Patrick Keady

Who will be in charge ?


It may – or it may not – be too early to ask who will be in charge if there is another healthcare crisis?  Although the NHS White Paper seems not to answer the question particularly well.


Who will be in charge is an important question.  Perhaps the most crucial of all.  Given the potential human and financial costs – the unnecessary loss of trust, reputation, lives, careers and money.


Under HM Government plans for the NHS, it seems that no single body – Department of Health, NHS Commissioning Board, NHS England, Monitor or the Care Quality Commission – will have the responsibility, authority and powers to monitor the health system as a whole, to identify potentially destabilising trends, and to respond to them with concerted action.


Providers will have a joint licence, that is overseen by Monitor and the Care Quality Commission.


The CQC will monitor safety and quality.  It will address failure to meet standards and the CQC will inspect against essential levels of safety and quality.


Monitor will be charged with ensuring that competition works in the interests of patients and taxpayers.  If and when price regulation is necessary, Monitor will set prices for NHS funded services, to promote fair competition and drive productivity.


The Independent NHS Commissioning Board will resource allocation and work directly with commissioners.  It and the NHS will be held to account through a set of national outcome goals, part of the wider NHS Outcome Framework.


The Department of Health’s duties for the NHS will shrink and be far more strategic, looking to improve public health, tackle health inequalities and reform adult social care.


While the Secretary of State will hold the NHS Commissioning Board to account. He will set legislative and policy frameworks for which the NHS works.


In the meantime, what steps are being taken to prevent systemic risk threatening the quality, activity and funding of health services.  Who is in the driving seat?  Are other Ministers and opposition MPs involved?  What expertise is being tapped into?  Are ‘special forces’ officials ready to spring into action, to be seconded specifically to deal with systemic risk?


Fingers crossed that there are robust plans in place to address these questions and that there will not be another NHS crisis.  And if the answers are insufficient, at least we’ll know who is in charge.


Someone who has to answer directly to Parliament, the Secretary of State for Health.


Over to you.  Is this posting helpful ?

What are your views about the proposals for the Department of Health, NHS Commissioning Board, NHS England, Monitor and the Care Quality Commission ?

Feel free to share in the comments section.



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