Health reforms pose a threat to NHS, warns draft risk register According to the draft document, "The NHS role in emergency preparedness/responsiveness is more difficult to manage through a more devolved organisation, and so emergencies are less well managed/mitigated." The list ranks the risks according to their likelihood and impact on a scale from one to five, before multiplying the scores to reach an overall total. Some 14 of the potential risks in the draft register have a total impact and likelihood score of 16 out of a maximum of 25. Other risks include the potential that "financial control is lost due to the restructuring of budgets distributed between or allocated to organisations within the system." At one point, the document warns of the risk that "costs of the future system cannot be controlled." Last year, the estimated savings of the reforms was revised down to just under £4.5 billion while the cost of the transition was estimated at £1.2 to £1.3 billion. The draft risk register also raises the issue of industrial action among workers angered by the reforms. It said: "Staff concern and union action relating to certain workforce options ... result in deterioration in relations, lower productivity in DH [Department of Health]/NHS; delays in programme." Another highly likely and damaging risk identified by the report was the public reputation of the health services. There is a risk that the transition will be presented in a negative light via the media. Two of the biggest risks which have already surfaced in the media are i) that the reforms will continue to be characterised through the prism of privatisation and ii) financial cuts," it said. In a last-ditch attempt to delay the reforms last week, shadow health secretary Andy Burnham accused the Government of gambling on the future of the NHS without allowing the public to see the potential risks. Health Secretary Andrew Lansley, who has been criticised for his handling of the bill, said at the time the register set out a "worst-case scenario." Liz Kendall, the shadow social care minister, told the Guardian it was "a damning indictment of the health bill." She added: "It shows beyond doubt the high risks the bill poses to patients and taxpayers. The government has repeatedly tried to hide these risks, but its own assessment of the bill makes them devastatingly clear. Patients and the public will not forget or forgive David Cameron for his reckless NHS gamble. A Department of Health spokesman declined to comment on the leak.