Justice CommitteeWritten evidence from Susanna Rees

The Cabinet and Andrew Lansley have over-ruled the information commissioner, Christopher Graham, and are not going to publish the NHS Risk Register because keeping details of risk secret means government is more “effective”. (1) The main defence of the Department of Health was:

“Mr Lansley’s officials had argued that releasing the risk register, when the Standard put in its FOI request in February with debate raging over the NHS changes, would have “jeopardised the success of the policy” (2)

Government feared that its policies would not have be made law if the full risks were known.

As Chair of the House of Commons Justice Committee, you are taking evidence from the Department of Health on Tuesday 15 April for the inquiry into the operation of the Freedom of Information Act.

Please could you discuss the following with the Department of Health:

[1] The Transition Risk Management Strategy of the Department of Health, published on 8th of May 2012 states about risk on page 7:

“Risk registers also play an important part in assisting the Department to advise Ministers of risks to programme delivery, as well as ensure that action is put into place to reduce or even eliminate the likelihood of a risk materialising.”


The Guardian reported that an early leaked draft of the Risk Register showed that risks to the NHS include (5):

long term danger to NHS ability to cope with emergencies;

the private sector will push NHS costs up;

changing the NHS too fast destabilises it; and

a risk that NHS finances may spiral out of control.

The general public will bear the brunt of risks being taken by Government and the general public will have to suffer the consequences of potential failure.

Why is government taking risks with tax-payer money and tax payer-owned assets, and at the same time refusing to share details of those risks, although Government is funded by the tax-payer and so is answerable to the tax-payer and the risk will be borne by the general public who use and pay for the NHS?

[2] What is the legality of Government hiding the truth about its policy on the NHS from the public? Is it actually legal to proceed with policies that have no mandate from the public and that may render an existing service unworkable?

The public has been unable to scrutinise the risks that Government is taking with public assets. There was no transparency over a Government policy that was unannounced and that was not explicitly part of the Conservative Manifesto, being only obliquely referred to on page 27 of the Conservative Party Manifesto 2010, here (3):

“We value the work of those employed in our public services, and a Conservative government will work with them to deliver higher productivity and better value for money for taxpayers. We will raise public sector productivity by increasing diversity of provision, extending payment by results and giving more power to consumers.

“Giving public sector workers ownership of the services they deliver is a powerful way to drive efficiency, so we will support co-operatives and mutualisation as a way of transferring public assets and revenue streams to public sector workers.

“We will encourage them to come together to form employee-led co-operatives and bid to take over the services they run. This will empower millions of public sector workers to become their own boss and help them to deliver better services—the most significant shift in power from the state to working people since the sale of council houses in the 1980s.”

On 5 April 2012 a full Judgement was made by the Information Tribunal on the Department of Health’s appeal against the Information Commissioner’s order of November 2011, that the NHS Risk Register be published (4). Paragraph 85 states that:

“From the evidence it is clear that the NHS reforms were introduced in an exceptional way. There was no indication prior to the White Paper that such wide-ranging reforms were being considered. The White Paper was published without prior consultation. It was published within a very short period after the Coalition Government came into power. It was unexpected. Consultation took place afterwards over what appears to us a very short period considering the extent of the proposed reforms. The consultation hardly changed policy but dealt largely with implementation. Even more significantly the Government decided to press ahead with some of the policies even before laying a Bill before Parliament. The whole process had to be paused because of the general alarm at what was happening”.

The Judgement implies that during the 2010 election campaign, the Conservatives effectively chose to withhold from the electorate their existing plans for the complete restructuring of the NHS. The court unanimously judged that the NHS Bill was contrary to the Conservative manifesto: unexpected, rushed, far reaching, pre-judged and without proper consultation.

[3] Why has it not been fully disclosed to the public that privatisation of NHS service providers is under way even though there is no evidence that turning healthcare in a market and privatising service providers to the NHS will result in a more effective service? (6)

An article published this week in the British Medical Journal presents evidence that the US healthcare system is bankrupting itself because the cost of its health insurance systems (half paid by the government and half by employers and employees) is becoming unsustainable and already is leading to reductions in coverage and benefits and the US market-based system gives the providers (doctors and hospitals) economic incentives to maximize their services and their billing , as if medical care were a commodity in trade. Providers have far more influence on expenditures for medical care than do vendors in other markets, so the US system will eventually spend itself to bankruptcy. (6)

[4] Would publication of the risks outlined in the Risk Register demonstrate that the claim by government that we cannot afford the NHS is based on weak evidence? The NHS is one of the lowest-cost health services in the world. (7, 8, 9)

May 2012

Prepared 25th July 2012