Secrecy by default - the issue with the NHS risk register
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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