NHS reform risk register reveals list of serious concerns

The Transition Risk Register - dated 28 September 2010 - was posted on two websites yesterday afternoon.

Former shadow health secretary John Healey had asked the DH to release the register under freedom of information law in November 2010, and a dispute between the DH and Information Commissioner over its release is ongoing.

Earlier this month a tribunal ruled that it should be published, but the DH had indicated it would appeal the decision.

The version of the register which emerged yesterday is one of the first iterations, and is dated three months after the government’s white paper had been launched.

The most significant and likely risks it identifies are about the transition causing the NHS to lose control of finance and performance. One entry says: “By dismantling the current management structures and controls, [there could be] more failures, including financial, eg GP consortia go bust or have to cut services, and credibility of the system declines as a result.”

It also warns that the “NHS Commissioning Board is not sufficiently developed to assess capability of consortia [or] GP leaders are not sufficiently developed to run consortia for example, they may be drawn into managerial processes which drive clinical behaviour (rather than the other way around)”.

And it says “there is a risk that the new system will be designed from an internal perspective, without taking into account the public/patient view [leading to it being] difficult for the public to navigate or hold to account”.

The register also highlights the risk of maintaining staff morale and dispute with unions.

Risks listed as “HMT Risks” – referring to the Treasury – include “inability to reduce running costs because of consortia numbers”; “loss of clinical time by GPs due to consortium management responsibilities”; “failure to manage referral demand”; “postcode commissioning”, “increase in catastrophic failure with no system management” and “GPs manufacture increase in their remuneration by playing the system”.

One entry - referred to as “Bill Risk (2nd Health Bill)” indicates there was a possibility in autumn 2010 of the DH splitting its plans into two separate bills, rather than a single large one. The risk is that no parliamentary time can be found for the second bill.

The DH’s Strategic Risk Register, a different document which has also been the subject of a freedom of information battle, remains secret. Earlier this month an Information Rights Tribunal ruled the DH should release the Transition Risk Register, but need not release the Strategic Risk Register.

The government, in particular DH permanent secretary Una O’Brien, has argued that a ruling saying they should publish risk registers would prevent civil servants giving honest assessments of policy in future.