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King's Fund thinktank warns of weaknesses in the coalition's proposed health reforms
GP consortiums and hospitals may not be fully accountable for the large sums of NHS money they spend and the care they deliver because of weaknesses in the coalition's reforms, according to the health thinktank the King's Fund.
In a report published after the end of the government's "listening exercise" triggered by widespread concern over the health and social care bill, the King's Fund says reducing central control of the health service could weaken accountability.
GP consortiums will be made responsible for most of the NHS budget – £60bn of public money. But, says the report, their governance mechanisms look weak. There are only limited requirements for how they should be constituted and made accountable to the public while separate health and wellbeing boards, bringing together local authorities and GP consortiums, have very limited powers to hold the consortiums to account.
The government claims the changes will bring a shift away from top-down performance management. But the Kings Fund says that relationships between GP consortiums and the NHS Commissioning Board (which will commission primary care and specialised services) – and between those organisations and the health secretary – could end up like the command-and-control managerial relationships the government wants to abolish.
"The potential weakness of both GP consortiums' internal governance mechanisms and the role of health and wellbeing boards mean that the NHS Commissioning Board and the secretary of state may well have good reason to intervene," says the report.
The thinktank also has reservations about the accountability of hospitals. With mixed evidence about the performance of hospital boards, scaling back oversight of foundation trusts by the regulator, Monitor, could significantly weaken accountability, it says.
"This report highlights weaknesses in the accountability arrangements set out in the health and social care bill," said Anna Dixon, director of policy and one of the report's authors. "The pause in the legislative process provides an opportunity to look again at these issues and strengthen accountability in the health system to drive improvements in performance and ensure that public money is well spent."
The Department of Health said: "The Kings Fund report raises some important issues, which we are already considering. The health secretary has been clear that there will be substantive changes to the bill, including on accountability, if they deliver improvements for patients.
The government's listening exercise wound up on Tuesday with health officials saying they received about 15,000 website responses and 720 letters. Professor Steve Field, overseeing the exercise, will present his results in mid-June amid suggestions from the deputy prime minister, Nick Clegg, that the changes required to the bill are so numerous the entire legislation may have to be delayed by up to six months.
Unguarded comments made by the prime minister while he and his deputy were waiting for Barack Obama to speak last week suggest it is now the two men's teams who are attempting to rescue the bill, with the health secretary, Andrew Lansley, marginalised.
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The government's listening exercise has ended but the Guardian's NHS blog will continue with all the news and debate about its outcome when Professor Steve Field publishes his report this month.