NHS reform must improve transparency and accountability

July 09, 2010 12:52 PM

There are big changes happening in the NHS - and on the surface of it, many of them are positive. The idea that GPs are best placed to understand local patients' needs and therefore best understand how money should be spent is a good one. This means that the bureaucratic Strategic Health Authorities (SHAs) would be drastically scaled back or scrapped, depending on which report you read. We've said before that they are unnecessary and expensive bodies that implement central government diktat, so the latter would be a more robust and preferable option.

On this morning's Today programme the acting chief executive of the NHS Confederation, Nigel Edwards, said that there were some "significant risks" with the proposed reforms. The current system where PCTs control financial management and assess performance will move to one where smaller contracts are placed based on individual decisions made by GPs. But this could be a positive thing: it could mean a less monopolistic system as large, one-size-fits-all contracts are replaced; and since PCTs usually follow the instructions of the SHAs, a less centralised one too.

But as always, there must be a note of caution. More details will be announced next week in a White Paper but if GPs are to be handed more responsibility, then it's imperative this is matched with full transparency. For example, GPs salaries are notoriously hard to pin down, while medical staff in Primary Care and Acute Trusts are open to more, if not full, scrutiny. What must be avoided is a situation where GPs are allowed to engage in shady deals with providers, meaning that patients and taxpayers lose out. Contracts, details of transactions, salaries and everything else for that matter have to be made fully available to the public.

Another related worry is that there will be a lack of accountability. The current heavily centralised system has many of its own issues with accountability of course, but it's right to worry about this. The White Paper must set out clear, robust rules on transparency and accountability so that everyone involved - GPs, PCTs, hospitals, contracted companies - know where they stand, and most importantly are accountable to patients.

There are big changes happening in the NHS - and on the surface of it, many of them are positive. The idea that GPs are best placed to understand local patients' needs and therefore best understand how money should be spent is a good one. This means that the bureaucratic Strategic Health Authorities (SHAs) would be drastically scaled back or scrapped, depending on which report you read. We've said before that they are unnecessary and expensive bodies that implement central government diktat, so the latter would be a more robust and preferable option.

On this morning's Today programme the acting chief executive of the NHS Confederation, Nigel Edwards, said that there were some "significant risks" with the proposed reforms. The current system where PCTs control financial management and assess performance will move to one where smaller contracts are placed based on individual decisions made by GPs. But this could be a positive thing: it could mean a less monopolistic system as large, one-size-fits-all contracts are replaced; and since PCTs usually follow the instructions of the SHAs, a less centralised one too.

But as always, there must be a note of caution. More details will be announced next week in a White Paper but if GPs are to be handed more responsibility, then it's imperative this is matched with full transparency. For example, GPs salaries are notoriously hard to pin down, while medical staff in Primary Care and Acute Trusts are open to more, if not full, scrutiny. What must be avoided is a situation where GPs are allowed to engage in shady deals with providers, meaning that patients and taxpayers lose out. Contracts, details of transactions, salaries and everything else for that matter have to be made fully available to the public.

Another related worry is that there will be a lack of accountability. The current heavily centralised system has many of its own issues with accountability of course, but it's right to worry about this. The White Paper must set out clear, robust rules on transparency and accountability so that everyone involved - GPs, PCTs, hospitals, contracted companies - know where they stand, and most importantly are accountable to patients.

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