliament in the late autumn of 2010 and the winter of 2011. That alarm has only grown. It was first expressed by the all-party Select Committee report of December 2010, and reiterated in its January 2011 report, which concluded:

“The Nicholson challenge was already a high-risk strategy and the White Paper increased the level of risk considerably without setting out a credible plan for mitigating that risk.”

Not only is this reorganisation unprecedented and therefore exceptional; the NHS as an institution is exceptional. We all need the NHS. We trust it when we are most fearful, and we utterly depend on it when we are most vulnerable. That is why it matters so much to people, and why there is an unprecedented and exceptional level of public interest in any changes to the NHS and especially any risks to the NHS. The plans are unprecedented in their nature, their scale, their pace and their timing. That means that there is exceptional concern over the risks associated with their implementation. That is why there is an exceptional case for releasing this transition risk register. The Information Commissioner has had the benefit of assessing the risk register, and he has stated:

“There is a very strong public interest in disclosure of the information, given the significant change to the structure of the health service”.

There are two other factors that reinforce the case for, and the public interest in, the publication of the transition risk register. First, the story of this reform is a masterclass in poor policy making. It has been misjudged and mishandled from the outset. Good policy making normally involves policy consultation, followed by legislation and implementation. The Government have turned that on its head. First, we had implementation ahead of any legislation, followed by a forced pause to consult on the policies when they encountered so much resistance. That all adds to the risks and to the public interest in and the case for the disclosure of the risk register.

The Department of Health has a poor track record on risk assessment, on the use of evidence in policy making and on policy delivery. When the Cabinet Secretary did his first capability review of the Department, he concluded:

“Management of risk across the delivery chain is weak. There is no formal linkage between risk registers and mitigation strategies held by the Department and those in the delivery chain.”

Two years later, when the capability review was repeated, many of the same problems still applied, and the Department was again flagged in the review as at an amber state of concern—[Interruption.] Yes, that was under the previous Government. My point is that the Department of Health has a poor track record on planning and dealing with management risk, which is why it is so important to publish the risk register.

Clearly, in a short debate such as this, we cannot nail all the arguments that the Government are trying to put up. Suffice it to say that the Information Commissioner has heard them and has judged that the register should be released. The arguments will be tested in court on 5 and 6 March at the Information Tribunal and I shall give evidence to that tribunal. All I am asking for—and all the motion is asking for—is what the Government have promised. Today, on the Treasury website, one can see the Government’s principles for risk management:

“Government will make available its assessments of risks that affect the public, how it has reached its decisions, and how it will handle the risk.”

That is what we are asking for.