Clear accountability needed in NHS reforms

27 April 2011

27 April 2011 | Adam Leach

“Robust accountability structures” must be at the centre of NHS reforms in order to safeguard taxpayer money, the Public Accounts Committee (PAC) has said.

Under proposed reforms, responsibility for health commissioning will be taken from Primary Care Trusts, which will be abolished in 2014, and handed to newly formed GP consortia. In a report published today, the PAC said that despite reform being in its early stages “key questions still need to be asked”. In particular, it called for more clarity on who will be held accountable after the changes come into effect. 

Speaking as the report was published, PAC chairwoman Margaret Hodge MP, said: “The department (of health) must have effective systems in place to deal with failure so that whatever happens, the interests of both patients and taxpayers are protected.”

Giving evidence to the PAC on in January, Sir David Nicholson, who, through the reforms will become chief executive of the NHS Commissioning Board, claimed he will ultimately be accountable for GP commissioning. “You’ll hold me [accountable], through my accounting officer process for commissioning,” he said. Sir David will continue in his current role as chief executive of the NHS until the establishment of the new NHS Commissioning Board in April 2012, which will oversee GP consortia. However, after Una O’Brien, permanent secretary at the Department of Health claimed the buck stopped with her department, the committee voiced concern. “It’s a bit muddled. I just don’t quite get it,” said Hodge.

While the new reforms are intended to devolve power and cut bureaucracy from the NHS, the PAC said there needs to be more clarity about the lines of responsibility between Nicholson, O’Brien, regulators Monitor, the Care Quality Commission and the accounting officers for foundation trusts.

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