Intended for healthcare professionals


MPs call for Lansley to publish risk register of NHS shake up

BMJ 2012; 344 doi: (Published 13 February 2012) Cite this as: BMJ 2012;344:e1062
  1. Clare Dyer
  1. 1BMJ

Pressure is mounting on the health secretary for England, Andrew Lansley, to release the confidential strategic risk register drawn up by his department outlining the dangers posed by his controversial shake-up of the National Health Service.

Fifty MPs including nine Liberal Democrats, whose party is the minority party in the coalition government, have signed an early day motion demanding release of the register. And Labour is to hold an opposition day debate later this month calling on the health secretary to publish it.

Following Freedom of Information Act requests by the London Evening Standard newspaper and by former Labour health spokesman John Healey, Mr Lansley was ordered last November by the information commissioner, Christopher Graham, to make the document public (BMJ 2011;343, d7404, doi:10.1136/bmj.d7407). But the health secretary elected instead to appeal to the information rights tribunal, which is scheduled to hear the appeal on 5 and 6 March.

The move has angered critics of the reforms, who argue that the register should be disclosed while the Health and Social Care Bill is still going through parliament so its contents can be taken into account in the debates. The tribunal will take time to produce its written decision and there would be scope for more delays if the government lost and sought permission for a further appeal, to the upper tribunal.

Risk registers are confidential departmental documents which look at possible weak points and ask what risks could be posed by new legislation so that any problems can be anticipated and dealt with. Mr Lansley argues that if a precedent were set and risk registers might become public officials would hesitate to be as frank as possible, which would affect ministers’ ability to reach the right decision.

Meanwhile, what may be leaks of the risk register’s contents are coming out. Labour Party member Eoin Clarke, in his blog The Green Benches, wrote: “I am told that the reason for [refusing to publish] is that the report contains a very serious warning about the long term damage the bill will do to the NHS.

“The chief warning in the report is that Lansley’s reforms will spark a surge in health care costs and that the NHS will become unaffordable as private profiteers siphon off money for their own benefit. The report specifically warns that GPs have no experience or skills to manage costs effectively.

“The profit element contained in Lansley’s reforms is the chief reason for the report citing these worries. This is the reason Lansley refuses to publish the report, because he has claimed that his bill will make costs in the NHS more affordable. This flaw in the bill if exposed would undermine his entire argument and it is the reason the report will not be published until the bill becomes law.”

In a separate development the editor of an influential Conservative party website, ConservativeHome, has urged the Prime Minster to delete large parts of the bill before it fatally damages “the Conservative Party’s electoral prospects.”

Tim Montgomerie, in a blog posted on 10 February (, said that three Conservative cabinet ministers had urged him to speak out because they believed that pushing ahead with the bill would be foolish.

“One was insistent that the bill must be dropped. Another said Andrew Lansley must be replaced. Another likened the NHS reforms to the poll tax,” he writes.

Mr Montgomerie argues that the bill has made the NHS “a big negative for our party again” and that with spending on the NHS falling from 3% or 4% in recent years to 0.1% in the years to come everything that goes wrong with the service in the future will be blamed on the bill. “It must be stopped before it’s too late,” he concludes.

For information on who stands where on the Health and Social Care Bill see table.

Who stands where on the Health and Social Care Bill

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Cite this as: BMJ 2012;344:e1062


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