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DH chief defends early implementation of NHS reforms

The Department of Health’s most senior civil servant has defended work to implement the government’s NHS reforms before its Health Bill has been passed, in evidence to a tribunal.

DH permanent secretary Una O’Brien, giving evidence at the Information Rights Tribunal, also said she felt “very deeply” that risk registers about the reforms should not be made public.

The tribunal is hearing the DH’s appeal against the Information Commissioner’s decision in November that the department’s “transition risk register” and “strategic risk register” should be published. Former shadow health secretary John Healey, who had requested the information, was a party to the case.

Ms O’Brien said on Monday she believed strongly that if the information was published it would mean civil servants not declaring risks fully in future, for fear of their work being published and “embarassing ministers”.

She said that would “undermine the management of risk” in departments therefore disclosure was not in the public interest.

She said: “My concern and that of other permanent secretary colleagues is [that if the registers were published] the articulation of risk would be insidiously pulled back from, step by step, in all other types of decisions.”

Ms O’Brien said: “Because the public is interested in a subject it does not translate into the public interest in [information being published]. It is actually in the public interest to have ongoing free and frank discussions between ministers and officials.”

She was also pressed at the hearing on the timing of the development and implementation of the reforms. In particular, Ms O’Brien was asked about the controversial issue of implementation before the bill has been passed. The bill is still going through its final stages in Parliament.

Counsel for Mr Healey and the commissioner raised issues including the clustering of PCTs, creation of “pathfinder GP consortia” and instructions from NHS chief executive Sir David Nicholson about implementing the reforms in 2010.

However Ms O’Brien said: “Every step that was being taken and is being taken has to be taken within the current legislative framework.

“All the existing arrangements and accountability which were in place in 2010 are in place now. PCTs are clustered but the formal accountability remains as it is until they are actually abolished.”

Of pathfinder GP consortia - many of which are now established as sub-committees of PCTs - Ms O’Brien said: “They do not have budgets, [and] they are not bodies corporate. Therefore they are not allowed to do commissioning and they will not be until legislation is passed. They are groups of GPs who have come together to work with [primary care trusts].”

Mr Healey is expected to argue that risk is an important part of the debate on the reforms, and that risk registers a tool for implementing rather than making policy, therefore their publication would not inhibit policymaking.

The appeal tribunal was due to continue on Tuesday and is expected to announce a decision between Tuesday and early next week.

Readers' comments (13)

  • You can't blame people for putting implementation in place before legislation is passed. It always happens. What no-one predicted was that the coalition would make such a collective mess of this and change and delay so much of it. But given that mess is a very public fact there is now an argument for publishing the register so that we can hold everyone to account for the farcical position we are in. The tine for shadows is passed. We must be allwoed to see what the perceived risks are.

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  • I oppose these changes and I am generally very supportive of FoI as a means of holding public bodies to account. However the issue of publication of the risk registers makes me nervous.

    There is an unjustifiable and a justifiable reason for witholding the register.
    If risk has been poorly managed, either because risks have not been identified or, more significantly, if risks have been identified but not mitigated, this should be transparent and is not a justifiable reason.

    Journalists and politicians have little experience of risk management and cannot differentiate btween well managed and poorly managed risk. Many will use the simple fact that a risk has been identified as a club to beat the government. This raises a serious danger that publication will undermine recent progress in getting Civil Servants to do proper risk management.

    The answer is surely to obtain external quality assurance of the risk register and publish that.

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  • Heard insideous was the buzzword used on the news. Interesting as the definition from the FreeDictionary is; "working in a subtle or apparently innocuous way, but nevertheless deadly".

    Which is precisely what this government has been doing with the NHS - hence why they want to keep this hidden to avoid embarrasing "ministers".

    How dare Una O'Brien declare what is in the public interest when recent polls suggest this is the exact opposite.

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  • "Ms O’Brien said on Monday she believed strongly that if the information was published it would mean civil servants not declaring risks fully in future, for fear of their work being published and “embarrassing ministers”.

    If a civil servant cannot properly and objectively list risks and defend them in public they should not be in the job. The argument advanced by Ms O'Brien is akin to saying her staff are spineless and without principle. That may be true but it is reform of her staff that is needed not a cloak of secrecy to hide their failings.

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  • Anon 2.20pm, well said. This is an interesting test of democracy - should we not be allowed to understand the risks when formulating, agreeing and implementing policy? Who knows the ensuing debate might end up with a better policy (it couldn't be any worse!)

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  • The Ministers and Officials who are 'clearly' better placed to have "free and frank" discussions about ruining our NHS need to get their excuses in order. You have Una O’Brien saying that they cannot release it in fear of her staff embarrassing her and you have Andrew Lansley saying he does not want it released because the changes to the bill do not reflect an outdated register.

    If they cannot discuss the excuses they are feeding to the public then how do we expect them to discuss our NHS properly?

    They should release the risk register that was requested in 2011 and also release the current version to prove to the public (who they have undermined by thinking we are too dumb to understand) that the risks they predicted in 2011 have been lowered by the changes that they have made to the bill. Unless more risks have been added....

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  • Well said Anon 2:20. We seem to have a problem Houston! Civil servants ought to work on behalf of the public good not the good of Ministers/Party, if they were doing their job well then it is publicly defensible otherwise it is a coverup of incompetence or worse. The Risk Register should be defendable best practice or it it too embarassing?

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  • OMG! Anon at 10.2 says:

    "Civil servants ought to work on behalf of the public good not the good of Ministers".

    If dear old Una sees that she is going to be v confused indeed

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  • Certainly looks like all caution, due diligence and political impartiality was deleted from the civil service code in this case.

    I wonder whether it's just shameless opportunism or a real loss of quality in senior posts?

    Judicial review used to be the big threat in such cases, but perhaps nobody can afford that challenge any more...

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  • Paul Johnson

    So all the people above who have their views anonymously think that nevertheless civil servants must do their work in the open?

    I agree with Anon 6-March 1.22 in principle - whatever the political merits of this campaign the danger (ha! risk!) is that it is robust risk management that might be harmed - but would add that I rather presumed the external assurance called for on the DH's management of risk was already in place via the NAO and the Public Accounts Committee?

    And I wonder how many people would be surprised/disappointed if when reading the risk register in question they found that it focuses (hopefully) at least as much on risks TO the reforms ("why we might not succeed in implementing them?") as FROM them? ("what harm could we do to the NHS if the reforms ARE implemented")?

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  • The rationale for not releasing the risk register is that the public cannot understand risks. This is quite patronising. Doctors used to use this excuse for not telling people they had a terminal illness. We have grown up. Tell our representatives.

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  • THESE are the bureaucrats that we need to be protected from. Not NHS Managers. Another shameful chapter in the history of the Department.

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  • Geoffrey Rivett

    Many years ago, before I entered the Department of Health, a Permanent Secretary was interviewed on Blue Peter and asked what the civil service did. His answer was "they present Ministers with a picture of reality, and then obey their instructions." The civil service is not a free standing body working in its own right for the public good, as it sees it. The presentation of a picture of reality in my view is better done behind closed doors, not least because the wilder ideas can be modified without loss of face. I do not believe any opposition politician wishing civil service advice to be published would have the same opinion when in power. Labour certainly did not believe in total transparency when they were.

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