A new chief executive in a new NHS and questions of accountability

It very nearly goes without saying that Simon Stevens will take on huge responsibility when he assumes the NHS top job in April, taking over from current NHS England chief Sir David Nicholson.

But responsibility – and more perhaps importantly accountability – are still huge issues the health service is grappling with.

Take just one programme – the National Programme for IT (NPfIT) in the NHS. The widely accepted failings of this multi-billion pound taxpayer funded project are still causing MPs frustrations over wasted resources and failure to deliver on core objectives. But they have also struggled to hold people to account.

Sir David had been the most recent senior responsible owner for NPfIT. And he has faced many grilling questions and criticism from frustrated MPs over the matter, who had already seen accountability passed between several individuals during the life of the programme.

Since NPfIT was dismantled, responsibility for elements that still exist have been transferred away from Nicholson. Tim Donohoe is now the senior responsible owner for the local service provider programmes that are going forward into the future.

But now, especially as Nicholson gears up to leave the health service altogether, can anyone be held accountable for the past on NPfIT?

Accountability in the health service is arguably more important than almost anywhere else. It’s often a very real question of life and death. And accountability is also a big thing when it comes to spending public money – the NHS does a lot of that.

Influential politicians have been growing more concerned about just how open to scrutiny the health service will continue to be in the changing landscape – in the new NHS that Simon Stevens will inherit.

In fairness there are some signs of movement towards better accountability that are being driven forward from the centre, especially as Tim Kelsey’s data revolution takes hold. Take for instance the online release of ‘death rates’ for surgeons. Or the results from the new Friends and Family test. There are also a whole host of statistics that are released on the performance of services, like the highly controversial NHS 111, and all at a time when health organisations are being caught up in the government’s transparency and open data agendas.

On top of that there are already examples of new NHS bodies answering for the mistakes of organisations that now no longer exist. For example, NHS England was on the receiving end of a £200,000 fine from the Information Commissioner’s Office for “one of the most serious” breaches of the Data Protection Act ever encountered. It was committed by, now dissolved, NHS Surrey. Whether NHS England picking up the fine is the same as being fully accountable for such a serious incident though is another debate.

Other signs point to fears of a health service that is shrouded in mystery.

Many groups were infuriated when the government blocked the release of risk assessments of the then Health and Social Care Bill, despite being ordered to release documents by the Information Commissioner and an information tribunal.

Grahame Morris gained 111 signatures from MPs for his House of Commons early day motion to extend the Freedom of Information Act to cover private healthcare companies, which he feared were being favoured over the NHS for billions of pounds of healthcare contracts and that the companies would be able to “hide behind commercial confidentiality”.

And Margaret Hodge, chair of the Public Accounts Committee said in an interview earlier this year that it was “no good trying to pass the buck” as services are transferred to new organisations in new delivery models. “They have got to make it absolutely logical and easy to follow the taxpayer’s pound,” she said.

This all comes as clinical commissioning groups are being encouraged to outsource their transactional and business support services to commissioning support units – which will become entirely independent market suppliers when they are no longer the responsibility of the NHS Business Services Authority, a Department of Health arms-length body.

And so with all this facing the health service, just how Stevens picks up the responsibilities and accountabilities of his predecessor will be interesting to see.

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