The NHS risk register – a weapon with dangerous fallout

Richard Wilson, the former cabinet secretary, warned yesterday that forcing the government to publish the NHS risk register could have unintended consequences:

It is deeply disturbing that the storm over the Health and Social Care Bill, now at its height in the House of Lords, may by a side wind do lasting damage to the Civil Service. What is at stake is the ability of officials to give their best policy advice to Ministers, and to do so in a private space, without being drawn into the political arena.

The tribunal’s ruling may, he argues, have extended the definition of freedom of information.

The technicalities are not really the point. What matters is that if the risk register were to be published, the precedent would reverberate across Government. Whitehall is watching, and rightly so. The Freedom of Information Act has already been harmful to the processes of government. This would be a major blow.

He has a point. It is one thing to provide data and statistics on government departments to journalists and other concerned members of the public. It is quite another to lay all internal documents open to public scrutiny.

Risk registers and other similar operational documents are not written with publication in mind. The language used will therefore be more frank than something which might go into a press-release. Taken out of context, these words could be used to whip up the sort of storm that carefully crafted press-releases are designed to prevent.

The whole point of risk registers and other internal reports is that they are supposed to tell it like it is. Lord Wilson’s fear is that if civil servants think that their words might one day be published they will be a lot less frank than they are now.

We have the best chance of being governed well if civil servants are able to give their best policy advice to their Ministers, frankly and on the basis of an impartial analysis of the options and the facts, in private. This applies to the risk register. We need Ministers to have before them documents which ‘speak truth unto power’ at those moments when they are on the brink of key decisions on a policy, or when they need to think through the risks of what they want to do.. There needs to be a private space where they can receive advice without worrying how it would look in the media or Parliament. These moments happen every day, every week, across government. The more important the issue, the more important that they receive the best advice.

If civil servants fear that their written advice may be published and used politically against the government they serve, they are bound with the best will in the world to write it differently, leaving out things which could be used as political ammunition. Worse still, they may not write these things down at all but give their advice orally. Oral advice has its place, but it is less considered, it is briefer and it may not be recorded. It is certainly not there for the Minister to ponder and read again when a meeting is over.

Some of you will say that people have a right to see these documents and that most are intelligent enough to understand the information within them. That may be true but it only needs a hostile and vocal minority to create a stink. You only have to look at the spurious spin and half-stories created by the tabloids and pressure groups to see the effect that even a little bit of deliberately misinterpreted data can have.

No one likes being at the centre of a media firestorm, even when they know the people fanning the flames are mischief-making numpties. If civil servants or other government advisers thinks there is the remotest chance of their words being published, they will pull their punches.

Publishing operational documents sounds fine in theory but I wonder whether our political culture is mature enough to deal with the material they contain. We already have a feverish atmosphere where any public sector story, no matter how silly or baseless, is seized upon and used to manufacture a mini-outcry. This hysteria is already heaping costs onto the public sector and creating an environment where managers are so scared of being beaten up by the tabloids that they daren’t invest £10k to save £100k.

In this atmosphere, the publication of management reports will only make civil servants even more risk averse, as they anticipate how their words might look in a newspaper article. With one eye on the Daily Mail, what would once have been frank advice will now be toned down. Forthright analysis and opinion will give way to anodyne, mealy-mouthed ambiguity. And we know what can happen in organisations when people dress their concerns up in non-committal language.

Lord Wilson’s views run counter to the prevailing political zeitgeist on both right and left. For public services, democracy, localism and empowerment are supposedly where it’s at now. He will probably be condemned as arrogant for ‘not letting the people decide’, or something like that. But if the publication of what have until now been internal operational documents becomes the norm, there will be unintended consequences.

Equivocal language and endless wordsmithing are the enemies of good decision-making and efficient management. Like most organisations, those in the public sector need more honest conversation not less. But if people think that their words might be published in a newspaper, wordsmithing is inevitably what they will do. Hours will be spent debating the nuances in each sentence. Lights will burn late as public servants fiddle about changing words here and there on Powerpoint slides. Just thinking about it is throughly depressing.

Lord Wilson’s warning is timely. It might sound like a great idea to force the government to publish the NHS risk register, thereby giving the opponents of its reforms more ammunition. But putting internal management documents into the public domain may set a dangerous precedent – one which could add yet another layer of complexity and inefficiency onto an already beleaguered public sector.

As the old saying goes, be careful what you wish for. For some, the publication of the NHS risk register is a useful tactical weapon but its collateral damage might be the frank and honest opinions of public servants.

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8 Responses to The NHS risk register – a weapon with dangerous fallout

  1. Pingback: The NHS risk register – a weapon with dangerous fallout - Rick - Member Blogs - HR Blogs - HR Space from Personnel Today and Xpert HR

  2. ermintrude2 says:

    Thanks for writing this. I come from a slightly different position of thinking that we should, as citizens, be trusted with more information rather than less but I can see the point even if I don’t fully agree with it! But I’m wholly removed from management so I didn’t realise they have heaps of private documents that I’m not intelligent enough to understand fully 😉

  3. You have an important point here, Rick, but I’d suggest the issue on this occasion is quite specific: the Government wants to push through a highly contentious bill without adequate time or even remote evidence of acknowledging the debate.

    If civil servants could be confident that proper scrutiny by MPs would be applied in a timely and transparent way without their having to produce quasi-confidential advice documents, there might not be a problem.

    But when the Government is totally determined to have its will (on a hugely important non-manifesto’d matter) then it seems very reasonable for MPs to demand that all available examination of that matter to date should be publicly available.

    MPs are after all answerable (we hope) to their constituents for the decisions they make; and that’s of course also a prime rule of governance on other decision-making bodies (e.g. company boards) as well.

    So if the Government wants to receive confidential advice, it must also allocate sufficient time for independent scrutiny by Parliament as a whole.

    That hasn’t happened by a very long way this time, so there are genuinely exceptional circumstances.

    If enough respect and time for debate is given by these in ultimate power to the people who will bear ultimate responsiblity for the decisions which have to be made, then the advice from civil servants can remain as those advisers would wish.

    It’s up to the civil servants to have the professional backbone to secure assurance on timings etc before they give their advice; parliamentarians can’t secure this for them because they won’t know until the advice has been given.

    It’s not enough for civil servants just to say, ‘Oh, we didn’t realise our advice would be open to one and all.’ That’s pathetic and unprofessional in any circumstance. They need to check first.

    So, the current NHS debacle is an exceptional circumstance and requires exceptional response (i.e. publication of the civil servants’ advice).

    In a more civilised, transparent and open circumstance I’d perhaps agree with the reluctant civil servants.

    But in the context of the current NHS ‘debate’ it’s surely essential that MPs know (and are thereby held fairly to account – and they will be held accountable by their constituents whether or not they have the opportunity to debate the full scenario) when they come to vote on the proposals.

    This is a massively important debate and at present it’s being held in a deeply untransparent context.

    That’s the real governance issue which must be addressed.

    Hilary Burrage

  4. Hilary says:

    Forgot to add, there is absolutely no excuse for civil servants (we pay them…) to offer palid advice anyway. Lawyers and doctors don’t have recourse to the excuse that other people might not be pleased about / understand the considered, professional advice which they must give.

    Civil servants are supposed to be neutral, not lapdogs of the government in power, when they do these evaluations. They are being thoroughly unprofessional if their advice is actually shaped by their looking over their shoulders in fear of the Daily Mail and co.

    If this was accepted as a principle the costs of the Freedom of Information Act (which is after all law, however imperfect – it seems to treat spurious concocted matters in the same way as really serious, big ones) would go down.

    In a ‘mature’ democracy civil servants, and we the public, need to get used to transparency and accountability, whether that’s through publication of advice, or, perhaps better still, through ensuring enough opportunity for proper scrutiny of big issues by ultimate parliamentarians, the decision-makers.

    So no hiding behind the ‘excuse’ of what the Daily Mail may say, please.

  5. Dipper says:

    “Risk registers and other similar operational documents are not written with publication in mind”

    I’d have to dispute this. Programme Management methodologies such as MSP have risk-registers as a central part of their process. These documents are maintained and available for scrutiny by the programme board which comprise senior representation from key stakeholders. In a programme such as a NHS reorganisation public representation is part of the process, and political or patient representatives would normally be part of the programme board and hence have visibility of the risk register. Publication of the risk register should be a small step.

    Its our NHS and our money. On who’s behalf would the Civil Service be acting if they want to prevent publication?

  6. Dipper says:

    “The whole point of risk registers and other internal reports is that they are supposed to tell it like it is.”

    to be picky. The point of a risk register is to tell it like it might be.

    For instance, one of the desired outcomes as I understand it is to reduce costs by enabling GP’s to select services on behalf of their patients. A risk is that the GP’s fail to achieve the desired cost savings by virtue of poor service purchasing. The risk register should contain a likelihood, a severity, a proximity, an identified owner of this, and what mitigation plans are in place, eg training plans, and audit plans. Also, as this is a targeted benefit then plans to measure the benefits achieved should be in place.

    If this risk is properly handled, I cannot understand what harm would be done by publishing the register. On the other hand, if it has not been properly done …

  7. Indy Neogy says:

    To add on to Hilary’s point – at some level the government is claiming that the risk register proves their case for them, but that we can’t see it, because of all the reasons you list. At that point I think it becomes reasonable to point out that we’ve been down this road before (Iraq and others).

    Given the well presented evidence to suggest that the risks are high, if the government wants to claim that the civil service has evidence that the risks are low, it needs to find a way to neutrally present that evidence. Otherwise, Lord Owen was entirely correct to suggest that in the absence of a presentation of evidence, the responsible thing for peers to do was to oppose the bill.

    And this is the key point – if an operational document is to be secret, then it cannot be the basis for campaigning for a policy. Either a neutral way of presenting it needs to be found, or public evidence needs to be generated.

  8. rogerh says:

    Publish and be damned is my advice, the media and politicos will soon get used to working in an open environment. Hiding unpleasant facts does not make them go away and the answer to the whiners is ‘and what is your answer?’ – they might (rarely) have an answer.

    The current trouble results from retaining a mini-monarchy business model for government, surely it would be better if civil servants had as their first loyalty the public, ministers being the temporary managers. The less room for obfuscation and the hiding of uncomfortable compromises ministers have the better. The main risk is Party funding and that is usually at the top of MP’s agenda. The polite concealment of intentions has not proved a brilliant model so far, at least for us shareholders.

    All that childish yah-boo across the green benches needs to go the way of the periwig (Oh, we still have those….).

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