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Lansley is scared to publish his own department’s list of risks to the NHS

The government must come clean and publish the full NHS Risk Register

The Department of Health's Risk Register lists potential risks involved in changing the NHS. The changes happening to our NHS right now are the biggest in its six-decade history, so the contents of the register are very important to parliamentarians scrutinising the Health and Social Care Bill.

When he was shadow Health Secretary, John Healey requested that the Risk Register was published so that the Bill could be amended to minimise the risk to patients. The government objected and Healey complained to the Information Commissioner. The Commissioner told the government to publish. The government is appealing against this, claiming that the potential risks have already been published in the Impact Assessments document.

There have been two Impact Assessments documents. The first was published in January 2011 when the Bill was introduced. Last June we had the so-called “pause”, and in response to the changes to the Bill a new version of the Impact Assessments was published in September. It is interesting to compare the two versions.

Both documents have a section on the so-called “level playing field”. The government’s policy is to allow providers from all sectors (NHS, voluntary and private sector) to provide healthcare for NHS patients. The problem is that the different sectors have costs inherent to those sector, and the Impact Assessments attempt to quantify these. The January version says:

"A recent study of fair playing field distortions was able to quantify the impact of some of the distortions identified. The majority of the quantifiable distortions work in favour of NHS organisations; tax, capital and pensions distortions result in a private sector acute provider facing costs about £14 higher for every £100 of cost relative to an NHS acute provider."

The study mentioned was carried out in 2009 by KPMG. For a short time early last year the government cited this 14% “advantage”, which led health policy experts to speculate that Lansley intended to charge the NHS for services that it received cheaper than the private sector: “levelling” the playing field. Understandably, there was a backlash when it was pointed out that the KPMG study was incomplete and ignored the “distortions” that put the NHS at a disadvantage: PFI, the vast cost of training and the universal responsibility for A&E. The government, sensing that it could not win, dropped the proposal.

The September Impact Assessments still contains the sections on the “level playing field”:

"A recent study of fair playing field distortions was able to quantify the impact of some of the distortions identified. Our conclusion from the report is that it cannot necessarily be the case that costs incurred by private acute providers are higher than their NHS equivalent – even though this independent report found that some quantifiable distortions result in £14 per £100 higher costs as some significant unquantifiable distortions not included are likely to act against NHS providers."

(Emphasis is from the original document.)

Notice the change of tone. The first is assertive and states as “fact” that the NHS has an advantage; the second says that the study was inconclusive. No new evidence is presented to explain this change in tone.

So why didn’t the first Impact Assessments say that the study was inconclusive (after all, the Department of Health had had the study since 2009 to make its decision)? The reason is that the Impact Assessments is a political document used to justify the policy rather than give real evidence about the risks of the policy. For this reason, we should ignore the government’s assertion that the Impact Assessments document contains the risks of the reforms and continue to campaign to get the full Risk Register published.

Richard Blogger writes about the NHS and social policy at NHS Vault.


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