In our hands

The Government is refusing to release the risk assessment for its NHS reforms. So why don’t we do our own?

Assessing risk is a crucial part of policymaking. The Department of Health has published impact assessments alongside the Health and Social Care Bill, but has so far refused to make public its ‘transition risk register’ and has failed to comply with the order of the Information Commissioner to do so. (The latest ‘combined impact assessment’ from September 2011 includes just a single, carefully drafted page on ‘Issues and risks’ for the main reform).

The DoH says that officials must be free to record all of the potential risks frankly and with the confidence that information will not be disclosed. It also says that the assessment could create alarm – though it has admitted that the assessment includes analysis of how the reforms might impact on the quality of NHS services, accountability and finances (including plans to save money).

Ironically, the ‘secret’ assessment also includes thinking on how stakeholders should be engaged in developing and implementing the reforms (and this, remember, for a reform that the Government says is about giving doctors and patients more control).

While most people would accept that some advice to ministers should remain private, surely we all have an interest in knowing the possible consequences of a reform as important as the Health Bill. And if, as the Government has said, the risk assessment informs what mitigating actions it is taking to avoid the negative impacts, shouldn’t we also have a right to judge its progress?

Good policy – and good policy implementation – depends crucially on this type of analysis, but there’s no reason it has to be done in private. First, we all know  the main risks anyway, since they’ve been debated publicly for months. Second, and more importantly, it’s likely that the quality of the analysis would be greatly improved if it was conducted publicly – by openly inviting medical professionals, managers, patients and other interested parties to use their experience and expertise to identify potential problems and propose solutions.

So if the Government continues to refuse to release its own assessment regarding the risks of its most important reform to public services, why not conduct our own assessment? It’ll probably be a lot more accurate – and we’ll make sure it’s publicly available as well.

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