Conflicting Accountabilities in the 2012 Health Care Reforms in England

Abstract

Analyzing the legislative process of the 2012 Health and Social Care Act in Britain, we investigate the different uses of “accountability” in the committee debates. Based on the minutes of the Public Bill Committee from 2010 to 2011, we examine the contested accountability relationships in relation to the Secretary of State for Health, the Monitor, and the Health and Wellbeing Boards. On the one hand, we discern a shift away from traditional forms of accountability toward professional, managerial, and legal forms of accountability. On the other hand, we note how the concept of “accountability” is used in various ways to gloss this shift over, whilst traditional political accountability is reasserted.

Keywords:

• accountability
• health care
• reforms
• United Kingdom

Notes

¹ The details of how the NHS is accountable are included in the document called “NHS Statement of Accountability.” The NHS Constitution designates for the Government the responsibility to ensure that a clear and up-to-date statement of the NHS accountability is available for this purpose. The most recent version of the “NHS Statement of Accountability” was published in 2009. It outlines that the Secretary of State is accountable through Parliament to voters for a comprehensive health service and for the use of public money and that any decision taken by ministers can, therefore, be scrutinized by Members of Parliament.

² In December 2010, the Government published “Liberating the NHS: Legislative framework and next steps” as its response to the consultations on the White Paper. This document summarizes some of the over 6000 consultation responses and outlines how the Government intends to legislate. DoH (2010).

³ See more about this in Health and Social Care Bill (2011), at 13.

⁴ See more the “probing” amendments in Health and Social Care Bill: Committee Stage Report (2011), at 18.

⁵ The issue of accountability was addressed in the requirements concerning the governing bodies of Clinical Commissioning Groups, as well as the publication of their constitutions and commissioning plans and in the duty to promote the NHS Constitution. The Opposition claimed that it is problematic that the Clinical Commissioning Groups are accountable to the NHS Commissioning Board and not to the Health and Wellbeing Boards. PBC Committee, 16th Sitting, 2011, February 15.

⁶ See more in detail Health and Social Care (Re-committed) Bill: the NHS Future Forum and the Committee Stage Report (2011).

⁷ For an extensive historical treatment of this problem see e.g., Bogdanor (2001).