'Accountability in the NHS is a mess'

Accountability in the NHS is centralised, opaque and confusing. One of the central aims of the Health Bill, introduced this week, is to introduce clear and transparent accountability to the NHS.

Ministers will no longer be able to cut across the independent decisions made by the commissioning board or the regulators

There are many aspects to the new accountability system, too many for a short article. But I shall outline some of the main changes.

First, patient power. The central premise of the modernisation of the NHS is to put patients first. Patients and the public will have more direct control and influence over the health service than ever before. Patient choice will be extended into every area it is possible to do so. From choice of GP, hospital, consultant and even, where appropriate, treatment. As the money will follow the patient, their decisions will matter as never before.

The public will also be represented in local decision making through the new local HealthWatch organisations, a development of local involvement networks. The new NHS Commissioning Board and commissioning consortia will also have a clear obligation to involve people in their planning decisions.

Second, local authority power. This government believes that there should be real local democratic legitimacy for decisions about local services. Local authorities will have the power to require information and attendance at scrutiny meetings of any provider that is funded by the NHS. This includes the scrutiny of GP practices, dentists, pharmacies, and independent and voluntary sector providers.

Third, clear national accountability. The Health Bill will set out clearly the roles and responsibilities of the health secretary, the NHS commissioning board, commissioning consortia, Monitor, the National Institute for Health and Clinical Excellence and the Health and Social Care Information Centre.

While ministers will still be ultimately responsible for the NHS to Parliament, our role will be to promote the autonomy of NHS organisations and to set the direction of the health service through a mandate that will be subject to full annual public consultation.

This mandate will set out clearly what the government expects from the NHS within that year.

If something goes wrong in a consortium, it will be for the NHS commissioning board to act. If there is a failure in quality of care, it will be the Care Quality Commission’s responsibility. Ministers will no longer be able to cut across the independent decisions made by the commissioning board or the regulators.

A devolved NHS with independent providers and patient choice needs a system of accountability that is crystal clear. The provisions in the bill will provide that clarity.

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