Changes to the Health and Social Care Bill: accountability

The comparison below sets out the Health and Social Care Bill's initial proposals as regards accountability, what has now changed and some key questions that remain unanswered.

The original proposals in the Health and Social Care Bill

  • The explicit duty on the Secretary of State to provide or secure the provision of a comprehensive health service removed.
  • Widespread powers for the Secretary of State to intervene if national bodies fail to perform their functions.
  • No specific requirements about how consortia should be governed.
  • Duties on GP commissioning consortia and the NHS Commissioning Board to involve patients in commissioning decisions.

What has changed in the proposed reforms?

  • The Secretary of State's duty to promote a comprehensive health service restored. Secretary of State will be ultimately accountable for securing the provision of services – this duty will be exercised through the NHS Commissioning Board and other bodies.
  • Secretary of State now able to intervene only if institutional failures are 'significant'. New requirement on NHS Commissioning Board and clinical commissioning groups to promote the NHS Constitution.
  • Clinical commissioning groups required to have a governing body that must adhere to Nolan Principles. Two lay members must be included to champion public and patient involvement and lead on governance.
  • Governing bodies must meet in public, with minutes of meetings and details of contracts to be published.

What is still unanswered?

  • How will the rights contained within the NHS Constitution be guaranteed?
  • How will the Prime Minister's pledge to keep waiting times low be measured and enforced?
  • Will the pathfinder scheme for commissioning consortia be properly evaluated and lessons learned to inform the roll-out of clinical commissioning groups?
  • Will the more prescriptive approach now set out in the Bill lead to over-centralisation and discourage locally led innovation?