The Liberal Democrats' health spokesman has criticised the 'complete lack of transparency' around Department of Health decisions.
Speaking at a lecture organised by the NHS Confederation, Norman Lamb said the way DH leaders operated was "completely opaque".
He said: "There is a complete lack of transparency among the leadership of the DH.
"No one has the foggiest idea how decisions are reached between [NHS chief executive] David Nicholson and the rest of the team."
The Liberal Democrats would impose a "substantial cut" on the DH and introduce a national commissioning authority with a transparent relationship with ministers, he said.
Other policies were to empower communities through locally accountable health boards and local tax-raising powers. Primary care trusts would have a legal duty to provide value for money.
In addition, entitlements would be used to improve access in areas such as mental health that are not subject to government targets.
"We have an 18-week maximum waiting time for other, physical, healthcare, but not even the blunt instrument of a target for mental health," he said.
Using the example of psychological therapies, he said patients would have to wait no longer than 13 weeks for treatments recommended by the National Institute for Health and Clinical Excellence, or receive private care.
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