ourNHS: Opinion

Why did the government say revealing NHS plans is not in the public interest?

The government has denied my Freedom of Information requests. At this rate, we’ll know who is redesigning the NHS only once it’s too late

caroline m.jpg
Caroline Molloy
12 February 2021, 11.43am
The past year has, more than ever, brought home the need for a properly run NHS
Peter Byrne/PA Wire/PA Images

When I discovered late last year that Downing Street had a secret taskforce, headed up by prime minister Boris Johnson’s controversial policy chief, Munira Mirza, which is reportedly planning major NHS reforms, I was intrigued.

After all, the past year has, more than ever before, brought home how essential properly run health services are to our daily lives.

So it seemed reasonable to use Freedom of Information (FOI) law to ask for copies of the advice being given to Downing Street by the taskforce, on how it should shake up the NHS, as well as information on who was advising the taskforce and its ‘Steering Group’.

My request felt even more pertinent given the small handful of names that the government has admitted are on the taskforce, including Adrian Masters – who, alongside his former McKinsey colleagues, had a huge role in writing the major, and destructive, NHS reforms of 2012. (I’ll come on to the new plans to supposedly “reverse” those reforms in a moment.)

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But the government – after initially instructing me to narrow my request, which I did – has now told me that it’s not in the public interest – our interest – to know the scope of what it is talking about, or with whom it is communicating, in relation to the Downing Street NHS Taskforce.

This is not a one-off. These FOI refusals from the government are becoming all too common. This is why, earlier this week, more than a dozen current and former national newspaper editors signed openDemocracy's public letter calling for MPs to urgently investigate the government's handling of FOI requests.

Given what’s happened to our Freedom of Information rights in recent years, I’m not surprised. But I am dismayed – and alarmed.

‘Solutions’ – but not for the public

During this pandemic, ministers have demonstrated their inability to sort out essential public health needs without turning to an army of management consultants and tech firms to decide their vision.

These private firms have been shaping what infrastructure and services are provided, when, and to whom – as well as what of our personal data is shared. They have dished out the ensuing blizzard of contracts to the outsourcing giants they have on speed dial. The consultants’ ‘solutions’ inevitably seem to suit the consultants and their corporate friends, if not the public’s actual health needs. The contracts that are emerging seem to tie the UK state into ever deeper and more opaque dependency on the consultant-outsourcing nexus, whether in terms of health data, the setting up of new testing and pathology services, or the provision of essential health supplies.

So is it not in our interest to know the extent to which these people are now involved in the biggest task of the 2020s: shaping the future of our health service, post-pandemic and post-Brexit?

The government disagrees. In its response to me, it has fallen back on one of the most abused exemptions in Freedom of Information law – that to reveal anything at all about what it is discussing, and with whom, would have a “detrimental impact on the ongoing development of policy” and hinder its ability to talk “freely and frankly”.

This is a ‘qualified’ exemption under the Freedom of Information Act (section 35(1)(a)) – in other words, one that has to be weighed against the public interest in transparency. But the Treasury – which has taken the lead in responding to my requests – tells me that its staff have weighed this up and decided that whilst they do understand the “inherent public interest in transparency and accountability….[and] in the work of government departments being transparent and open to scrutiny to increase diligence” – the public interest is nonetheless, best protected by secrecy.

I am challenging these FOI refusals. If the cogs turn at their usual pace, we might eventually know who is redesigning the NHS and to what ends – but only once it’s too late

The only thing the Treasury is willing to reveal is that the discussions relate to “health and social care priorities for the duration of this parliament”. This sounds pretty significant, particularly as we already know the government is planning major upheaval while the NHS is already reeling.

Indeed, it gets worse. The Treasury’s response was secretive. But the Cabinet Office’s response (on behalf of 10 Downing Street) was simply unbelievable.

The Cabinet Office told me that Number 10 had no records of any documents, emails or briefings that the Downing Street NHS Taskforce shared with Munira Mirza. Last summer, Mirza chaired weekly meetings of the taskforce’s Steering Group. Are we really to believe there were no paper or electronic materials produced, circulated, and retained, to support their deliberations?

A wearying process

I am challenging these FOI refusals, of course. But as every journalist knows, requests for internal reviews and appeals to the Information Commissioner’s Office are a wearying process. If the cogs turn at their usual pace, we might eventually know who is redesigning the NHS and to what ends – but only once it’s too late.

Of course, ministers and civil servants need space to bounce policy around. But what can possibly be the public interest defence in not revealing who they are being briefed by? And what of the principles underpinning our democratic consultation rights, that the public has the right to know about major reform plans at a formative stage, not just when the i’s are being dotted and the t’s crossed?

Perhaps you think I’m worrying about nothing. After all, last weekend’s leak of a draft white paper on NHS reform, which was subsequently filtered through the soothing lens of the BBC, told us that Boris Johnson’s government is getting rid of all that nasty NHS competition that former health secretary Andrew Lansley and ex-prime minister David Cameron introduced.

The narrative in the white paper leaves the door wide open to private firms making a packet from providing the bits of health services they want – and to cutting to the bone, the bits the private firms don’t want

Except, of course, when you read the white paper, published on 11 February, it says nothing of the sort. In fact, it doesn’t tell us very much at all. You can interpret it optimistically, tuning your ears to the reassuring narrative, or sceptically, noting the lack of key details. In fact, the narrative in the paper itself leaves the door wide open to private firms making a packet from providing the bits of health services they want – and to cutting to the bone, the bits the private firms don’t want.

Earlier this week, The Times reported that under the new plans, private firms will be advised to take the NHS to court if they fail to secure the contracts they want, and those holding NHS purse strings will have to pay for patients to attend a wider range of private facilities. So far from reversing earlier privatising reforms, it now appears the initial reports were rather over-optimistic, which was also the case with an earlier draft of these plans.

While much remains hidden, one thing appears crystal clear from the leaked draft white paper: ministers are grabbing back political control over the NHS. No longer is there to be a pretence – as we had in 2012 – that it’s doctors, or even NHS managers, running the show.

That’s why it is even more crucial to know which individuals, organisations and corporate interests have the ear of the government and its advisers, and what they’re whispering. That’s what Freedom of Information is there for.

Of course it’s ‘sensitive’. It’s also about our health and livelihoods. We deserve better. It’s time to end this drip-feeding of misleading and vague narratives whilst the real work goes on in the shadows.

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