Press release: NHS Confederation calls for strong accountability in the NHS
23 Jan 2008
The NHS wants and needs to be more accountable to patients and the public, says the NHS Confederation in a report launched today - Principles for accountability: putting the public at the heart of the NHS.
The NHS Confederation, through its Primary Care Trust Network, has explored ways forward to improve the local accountability of primary care trusts, through a consultation with its members and a seminar of leading experts.
Greater accountability can be achieved by:
- strengthening existing structures, in particular, health overview and scrutiny committees in local government
- more deliberative events to promote further public involvement in primary care trust decision making
- greater transparency and information for the public about how decisions are made
- building better relationships and more information sharing between local government and primary care trusts
Gill Morgan, chief executive of the NHS Confederation, commented:
"The NHS Confederation has long advocated for improvements in local accountability. However, there is a cross-party consensus against further structural change in the NHS, and the public are sceptical about political involvement in the NHS. This report demonstrates a real commitment from NHS managers to strengthen the transparency of decision making in the NHS and to consider ways forward. The success of PCTs rests on them focussing more on patient and public engagement"
The latest Healthcare Commission Annual Health Check showed that PCTs that have been reorganised do not always perform as well as the rest of the NHS. Further structural change will not benefit patient care or improve accountability arrangements.
While PCTs are already accountable to the public nationally through the secretary of state, to parliament through regulators and locally through local government, more must be done to increase understanding and legitimacy of trusts and their actions.
The NHS Confederation has outlined some clear principles for local accountability arrangements, intended to enable strong governance and decision making which involves local people.
These systems should be:
- clear, accessible and transparent - a core part of any local system
- inclusive - avoid sectional interest and take into account a wide range of views
- responsive - react to the concerns of local people and show how these have been considered and addressed
- sustainable - build relationships over a period of time to build trust on a personal and organisational level
- pro-active - a comprehensive approach to engagement and consultation
- able to deliver difficult decisions - this includes decisions around which services and treatments are funded; the public must be assured that their concerns will be acted upon as quickly as possible
- cost effective - investment or resources must be in line with patient benefit and bureaucracy avoided
- able to promote a reduction in health inequalities - while remaining inclusive, systems should demonstrate that health inequalities are being reduced, supporting the aim of the NHS to improve public health
David Stout, director of the Primary Care Trust Network says:
"Primary Care Trusts will not become more accountable to the public if they continue to be subject to constant reorganisation and restructuring. Some 80 per cent of our members want the present systems to be given a chance to fully develop. New accountability arrangements introduced by the government only last year need time to be established and used to their full potential. The proposed Local Involvement Networks (LINks) designed to give patients greater say in health services are still being set up. Local Area Agreements with local government are at an early stage. The Comprehensive Area Agreement has not yet been implemented. These systems need time to bed in."
"The majority of our members said there needs to be local flexibility in accountability arrangements coupled with national performance indicators. Primary care trusts need to develop solutions that are appropriate to their local circumstances, for example, a rural PCT covering several local authorities will need different arrangements from an inner city PCT. Arrangements must support work by the local NHS to tackle health inequalities and make the often difficult decisions that effect their local populations. A prescriptive national model is not the answer."
A MORI poll conducted on behalf of the NHS Confederation shows that the vast majority of the public do not want MPs and local councillors to take decisions about which treatments are funded by the local NHS. Some seventy per cent believed that clinicians working in the local NHS should do this, with 33 per cent favouring patient representatives and 23 per cent local NHS managers. Only nine per cent think MPs should be part of the decision making process and only six per cent think councillors should have a say.
Notes for editors
- The NHS Confederation represents more than 95% of the organisations that make up the NHS. Its members include the majority of NHS acute trusts, ambulance trusts, foundation trusts, mental health trusts, primary care trusts, special health authorities and strategic health authorities in England; trusts and local health boards in Wales; and health and social service trusts and boards in Northern Ireland.
- The PCT Network represents the majority of primary care trusts in England. It was established in December 2006 to provide a distinct voice for PCTs. The Network is part of the NHS Confederation;
Contact details
Contact Niall Smith 020 7074 3304 or 07767 770309, Ruth Kennedy 020 7074 3312 or 07884 47 3086, or Ruby Casey-Knight 020 7074 3306 or 07881 957305. For out of hours media enquiries, please call the Duty Press Officer on 07880 500726
Back to media centre
