Acceptance of NHS reform could hinge on accountability

If the Government’s listening exercise can encourage ministers to clarify the lines of accountability, the decentralisation introduced in the Health and Social Care Bill may be more widely accepted. The Institute’s recent report, Nothing to do with me? put forward guiding principles on ministerial accountability within decentralised services. The report argues for a new consensus about the accountability of ministers, as well as officials, as services are devolved. Greater clarity is needed on two fundamental points: what a minister should properly be held accountable for, and how Parliament can best play its role in holding ministers and others to account. Guiding principles The report suggests two guiding principles: the use of public money should always be subject to ultimate scrutiny and oversight by elected public representatives, acting on behalf of taxpayers accountability should be aligned with effective responsibility, with scrutiny and oversight focused first on the person or body with the most appropriate remit and powers (see page 9 of the report). Putting these principles into practice implies an end to top down accountability by default. But changing perceptions of who is accountable takes: time clarity about who is responsible for what actions within decentralised services political skill and discipline [...]