Whitehall argues against revealing NHS risks

Publishing an assessment of risks associated with the controversial NHS reforms would inhibit civil servants from speaking their minds to Ministers in future, the Government argued yesterday.

The Department of Health (DoH) is appealing against a November ruling by the Information Commissioner that it must make public the risk register which is based on civil servants’ thoughts on the potential impact of the Health and Social Care Bill.

The DoH had earlier refused a Freedom of Information request to publish it, insisting there was a stronger public interest in withholding the register from public scrutiny than in putting it into the public domain.

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And as controversy surrounding the reforms continues to dog the Government, Ministers yesterday said large increases in private work by NHS hospitals would require governing bodies’ approval.

In a concession aimed at securing House of Lords support for the shake-up, Ministers promised a vote on any move to increase the proportion of private income by five per cent or more.

Raising the cap to allow foundation trusts to raise up to 49 per cent of funds through private work has been one of several controversial aspects of the Health and Social Care Bill.

Deputy Prime Minister Nick Clegg publicly backed the need for further changes to the legislation last week as he sought to head off a revolt over the reforms at a Liberal Democrat conference this weekend.

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The legislation returns to the House of Lords today for the latest bout of what has been a bruising fight for the Government over one of its flagship policies.

At yesterday’s Information Rights Tribunal hearing the Government’s appeal, DoH Permanent Secretary Una O’Brien said: “The purpose of these registers at this level is really to think the unthinkable. It’s really to draw out the range of things that could possibly happen or that might go wrong.

“We deliberately encourage colleagues to express themselves in relation to these risks in a very forthright way and to be very specific, to grab attention.”

She described the risk register as a “safe space” for officials in the department to raise issues “without fear or favour”.

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She added: “(It) is an extremely important part of the relationship between civil servants and Ministers, especially when a policy is controversial.”

But putting this information into the public domain would ultimately have an “insidious” effect, she warned. “I think people would refrain. They would step back. It would become insidious,” she said.

The risk register in question was drawn up in autumn 2010, at an early stage in the development of the Government’s policy on NHS reform, Ms O’Brien said.

It therefore only provided a snapshot of a particular moment in time, she argued.

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Former Cabinet secretary Lord O’Donnell said the danger in releasing a risk register was that “people might think it’s a balanced document”.

He told the hearing: “It’s not a balanced document, it’s asymmetric. The point about a risk register is you don’t spend a lot of time thinking about the positives.

“By nature it tends to understate the probability of “good outcomes” and “overstate in people’s minds the possibility of very bad outcomes,” he warned.

Lord O’Donnell also cautioned that it would be used as a party political stick with which to beat the Government.

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Making his ruling last year, the Information Commissioner concluded there was a “very strong public interest” in disclosing the risk register.

But Health Secretary Andrew Lansley has said it would be “completely misleading” to publish it.

Labour argues that full disclosure is needed and says local risk registers already show the scale of damage that could be done to the NHS by the Bill.

Shadow Health Secretary Andy Burnham called on the Government to “come clean”, saying: “It’s essential that patients, the public and Parliament know the full scale of the risk the Government is running with the National Health Service before approval is given to this Bill.”

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The British Medical Association, the Royal College of GPs and the Royal College of Nursing, which all want the Bill scrapped, have also called for the register to be published.

The two-day hearing is set to resume today.