A risk register is not news. Everybody has to manage risk. It means envisaging worst case scenarios and working out ways to reduce the risk that they occur and to limit the damage if they do. Government departments have lots of risk registers. National Voices has a risk register. So do you. People do not necessarily want to broadcast the contents of their risk registers. A more interesting story would be: who leaked these documents, and why?
A seven day NHS is a perfectly reasonable ambition for a government to cultivate. At its heart is the idea that illness (or accident or exacerbation) can strike at any time and your chances as a patient of a safe and effective response should not be determined by an accident of timing, any more than they should be determined by an accident of geography. A wristwatch lottery is as unfair as a postcode lottery.
The tricky workforce implications of achieving a genuinely seven day service are not exactly a secret. The fact that the government seems committed to its 2015 manifesto pledge, despite knowing the risks, hardly amounts to a conspiracy to undermine the NHS. If the default response in the face of risk was to give up, not much would get done.
Nevertheless, the government has a case to answer. What do they mean by a seven day NHS? It is not altogether clear. The BMA would argue that we already have a seven day service and they are partly right. Emergency services operate 24/7 - they need to. GP services don’t - they don’t need to. A seven day service can’t and shouldn’t mean that everything is available on a 24/7 basis. The overriding principle needs to be safety.
It doesn’t help that the evidence of fluctuations in safety throughout the week is unclear and contested. It appears that there is a 'weekend effect' with hospital inpatients more likely to die at weekends than on other days. But experts say this might have more to do with the state of the patients admitted than with the way hospitals are staffed at weekends.
It doesn’t help that the weekend effect has been a key rationale for changing the contract for junior doctors. Do we have the optimum deployment of health and care staff throughout the week and day? The answer is almost certainly no. It is a shame that this question has now become tainted by association with a national industrial dispute.
In fact much of the detailed work on deploying staff is a local matter. It's not just about emergency and acute care but about the whole pattern of services, and not just in hospitals. It would be much better if this work were done in partnership between commissioners, providers, clinicians, patients and local communities.
Above all, the risk register non-story has touched a raw nerve because it reinforces the sense that there is a mismatch between the government’s stated aims for health and care, which are on the face of it laudable, and the available resources, which increasingly seem unequal to the task. However defined, a seven day service will cost money. Is it affordable at a time when most trusts are in deficit and waiting times are lengthening? Can the staff deliver it when they are already working eight days a week? We should be reassured that the behind the scenes civil servants are advising ministers about the risks. But we are entitled to know what the government is going to do in the face of these risks.