The UK Government has decreed the risks of NHS reform to be a state secret. Maxine Vaccine looks at what the veto on publication of the NHS transition risk register is covering up.
Yesterday’s news is really the WTF to end them all. Having lost two legal battles in its attempt to keep Whitehall’s statement of the risks of the Health and Social Care Bill from meeting the public eye, the UK Cabinet decided to impose state secrecy legislation designed for use in times of war.
This means that the transition risk register, written to advise ministers on what could go wrong with what Sir David Nicholson called “the reform so big it can be seen from space”, will never be published. Its publication would be a crime on a level with the disclosure of state secrets to a military enemy.
According to Andrew Lansley, this “exceptional” measure is necessary to safeguard the policy-making of the future. If the risk register were made public, he claims, all such documents would have to be watered down for public consumption. In other words, our democracy cannot afford transparency even on health reform.
However, the risk register was briefly leaked online last month – so we already know that it predicted a significant risk not only of increasing health inequalities and gaps in service provision, but also of a systemic breakdown of the health service as such.
What kind of breakdown? The kind where a disorientating shift in health service management and responsibility runs into steep funding cuts – and the system breaks apart like a poorly manned sailing ship in a hurricane, leaving millions of people without access to any but the most basic services.
What would happen then? Firstly, Foundation Trusts struggling to keep afloat would be assessed as having failed economically, and taken over by private health providers such as Circle. That has started to happen already, but a breakdown of the system would make it endemic.
Secondly, the new CCGs would be unable to juggle the priorities of health service management with severely reduced funds, and – with the private sector already in charge of their data and administration – would have to surrender their decision-making to private health providers.
This is surely what Lord Howe had in mind when he commented in 2010 that he did not expect GPs to become managers, and that the GP consortia would depend on “their private sector partners” for commissioning functions.
It’s also what former NHS Chief Commissioner and current Government health advisor Mark Britnell had in mind when he told a conference of private healthcare companies back in 2010: “The NHS will be shown no mercy, and the best time to take advantage of that will be in the next couple of years.”
That’s why Andrew Lansley, as the Health Bill was about to become law, abandoned any pretence that the legislation was about “empowering clinicians” and, as every organisation representing clinicians in the UK told him the Bill would damage the NHS, responded with the supreme indifference of a village squire witnessing the Peasants’ Revolt.
And for pharmaceutical sales professionals trying to identify where the new NHS customers are, the message is pretty clear. Your immediate customers are standing, as a GP recently put it, “baffled in the ruins” of the NHS. But your longer-term and most important customers don’t spend much time around here. Their companies are based in the US and Germany, and they are closing in on the NHS like sharks around a harpooned whale.
Maxine’s views are not necessarily those of Pharmaceutical Field.