Ministers should heed warnings over accountability

This week it's Monitor's turn to warn that as the proposals stand, there is a risk of duplication of its own powers and a consequent lack of accountability.

This will be a problem not only for the foundation trust regulator and the new commission, but more importantly for any trusts that find themselves at one corner of a confusing three-way relationship at precisely the point they are encountering difficulties.

The Healthcare Commission and the Commission for Social Care Inspection, both of which already know their days are numbered, have also been issuing warnings that their replacement's powers would be weaker the way ministers envisage them at present.

Health minister Ben Bradshaw has rounded on them for changing their position. But they say they are between a rock and a hard place. As CSCI chair Dame Denise Platt put it: "We recognise the tsunami when it comes."

It is vital to distinguish between the inevitable disappointment of people working in organisations soon to be wound down and the invaluable advice they can give while still there. The new commission must take the best from these organisations and build on it.

Warnings over accountability should be heeded. As a leaked letter from Healthcare Commission chair Sir Ian Kennedy to health secretary Alan Johnson shows, it needs to be clear whose job it is to do what.

The King's Fund argues that many of these issues could be resolved via the proposed NHS constitution, which could set out clearly "where the buck stops".

This makes it of vital importance to listen to the think tank's warning that it must not be rushed. A constitution could clarify accountability, but it would be with us for many years. It must be meaningful and robust.