Health Solutions

For the first half of the 2000s, the Chief Executive of the NHS was the man in charge, with clear accountability for the NHS’s success or failure at national and local level.

There was of course a degree of political interference, most notably in response to evidence of national failures, for example the introduction of waiting list targets, health inequality targets, and latterly the Vital Signs targets. There was also political interference at the local level, with MPs accountability to their electorate leading to them campaign vigorously to over-turn proposals to close NHS facilities, often despite overwhelming clinical evidence. Nevertheless the system of accountability for the use of NHS resources seemed clear.

The seeds of change were sown in the mid to late 2000s. Firstly with the establishment of Foundation Trusts, with their own accounting officers, followed by initiatives aimed at enabling the Department of Health and the NHS Executive to devolve responsibility for decision making to the front line.  But in exchange for increasing freedoms, came an increase in the role and responsibilities of regulatory bodies, particularly for Monitor and the Care Quality Commission (CQC). There then followed what has been  a more seismic shift in accountability and responsibility, with the election of the Coalition Government and Andrew Lansley’s vision for  “Liberating the NHS” and the Health and Social Care Act 2012.

All was clear, reforming the health system was going to remove central day-to-day strategic management and control of the NHS.  The Department was to be responsible simply for the stewardship of the system as a whole with the permanent secretary of the Department having sole accounting officer responsibility for the proper and effective use of resources voted by Parliament; supported by a system of assurance around the commissioning, provision and regulation of healthcare.  So that’s clear, or is it? The reality of the last 12 months looks