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'Confused and opaque' NHS England insufficiently accountable to the public, says MP report

NHS England is ‘confused and opaque’, and lacks enough accountability to the public, an influential group of MPs has warned.

As the largest public body in England, with an annual budget of £95.6 billion, NHS England’s accountability to the public ‘should not be in any doubt, but the current arrangements for it are extremely complicated and still evolving,’ the Commons public administration select committee (PASC) said.

It singled NHS England out in its report on arm’s-length public bodies released today, saying it was a prime example of the ‘inconsistent and cluttered system of quangos, executive agencies and non-ministerial departments’, that were ‘poorly understood even in central government and where accountability is confused, overlapping and neglected, with blurred boundaries and responsibilities’.

The PASC said that ‘arm’s-length Government is confused and opaque’ with ‘inconsistent’ organisational forms and names and accountability arrangements and reforms which ‘so far have been ad hoc’.

The report stated: ‘However complicated the arrangements may have to be, there is no excuse for lack of a clear understanding of statuses, roles and relationships. It is not acceptable that the Department of Health took more than two years to update its “accountability system statement”. This left accountability relationships unclear during a period of major organisational change.’

PASC chair Bernard Jenkin MP said: ‘Vast amounts of money are involved here, £95.6 billion in the case of NHS England alone, and it is simply not acceptable that there is no clarity or clear accountability for that kind of public expenditure.’

He added that whichever political party wins next year’s general election has to clarify the structure of government.

He said: ‘The architecture is not meant to be reminiscent of the film, “The Matrix” where doors open on virtual worlds which are insulated from reality and hidden from the public and from those meant to be accountable for them.

‘Whoever wins the election, there is bound to be more change in the structure of Whitehall, involving arm’s-length bodies. It would be very helpful to any government with a new mandate to establish a clear framework for such decisions before the election.’

Readers' comments (15)

  • any chance of restarting with a competent NHSE then?

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  • Andrew Lansley's changes worked well then....

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  • ..maybe we could vote in some politicians with experience in public relations to brain storm a plan in an office in London to reorganise the whole thing...again

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  • Vinci Ho

    Please do not 'insult' one of my favourite films all time.
    The 'architect' in Matrix deliberately created virtual reality to fool ordinary people so that the machines can divide and rule human beings with no resistance in a world of dystopia.
    On that tone, NHSE had performed 'very well'? What the government perhaps had underestimated was the resistances from medical professions.
    Hence , people like Darth Vader and Agent H can just put all the blames on NHSE at the end of the day. Sorry, not too much sympathy for those who worked for the devil , you should know one day you would be betrayed by the devil anyway.......

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  • Opacity in NHS is a major problem.
    I questioned my Carr-Hill details as was being paid for more than 500 patients less than actual list size. The incomings were only 28000 up while weighted list size was up by 1000 patients.
    The guys in OpenExeter said to me; 'Your data is being changed manually at the Primary Care Agency'. But when I asked them to put this in an email - two of them on different occasions declined to do so because ' My Boss won't allow me to do that'.
    So with 1200 patients beyond 3 miles, the Rurality index did not budge and is still below 1 meaning thereby that global sum is effectively reduced by that facotr.
    When we began to input mileage into patient registration, there was a hue and cry at the Kent PCA for two months and we were told to remove this data.
    Solution: Start by liquidating NHSE and stop the same people moving from one County to the other when things get hot for them. When you have a failed Director or Chief Exec, sack him or give him a position suitable to his capabilities but don't make him an Advisor or Director where he may fail agin. Protect him please from his/her own follies and weaknesses:)

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  • In my opinion, NHSE isnt opaque and confused. Its simply malicious towards GPs.

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  • nhse is a revolting unaccountable bullying disorganised overpaid shower of absolute incompetents with no mandate whatsoever for their bizarre and evil nhs wrecking..GPC we need ruthless confrontation .....i think most GP's are so sickened with them and the catastrophic damage they are doing to patient care that there needs to be an end to all co-operation with this repellent deluded failed out of touch unelected quango.

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  • surprise surprise.
    time to break apart this unaccountable unelected failing incompetent quango and expose its weird agenda to public scrutiny..they behave in a dictatorial way as though they think they are not a public body and operate behind an iron curtain.

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  • "Anonymous | GP Partner | 11 November 2014 0:42am
    nhse is a revolting unaccountable bullying stalinist disorganised overpaid shower of absolute incompetents with no mandate whatsoever for their bizarre and evil nhs wrecking"

    But its critics are less kind.....

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  • "nhse is a revolting unaccountable bullying stalinist disorganised overpaid shower of absolute incompetents with no mandate whatsoever for their bizarre and evil nhs wrecking.."

    I'm so glad you have taken care not to generalise.

    After all, everybody who works in the public sector is a money grabbing incompetent who was fully behind the Tory government plan to destroy the NHS and the public sector as a whole. But hang on, why would NHS workers want to destroy the NHS? Oh well, no time for logic now.........

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