Is FOI costing the NHS?

A guest post from Paul Gibbons

Browsing through the written evidence from public bodies submitted to the Justice Select Committee in advance of the post-legislative scrutiny, there is a common complaint. FOI is an expensive use of public bodies’ limited resources, and money spent on answering FOI requests is money not spent on providing the core public services that those organisations are there for.

The most emotive arguments on these grounds come from bodies linked to the NHS. Just last week, Sue Slipman of the Foundation Trust Network wrote that “NHS bodies are being forced to spend millions on FoI instead of patients and the rules need to change”. On first reading, this is a persuasive argument.

Of course FOI costs money. Providing any service, and indeed scrutinising any service, costs money. Sue estimates that the cost of FOI to the NHS is £30 million. She does not set out how she reached this estimate, but most people would agree that £30 million is a large amount of money.

However, as always, it depends how you look at it. The budget for the NHS in 2011/12 is £105.9 billion. I’m not great with my maths, but by my calculations, £30 million is approximately 0.03% of the total NHS budget. In other words 99.97% of the budget is unaffected by FOI, even if you accept the estimate put forward by the Foundation Trust Network.

Whilst we’re playing with statistics, I’ve been doing some digging. According to a House of Commons Library briefing real terms expenditure on the NHS between 1999/00 and 2009/10 rose by 88%. The average rise in annual expenditure on the NHS between 2000/01 and 2009/10 was 6.5% – the highest in the history of the NHS. Spending on healthcare in the UK in 2010/11 made up 18% of all Government spending – the joint highest area of expenditure.

Is it really that unreasonable that a very small proportion of all that money should be spent on allowing the public (who pay for it through their taxes, let’s not forget) to scrutinise the NHS?

And as I’ll be saying a number of times during this campaign, any assessment of the cost of FOI has to be set against its benefits. FOI requests to the NHS have established that a very similar amount to the £30 million spent on FOI is spent on chaplains each year. We also now know that Capita makes £92 million from the NHS annually. Earlier this month the Mail on Sunday told how it used FOI to expose controversial close links between the NHS and McKinsey & co. It reported that McKinsey has already earned at least £13.8 million from the NHS since the Coalition Government came to power, and is positioned to make more should the proposed reforms of the NHS be completed. We will never know of course whether awareness of the public’s power to scrutinise the NHS has prevented significant expenditure in some situations. But I bet it has.

Let’s assume for a moment that you’re not quite convinced, and you still think FOI costs too much to the NHS. Well, even Sue Slipman suggests how that cost could be reduced without removing the rights of the public to question authorities. She says:

“Some trusts are making huge efforts to publish more information on their websites so that patients and the public can find information. One trust has found that this led to a small fall in FoI requests. When the information is already published as part of a publication scheme or in a virtual reading room, or has been requested previously, the FoI requestor can be referred directly to the publication scheme.”

This rather suggests that there is scope for NHS Trusts to manage the impact of FOI rather more effectively than they do at present. This is very much in line with the evidence provided to the Committee by Jim Amos of University College London’s Constitution Unit last week when he compared the performance of different authorities in responding to FOI requests. He suggested that in many cases, the authorities claiming that answering FOI requests took many hours often had very inefficient processes for dealing with FOI requests.

I am not unsympathetic to the NHS and its view of FOI. Between September 2009 and May 2010 I worked as an Information Governance Manager in an NHS Hospital Trust, so I have experience of dealing with FOI within the NHS. There was some irritation from colleagues at having to answer FOI requests when they were clearly under a range of pressures from all quarters. And it is difficult to say to a senior nurse or consultant that they should prioritise answering an FOI request over other activities.

However, in my experience, answering requests rarely involves clinical staff. Even when it does, they are the most senior clinical staff – the Medical Director, the Director of Nursing, for example. Their roles already involve administrative work, and they are paid handsomely for it. It is simply not true to say that time spent answering FOI requests is time not spent on patients in the vast majority of cases. And let’s be clear. Removing or limiting the demands of FOI will not stop NHS Trusts having to deal with patient complaints, answering general correspondence or, as Tim Turner pointed out, having to answer Environmental Information Regulations requests. There will still be significant administrative demands on the NHS.

If NHS Trusts want to cut the cost of FOI, they should look first at how efficient their processes for handling FOI requests are – and for instance, whether they are publishing enough information. And they need to consider the bigger picture. The vast expenditure on the NHS should be subject to scrutiny. FOI is one way in which it is held to account and it costs relatively little to administer.

Paul Gibbons is an FOI Officer for a public authority, and blogs at foiman.com You can also find him on twitter under the name @FoIManUK

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