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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.’