The question of national accountability in the English NHS has come to the fore following the 2012 Health and Social Care Act, which has led to a new system of accountability with power dissipated across several national organisations. This can appear from the outside to be a fragmented approach in which NHS providers and others are often subjected to conflicting messages. A reasonable question resulting from these changes is therefore: who is in charge, for what are they accountable, and who is ultimately accountable for what is provided to patients and service users in return?
With various national organisations now in play, including NHS England, the Care Quality Commission, NHS Improvement, Public Health England and of course the Department of Health, this seminar discussed the role of national accountability and decision making in the NHS, focussing on central power and how this may impact local decision making.
Key questions that will be considered are:
- Are the current arrangements clear and, if not, how can they be improved?
- How aligned, or otherwise, are the various national statutory organisations? What are they each statutorily accountable for and where do their respective responsibilities begin and end?
- With operational independence increasingly devolved from the Centre to arms-length bodies such as NHS England, are the ways in which political leaders operate aligned to the vision of the Lansley reforms?
- With the NHS facing a prolonged period of constrained funding, are current accountability mechanisms at both national and local level clear about how and where prioritisation decisions are best made?
- And, finally, what impact do current national accountability arrangements have on patients? Is it clear who within the system is responsible for their care?
The roundtable brought together around 15 parliamentarians, policymakers and representatives from national stakeholder bodies to consider these key questions. The seminar was hosted by Dr Sarah Wollaston MP, Chair, Health Select Committee, and co-chaired by Nigel Edwards, Chief Executive, Nuffield Trust. Pfizer provided a grant to cover the cost of this event, and the Nuffield Trust maintained control over the programme content.