NHS Risk Register: To publish or not – which is the biggest risk?

I am a Prince 2 practitioner, trained in running projects using the ‘process based method for effective project management in controlled environments’ so popular in the public sector and favoured by the NHS. Much of the training course is plain old common sense, but the formal structure given to key elements of project design ensures that errors and omissions can be avoided and, most important of all, risk is managed.

Within the Prince 2 manual, the purpose of the risk theme is to ‘identify, assess and control uncertainty and, as a result, improve the ability of the project to succeed’. Just the sort of actions one would take when restructuring or re-forming a major institution such as the NHS.

The training goes on to help project managers:

Identify risks that could affect the projects objectives
Assess likelihood, immediacy and impact of each risk
Control responses to the risk, assign risk owners, execute and monitor responses. (i.e. take remedial action)

As the Information Commissioner placed an order to the Department of Health (DOH) to publish the Health and Social Care Bill risk register, it is reassuring to know that such a document exists. However Andrew Lansley, UK secretary for State for Health still won’t confirm that the register will be published and despite the fact that a recent tribunal has rejected the DOH’s appeal against this publication, the Coalition continues to drag its heels.

I have some sympathy with the view that it is not ideal for risk registers in general to be made public. To the ill-informed eye, such a document could be misinterpreted and the risks overestimated. But with such a major political and social issue, surely refusing publication will do more damage than exposing the flaws of a Bill that is already so blemished and devalued.

So one must ask – why? Why doesn’t the ‘nothing about me without me’ mantra apply to the risk register? The risks of top down re-organisation have already been discussed ad nauseam. Any change involves risk and as long as this risk is ‘identified, assessed and controlled’ then the likelihood of success will be greater. So shouldn’t the publication of the risk register reassure us that all bases are covered?

I suspect that the risk register won’t tell us anything new, but it will probably prove one thing. That Andrew Lansley was fully aware of the identification and assessment of major problems with his legislation even before the Bill was presented to parliament. But he went ahead without taking the controlled responses required to actually succeed and achieve the ultimate project goal. To improve the NHS.