Sunday, 11 March 2012

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.


Patrick Keady said...

Many thanks for this Marcia. While we are not sure as to why the risk register is shying away from the spotlight, risk maturity could be relevant. It seems that all organisations go through five levels of risk maturity - undeveloped, formalised, established, embedded and formalised. And while the Coalition is not an organisation per se, perhaps it's risk maturity is evolving along similar lines? Click on my name for more on risk maturity.

Chairman Chegwin said...

While I think the Government (and DH) has mishandled the risk register affair (it should have been given up much earlier in the process instead of dragging things out), I do think that this episode has serious implications for how those of us in Whitehall go about developing policy and systems in the future.

I'm all for openness in the policy process but to me risk registers are internal planning documents - and not very exciting ones at that most of the time! This episode has become political because opponents of the Bill STILL haven't found the killer blow to scupper the Government's plans, hence any little opportunity is seized upon.

Do you really think publishing the risk register will help move the debate forward in any sensible way? Of course not - it's contents (which are probably out of date anyway) will be picked over and sensationalised in the same breathless fashion as people talk (completely incorrectly) about EU competition law, American-style health systems, privatisation etc etc etc....

There has to a part of the process where policymakers get to "think the unthinkable" and assess what *could* go wrong. How else do we advise on the correct options to put to Ministers? Putting that process in the public domain at an early stage so that the ill-informed and professional wreckers can pick everything apart will very quickly ensure that nothing gets done.

If that's what people want then that's fine, but sometimes you have to be a little bit careful what you wish for....

Finchers Consulting said...

Thank you Patrick and Rob for your comments. As you say Rob - the killer blow hasn't been applied to the Bill yet - and probably never will. I agree with you about the dangers of exposing risk registers in general, especially if the Daily Mail get's hold of them!It's a side show anyway. We already know that Lansley doesn't listen! It's just another example of incredibly poor communication and not nipping an issue in the bud at the outset.

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