A confidential risk register prepared by the Department of Health reveals civil servants’ grave concerns about Andrew Lansley’s sweeping reorganisation of the NHS. The register emerged late last night after a leak to health writer Roy Lilley (PDF version).

Set out as a colour coded chart, the document is covered in red (not a good sign). The following items are among those receiving a “likelihood score” of 4/5 and an “impact score” of 4/5:

  • Point 3: Private sector could “add costs to the overall system”
  • Point 4: Implementation begins before adequate planning
  • Point 5: A disjointed system with NHS moving faster than other areas
  • Point 7: “Financial control is lost” due to restructuring
  • Point 15: “more failures” such as bankruptcies and cuts to services
  • Point 34: Low staff morale
  • Point 35: System designed “without taking into account … patient view”

And while receiving a slightly lower likelihood score of 3/5, the following risks are among the most damning:

  • Point 12: “emergencies are less well managed/mitigated”
  • Point 13: “costs of the future system cannot be controlled”

Another notable item receiving a high score was, erm, bad press coverage:

“Public reputation. There is a risk that the transition will be presented in a negative light via the media.”

In this draft dated 28 September 2010, the corresponding “mitigating actions” cell was left blank.

It is somewhat ironic the suppression of the register itself would form part of their management plan.

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