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No hiding place now

No hiding place now

Just exactly who will be responsible for failure in the new NHS, Mike Sobanja explains

Dear Florence, we have found the answer...

Nearly thirty years ago, as a precursor to the introduction of general management in the NHS Roy Griffiths famously said: “If Florence Nightingale were carrying her lamp through the NHS today she would be searching for the people in charge.’ The result was the demise of multi-dsciplinary  consensus management in the NHS. Next month, the Francis enquiry may ask a similar but more powerful question – “who is accountable for the quality and safety of services in the NHS?”

The answer may well be found in a document that emerged from the Department of Health recently – not the NHS Commissioning Board by the way – the real Department, responsible for policy and continuing to do so. Una O’Brien, the DH’s very own Sir Humphrey produced a masterpiece of who is accountable for what in the new NHS. I reckon it ought to be compulsory reading for anyone who wants to know exactly “where the buck stops” after 1 April next year.

The Accounting Officer system statement may be seen as a sedative to some, but read further, think about the issues, and it may do more to keep many awake at nights rather than the opposite.

Of course this is rooted in financial responsibility, in itself a crunch issue, but when we read that the duties of the Principle Accounting Officer include not just money but whether the individual organisations within the system are “are performing their functions and duties effectively and have the necessary governance and controls to ensure regularity, propriety and value for money” we can appreciate that this goes much wider as a matter of policy – more of a “who carries the can” philosophy than simple financial control.

The result is clear and the language unambiguous. There is a clear line of sight throughout the system between Accounting and Accountable Officers. This is personal responsibility, not diluted by Boards and Committees.

Equally, and rather adroitly, I thought, was the statement made by Una O’Brien that “I am accountable not for trusts’ individual decisions (which are a matter for trusts, their boards and their Accounting Officers or Accountable Officers), but for ensuring there is a system of regulation and oversight....” 

So why should all of this keep the front line awake and why is it not just for the policy wonks?  Ask yourself the question – when a clinical service fails (Bristol babies, Staffs etc) who is going to be held to account?  Robert Francis QC may well tell us the answer. But in the new NHS I believe the answer is clear - investing public money (call it commissioning if you will) in a failing service is not just a waste of money, it is rightly a negligent and culpable act or omission. As we move away from a nationalised industry model, those who seek to invest resource must also be responsible and held responsible when the service fails.

 Are you listening Clinical Commissioning Groups? – Sir Humphrey hasn’t  just spoken, she has shouted from the rooftops...


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