Reproduce/Retweet re: Risk Register

Public Health for the NHS

Media Release
For Immediate Use: Thursday 18th March 2012

Too Risky to Tell the Public?

Lords to Debate Halting Health Bill until Risk Register is Published

On Monday Crossbencher Lord Owen will move a motion in the House of Lords to halt the Health and Social Care Bill until the Government publishes the Transitional Risk Register for the NHS. He comments:

“I believe, and many others do too, that the risks of going ahead with this Bill are greater than the risk of stopping.”

The Government continues to refuse to publish the Register, despite being instructed to do so by the Information Commissioner and then losing an appeal to the Information Tribunal.

However, it is possible to use published documents to estimate the types and level of risk that the Health Bill would create in the NHS. Analysis of the Combined Impact Assessments published on the Department of Health website [1] shows the following as foreseeable outcomes:

  • System failure because GPs lack relevant skills and adequate time;
  • Threats to the financial stability and viability of Clinical Commissioning Groups;
  • That rather than achieving promised savings, costs will greatly exceed those in the current system;
  • There will be a fixed budget for each person, with all further costs payable by the patient or their private health insurer. GPs will have to enforce this rationing and explain it to patients;
  • Collaboration is expected to suffer (because competition law considers it “anti-competitive”);
  • Organisational self-interest may undermine the quality of care;
  • Prioritisation of private patients may lengthen waiting times for NHS patients.

At a population level some consequences of the major organisational and funding changes involved are predictable.  Given these major financial and functional problems, one overall risk of the Bill is a rise in ill health and in preventable deaths.

The exceptional value for money of the NHS is likely to fall to levels typical of healthcare systems based on competitive markets. For example, studies have shown that for-profit US hospitals had 2% higher death rates and 19% higher costs than non-profit hospitals [2]. Targeting of services to vulnerable populations will suffer, as such services are less commercially attractive. Meanwhile consumer-driven healthcare tends to over-treat those that can pay, in order to please patients and boost profits, and this can be dangerous to patients [3].

Another change likely to have affected the contents of the Register is the imminent switch to a limited package of state-funded treatments to be provided through CCGs, as presented at the recent Nuffield Trust Health Policy Summit supported by McKinsey [4].  This reduced entitlement will lead to a major expansion in top-up private health insurance and could mean a return to the era of unpayable medical bills, which was a major reason for the creation of the NHS [5]. In the USA, 62% of personal bankruptcies are due to medical charges. Of these, 78% had valid health insurance that would not cover their costs, with the families of disabled children among those worst hit [6].

Commenting, health services researcher Lucy Reynolds said:

“The refusal to share the Transition Risk Register may aim to conceal the imminent change from a trusted National Health Service that treats according to medical need and protects against unaffordable medical bills, to an inferior one which commercialises care and exposes patients to financial risk.

This change may be impossible for a future Government to reverse, because providers could claim compensation under EU competition rules in the event of attempted renationalisation. Mr Cameron and Mr Lansley want to stop the public discovering that the insurance industry will be the main beneficiary of the Bill, while the public – especially the elderly and the chronically ill – will suffer.”



Dr Lucy Reynolds 07905 279777
Ian Willmore (media) 07887 641344

Notes to Editors

[1] These are available as a single pdf at

[2] See Woolhandler S and Himmelstein DU. Competition in a publicly funded healthcare system. BMJ 1 December 2001;335: 1126-1129

[3] In the USA Fenton et al explored the outcomes of patients who reported most satisfaction with services compared with those of the least-satisfied. They found that if the most severely ill were removed from the sample, excess mortality was 44% higher among the more-satisfied group after adjustment for other factors. This is a result of patients seeking or being offered inappropriate treatments: unneeded interventions can harm patients. Fenton JJ, Jerant AF, Bertakis KD, Franks P. The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality. Arch Intern Med. 2012;172(5):405-411.

[4] 2012 Health Policy Summit 29 February -1 March 2012

[5] Origins of the NHS. The Cabinet Papers 1915-1981. The National Archives.

[6] Himmelstein DU, Thorne D, Warren E, Woolhandler S.  Medical Bankruptcy in the United States, 2007: Results of a National Study. The American Journal of Medicine August 2009;122:741-746

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