Skip to main content

NHS: Risk Register

Volume 737: debated on Tuesday 15 May 2012


Asked by

To ask Her Majesty’s Government when they consider the time will be right to publish the NHS risk register.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and, in so doing, I declare an interest as chair of an NHS foundation trust and as a consultant and trainer on the NHS and health issues.

My Lords, the transition risk register will be published when the balance of public interest favours disclosure. We will continue to be open about risk. Last week we published a document containing information on all risk areas in the register, along with a scheme of publication for future review and release of information on risk.

My Lords, I am extremely grateful to the noble Earl for that because he said that it would be published when the balance is in favour of the public interest. Can I take him back to the judgment of the First-tier Tribunal, which concluded that risk registers,

“would have provided the public with a far better understanding of the risks to a national institution”,

on which millions depend? Surely the public interest and parliamentary scrutiny actually depended on that risk register being published, and it should have been published when the Bill was in this House.

My Lords, we do not agree with that. We have, as I have mentioned, published a document setting out a summary of all the risks in the register and the mitigating actions associated with each category, but we resist publishing the risk register itself at present. It is essential that officials are able to formulate sensitive advice to Ministers, making frank assessments and using direct language, without the fear of causing unnecessary embarrassment for the Government or damage to their area of policy. That is the essence of the reason.

Is my noble friend aware that there is nobody more passionate about the NHS than I am, but that a great many people outside want civil servants and other advisers to Ministers to point out the whole extremity of risks in any policy, whether it is policy A, B or C? At the end of the day, they expect Ministers to look at those risks and take appropriate decisions. Against that background, therefore, the strategy that my noble friend is following is understood outside by the ordinary public. It may not be understood by the lobby groups; nevertheless, it is the public whom we serve.

My Lords, I am very grateful to my noble friend, and he is right. The risk assessment process, carried out by civil servants and detailed in these registers, is an integral part of the formulation and development of government policy. It is in the public interest that this process be as effective as possible. We are clear that where policy is sensitive, that necessitates confidentiality.

My Lords, I take it that the decision that was made was a government decision, which was collective. I recall that the Deputy Prime Minister, before he became Deputy Prime Minister, was very keen on transparency. Was he therefore comfortable about the withholding of this information? If the noble Earl does not know, perhaps he could come back and let the House know.

My Lords, the decision to exercise the veto, which is a decision provided for under the Freedom of information Act, was made by my right honourable friend the Secretary of State for Health. However, he would not have been able to exercise the veto without the collective approval of the Cabinet, and that approval was secured.

My Lords, last Thursday I asked the Minister a question that he answered in part. The part that he did not answer was whether the transitional risk register drew to the Government’s attention the risk that patients would have to wait longer to see their GP. Speaking as someone who uses the NHS and as part of the British public, I fear that the delays are getting longer and will continue to do so. Could he please now answer the question about whether or not this was in the risk register?

I acknowledge that I did not answer that question and apologise to the noble Lord for not having done so last week. The whole issue of stakeholder support is one that the risk register addresses, as he will see from the document that we published. I do not recall the specific issue of waiting times to see one’s GP arising in the risk register for the simple reason that, although I acknowledge that it is currently a problem in some parts of the country, particularly London, that is not a direct result of anything that the Government are doing in our reform programme.

My Lords, would my noble friend decline to take lessons in these matters from those who supported former Prime Minister Blair in not publishing a full and frank assessment of the intelligence reports on which he committed this country to a war?

My noble friend makes an extremely good point because there are sensitive matters that any Government will inevitably wish to keep confidential if good government is to be maintained.

I am most grateful to the noble Lord, Lord Peston, for resuming his seat. Naturally, only one person should be on their feet at one time. There is time, although we have now wasted a little more of it, so perhaps we might hear from the Liberal Democrat Benches and then from the noble Lord. We have had two questions from the Labour Benches.

My Lords, risk registers are a tool to inform policy-making, so is the department currently working on a risk register for the implementation of the social care Bill, including the risks around the failure to reform the funding of social care?

In answer to that characteristically helpful question from my noble friend, the department will put in place thorough programme-management arrangements as it takes forward the draft care and support Bill and plans for its implementation. That will include monitoring and assessing risks as they arise, to ensure smooth passage through to implementation.

My Lords, I repeat what I said last time: it really is about time that the Liberal Democrats recognised that they are part of the government side. Everyone is getting quite fed up with this demand to be treated separately.

Is it not trivially obvious that all decision-making involves risks and therefore the Government’s refusal to publish this register would cause a reasonable person outside to come to the conclusion, much as the Minister might dislike this, that the Government really are trying to hide something that was damaging to them?

My Lords, I cannot answer for those who see something suspicious in what the Government are doing. All I can say is that we are absolutely clear that the circumstances in this case were exceptional. The FOI request from Mr Healey was made at a particularly sensitive time when the need for a safe space for civil servants and Ministers was especially high. The Freedom of Information Act was drafted specifically to allow for the ministerial veto. It is not just about the specific content of the risk register; it is also about preserving risk registers in general as frank internal working tools in the interests of good government.