Controversy has been sparked by Health Secretary Andrew Lansley’s decision yesterday not to publish the official internal risk assessment for the NHS reforms. His explanation is cogent, making the case to retain ‘a safe space where officials are able to give ministers full and frank advice in developing policies and programmes’. When Labour spokesperson Andy Burnham says ‘this disgraceful decision is a cover up of epic proportions’ we must, assume, first, he has forgotten that the Labour Government of which he was part would never have dreamt of publishing something so dangerous and, second, he has fully consulted his shadow cabinet colleagues – particularly Mr Balls and shadow defence secretary Jim Murphy - about this radical commitment to treat departmental policy development as a totally open book if and when Labour returns to office.
But while understanding the reasons for Mr Lansley’s decision in practice I think it is wrong in principle. Of course, were the risk assessment published it would lead to a slew of alarmist headlines. By definition risk assessments are there to interrogate worst cases; for example the RSA’s includes fire and flooding as well as IT melt-down or a sudden drop in Fellowship recruitment.
When I was in Downing Street we took it for granted that when an evaluation of Government policy was, say, 80% positive it would be the other fifth which would be the story. In news coverage of the risk assessment, the detailed metrics of the Departmental evaluation would be ignored or come well down a news story highlighting all the terrible things that could conceivably go wrong with the reforms. (By the way, as Ben Goldacre’s deconstruction of cancer scare stories vividly underlines, the problem of proportionality in risk reporting isn’t just one for politicians.)
However, there are two principles which outweigh my natural sympathy for ministers and officials and scepticism about the press. First, the simple question of public accountability; if ministers are taking big risks with our money and our services and if open government means anything, surely we deserve and need to know about it? By all means ministers can tell us why they disagree with the assessment or why they think the risk worth taking, but to supress the assessment itself is hard to justify and will simply lead people to assume the worst.
The second reason goes back to that old RSA favourite ‘the social aspiration gap’. As my regular reader will recall (‘hi mum, lovely to see you the other night, try to not to work so hard’), the idea of the gap is that in certain ways we need to enhance citizen capabilities if we are to create the future most of us say we want. One of those attributes is greater engagement, by which is meant a capacity in citizens to recognise and relate to the difficult choices which need to be made by us and on our behalf.
In the same newspaper in which I read about Mr Lansley’s decision there is a powerful column by Daniel Finklestein. The Executive Editor of the Times expresses his anxiety at the rise of extremist populism across Europe and calls on voters to face up to the necessity of hard choices on the road back to economic stability. But, as he says, to escape the folie a deux of dishonest politicians and an unreasonable public requires a step change in the candour and courage of mainstream leaders; ‘At the last election no party felt able to level with [the voters] about how bad things were, and what would be needed to put things right because they correctly divined that if they tried to do so they would be horribly damaged’.
Which takes us back to Mr Lansley’s dilemma and the case for sharing Governmental dilemmas with the public. Any genuine economic and fiscal risk assessment carried out before the last election would have forced politicians to confront the issues more openly and honestly and would have prepared the voters better for what was ahead.
Medium term pain for long term gain: what’s true for the economy is true also for the quality of dialogue between politicians and citizens.
PS: On the subject of risk, it’s now less than 4 weeks until I try and do a mountain marathon in aid of the RSA Great Room appeal. I haven’t actually done a risk assessment, but on the basis that risk needs to be balanced by gain, all donations gratefully received …
Hannah Webster reflects on new research that highlights the difficulty for those with long-term health conditions to achieve economic security.