Viewpoint: Reconsidering accountability in an age of integrated care

This paper examines the future of governance and accountability in the NHS and social care amid the rise of new provider models.


Published: 14/07/2015

ISBN: 978-1-910953-01-3

Download the Viewpoint [PDF 464.5KB]

Last year’s Five Year Forward View in late 2014 called for a shift from traditional NHS structures to provider models which would unite hospital care, community care and general practice. These new arrangements have considerable implications for the way that local services are budgeted, as well as the role of Clinical Commissioning Groups. 

In this Viewpoint, Ben Jupp argues that the purchaser-provider split, after 25 years, will lose its position as the cornerstone of NHS structure and accountability under these developments. If the health service is to remain fit for purpose, the paper stresses the need for these new providers to be held to account in new ways.

Accountability arrangements are critical to any system. They set the framework for strategic decisions about how services are provided and to whom, the quality of those services and whether the funds available are well spent. They determine how much say local people and users have alongside regulators and national and local politicians. Weak, poorly designed accountability arrangements are likely to lead to strategic or service quality failures or poor value for money.

Andy McKeon, from the foreword

In the paper, Ben recommends that these new integrated providers will need careful attention and robust regulation, including tougher licensing and a possible ban on becoming profit making companies, in order to mitigate some of the risks. Local authorities must overcome the steep financial pressures they face and support democratic accountability across health and social care. Clinical commissioning groups must also find a new role, as strategic and population health responsibilities pass over to new providers.

The paper aims to raise the debate around these challenging issues, and includes expert responses to Ben’s viewpoint from Stephen Dorrell, former Secretary of State for Health; Cllr Izzi Seccombe, Leader of Warwickshire County Council; Jan Sensier, Chief Executive of Engaging Communities Staffordshire; and Dr Steve Kell, Co-chair, NHS Clinical Commissioners. 

Suggested citation

Jupp B (2015) Viewpoint: Reconsidering accountability in an age of integrated care. Viewpoint. Nuffield Trust.