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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)

  • 'Confused and opaque NHSE" - it certainly is:

    Simon Stevens addressing GPs five weeks ago:
    ...should we back the arrangements that now exist in Northumberland and Newcastle where you could say that single organisation like a hospital could also provide list-based general practice on the same terms as GPs?

    Ian Dodge, National Director, yesterday:
    NHSE Board paper 111406, Commissioning Strategy:
    Item 5. Co-commissioning could potentially lead to a range of benefits for the public and patients, including:
    • Improved access to primary care and wider out-of-hospitals services, with more services available closer to home;
    • High quality out-of-hospitals care

    Mike Bewick, NHSE deputy medical director and ex-GP, last week:
    Up-skilled GPs, “specialist generalist” or “hospitalists” as the Americans call them, could be working across hospital and community settings to reduce the cost of running the acute beds and improve care continuity.

    What are our BMA & RCGP "leaders" doing about it?
    (polite answers only please)

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  • presumably they don't read the criticisms so how does the message that they are unwanted/umloved get across or is the most important question at interview 'do you have athick skin?' do you give a toss about patients or GPs or even the NHS? or is this a practice run for your next vile job?

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  • 'Up-skilled GPs, “specialist generalist” or “hospitalists” as the Americans call them, could be working across hospital and community settings to reduce the cost of running the acute beds and improve care continuity.'

    And turning 'ordinary' GPs into glorified community housemen/women?
    Hospital docs have become so specialised they refer to GP all the time! The 'divide' works by stopping GPs meddling in what they do not know and vice versa.
    We've all seen the mess that trying to deliver hospital at home causes.

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  • It must be awful to work for NHSE. There must be some people who work there who are trying to do their best.

    But to be stuck in such as evil organisation must be soul destroying. I really hope if there are honourable people left within NHSE they speak out sooner rather then later when saving the NHS will be too late

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  • andrew Field

    Personal grievances and upset, conspiracy theories and privatisation agendas abound. Vitriol and contempt are inevitable.
    My view is that the take home message lies in the following paragraph laying out the immense problem and cost of major organisational change:
    "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": Exactly!
    It is the repeating cycle of major organisational change and the confusion of multi-agency accountability and remit that is at the heart of the NHS' problems. I think this is well known and it has to stop or the NHS will crumble into nothing.
    Is privatisation the only conceivable outcome of the need to create efficiency and depoliticise the NHS? Unless a genuine political alternative is found the service will definitely be fragmented and the core of the whole service delivery ethic lost, never to be recovered. The real legacy following on the heels of Olympic triumphalism will a patchwork postcode lottery of fragmented non-comprehensive care, increasingly unaffordable and incoherent for future generations.

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