The Health Secretary, Andrew Lansley, has suffered another major setback in his struggle to get his highly controversial plans for NHS reform on the statute book.
Risk assessments drawn up by the four English health regions warn that there is a high risk of the proposed reforms reducing safety and patient care and causing overspending. The internal reports warn of a high risk that the improvements in management and reduced costs that the reforms are supposed to achieve may not come about.
David Cameron is insisting on pressing ahead with the Health and Social Care Bill in the teeth of opposition from health professionals and the public, despite the risk that it will damage his efforts to change the image of the Conservative Party by insisting that it poses no threat to the NHS.
The assessments were drawn up last month for the four NHS regions – London, the South of England, the Midlands and East of England and the North – created last year by merging smaller regions. In London, officials have warned that there is a high risk of losing key staff, which, combined with poor information sharing, could lead to a "preventable harm to children".
Last year, civil servants at the Department of Health drew up a one-off national-risk register that is thought to have raised similar concerns. Mr Lansley is fighting a legal battle to avoid having to publish it. Risk assessments are intended to highlight future problems so that they can be averted; such reports are not normally published because officials say the prospect of publicity would inhibit those drawing them up from giving frank advice to ministers.
The risk assessment for the North of England warns that the drive to achieve higher productivity could have a major impact on the quality of health care. It also claims there is a high risk of "organisational and system instability" damaging the quality of management, and uncertainty caused by the changes that could reduce the performance of staff and organisations.
Lower-rated problems – still considered high risks – cover a wide range after existing mitigation, including a "loss of grip on current performance". The assessment determined "safety is compromised by lack of clarity on accountability, poor morale, and loss of knowledge", the benefits of the reforms are not achieved and there is a loss of public confidence in the NHS.
The report for the Midlands and East of England warns of the upheaval likely to be caused by management changes and targets to cut spending. It also warns of the potential for conflict between different parts of the NHS, reduced quality and safety, neglect of primary care and overspending
Peers overrule £100m cut in housing benefit
The Government lost yet another vote on its Welfare Reform Bill in the House of Lords last night.
In the latest of the upper house of Parliament's objections to the proposals, peers passed an amendment rejecting a £14 cut in housing benefit payments to disabled people, war widows and foster carers who have one spare bedroom, negating the so-called "bedroom tax".
Should the Lords succeed in seeing the amendment passed into law, their latest intervention would cost about £100m.
But as with many previous changes peers have made to the Bill, it is likely that MPs will remove the amendments when the proposed legislation goes back to the House of Commons.