NHS accountability debate ‘lacks clarity’
pharmafile | April 17, 2008 | News story | |Â Â Â
A leading thinktank has criticised what it calls a lack of clarity in the debate over accountability in the NHS.
The King's Fund said while politicians have fallen over themselves to talk about making the health service more locally accountable, there is considerable doubt over what this actually means.
The thinktank's new report, Should Primary Care Trusts Be Made More Locally Accountable?, says that "accountability" could be interpreted as meaning local people should be consulted ahead of changes in services, or PCTs should provide information on how decisions are made, or that the public has the right to demand certain services and even the power to remove health bosses.
The report also suggests it is not even clear to what extent people want more control over how PCTs spend their money.
Report co-author Ruth Thorlby explained: "While people have strong views about big, one-off changes to their local services – like the closure of a ward – there is little evidence of public demand for an active role in deciding how health service money is spent day to day."
The paper is the Fund's latest broadside ahead of the completion of the review by surgeon and health minister Professor Ara Darzi into the future direction of public healthcare.
Darzi, appointed last July by Gordon Brown, is expected to deliver his verdict in time for the NHS's 60th anniversary in July this year, and allowing local people to have more say over how their healthcare is delivered will be a central theme.
Report co-author Richard Lewis said: "Giving power to local people raises various questions, such as what happens when local people want to keep a service that national policy has deemed should close, or they want access to a treatment that NICE says is not cost effective?"
Greater local decision-making would lead to more variation in services, adding to the impression of a postcode lottery, the report adds.
"Governance of the NHS is highly centralised, and PCTs spend similar amounts of public money to local government without any of the democratic accountability that exists for councils," says Thorlby.
"Until now, efforts to enhance public involvement have been patchy. Part of the debate around local accountability in the NHS must be on what would be an acceptable price tag for involving the public more in decisions."
The report suggests that giving local councillors control over PCT budgets, or electing PCT board members, could give greater democratic weight to the NHS. But improving service quality would be better achieved by less radical change, such as having citizens' juries or enhanced Public Patient Involvement Forums focus on specific PCT functions.
King's Fund chief executive Niall Dickson is chairing the Local Government Association's independent cross-party commission to examine how people can have a say in how local health services are run. It will report in July.
