Secrecy by default - the issue with the NHS risk register

Image: NHS Petition Hand-in by 38 Degress: CC-BY-2.0 licence

The Health & Social Care Bill has finally made it through Parliament. Despite vociferous campaigns from both the general public and medical professionals, the huge top-down reorganisation of the NHS has already begun.

Regardless of what you think of the need to restructure the NHS in general or these reforms in particular, there is one big issue with the way the decision was made in the first place. MPs were asked to vote on the Health and Social Care Bill without having access to crucial information about the potential impact of the reforms. Specifically, Andrew Lansley and the Department of Health have for months been fighting a losing battle to withhold from publication the transition risk register. This document, drawn up by civil servants, details the risks arising from implementing the measures proposed in the Bill. The Information Commissioner ruled last November that the register should be published, and an Information Tribunal rejected an appeal from the Department of Health in early March, again ruling in favour of the publication of the risk register. Yet here we are weeks later, with the Bill on the cusp of receiving Royal Assent, and the risk register has yet to be seen.

As a project manager, I am stunned. If I asked my project board to make a decision on something and did not provide them with a full and detailed analysis of options and risks, I would get sent out of the room and told to do my homework. If I provided an excuse like the government's - that if I gave the board access to my risk register my project team might be less honest with me in future - I would, frankly, deserve to be stripped of my professional qualifications and sacked. Yet this is precisely what the coalition government has done by asking Parliament to vote on the Health and Social Care Bill without publishing the risk register. Publication of the register, so the government and former Cabinet Secretary Lord Wilson, would jeopardise "the ability of officials to give their best policy advice to Ministers".

This is a symptom of a lack of transparency and accountability that is deeply ingrained in British political culture. The default state of information is closed, guarded, secret. Even published government information is under Crown copyright, meaning the government can restrict publication and distribution through legal threats and copyright litigation. Bear in mind that this is data and information the creation of which we as tax payers fund directly. That we should then, by default, be prevented from accessing it unless the government is feeling particularly benevolent is a disgrace. As Heather Brooke points out in her book The Revolution Will Be Digitised, the approach to publishing government data is a key point of difference between the UK and the US, where government information is by default in the public domain. This makes it both easier to hold government to account and to use such data for innovation.

Government transparency, rather than government secrecy, should be the default. Politicians and civil servants both should be held accountable for their actions. That can only happen if documents such as the NHS risk register - documents absolutely vital for making decisions on something like the Health and Social Care Bill - are made available both to MPs and to the general public during the legislative process.

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Comments (1)

  1. HR McKay:
    Mar 26, 2012 at 09:54 AM

    I asked the UK government in November 2010 what the extimated increase in the UK death rates (or, how many people they expected to kill) with their swathing and unnecessary cuts in public spending coupled with their proposed policy reforms.

    In February 2012 I at last received a response from Mr D. Alexander, Chief Secretary to HM Treasury in which he stated "The Government does not BELIEVE that vital [sic.] cuts in public spending that we have implemented will cause an increase in death rates in the UK..."
    [my emphases]

    In other words, the Tory/LibDem Coalition government don't know and don't care how many people they kill so long as public spending is reduced. This government is manned by MURDERERS who will happily kill you or allow you to die for a deliberate and conscious decision to reduce State funding in our most vital of services Nationwide.

    On 7 March 2012 I sent this follow-up email via my local MP and, to date (26 March 2012), I await a response from Government -

    Thank you for forwarding the letter dated 10 February 2012 by Chief Secretary to the Treasury Mr Danny Alexander. And I'd be grateful if you pass on this email to our Government.

    I note with considerable consternation that "The Government does not BELIEVE that the vital cuts in public spending ... will cause an increase in death rates in the UK...." [my emphasis added]

    Evidence is already being collated indicating that your mere belief is unfounded and profoundly in error. For example,
    "In internet circles, where many disabled campaigners congregate, names are bandied around of those who have committed suicide through fear of going cold and hungry and feeling that they are increasingly a burden to society.
    At the last count there were some 103 names linked to such suicides and I have actually heard people say that they would consider suicide as a way out of this constant state of anxiety and despair.
    What alarms me is how this dispassion towards people with disabilities appears to be spreading from the Coalition down."
    http://www.dailymail.co.uk/debate/article-2110900/Suicide-training-Job-Centres-Cancer-patients-scrubbing-floors-Welcome-Cameron-s-Brave-New-World.html

    And from the same article we learn that our Civil Service staff are to be taught suicide prevention skills to assist those hardest hit, rather than easing the pressure sick, disabled, elderly and mentally ill people already have in dealing with their environment by allowing them an independent life via generous rates of State Benefits which can only help assist our failing economy.

    For the Treasury and our Government to make such brutal cuts in public spending that will adversely affect the poorest and most vulnerable people in society without being FULLY AWARE of the impact on death rates is crassly irresponsible and, with respect, an indication of mass psychosis within Government.

    I respectfully request the Welfare Reform Bill and the NHS reforms be withdrawn and scrapped without further delay to allow a proper and unbiased series of impact assessments to be conducted to discover the true effect upon the health of our Nation and our populace.

    We didn't fight for our freedom from Fascism and Nazi concentration work camps merely for the UK to do it better than the Germans. The UK Government policies will result in a culling of our population based solely on income and health.

    I urge this Government to please cease putting our most vulnerable people at higher risk of death.

    I also warn against an increased level of crime and civil unrest if these current policies are pursued, and after such a long period of peace with the IRA etc, our cities would prefer to stay peaceful but the actions of this Government will leave people with no choice but to fight back as best they see fit.

    Please cease these reforms and desist from culling our population.

    Sincerely,

    Robin McKay (Mr.)
    Paisley
    Scotland, E.U.


    Perhaps ORG and the network of similar organisations can assist in persuading our Government to cease killing us?

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By Milena Popova on Mar 25, 2012

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