The government's health reforms propose radical changes to the structures and processes within the National Health Service (NHS) in England that have provoked unprecedented debate, protest and opposition. One of the core issues is how providers and commissioners of care will be held to account in the future if many of the existing lines of accountability are removed, and there are deep concerns about whether the proposed substitutes are adequate for the task.
The reforms could significantly reduce the day-to-day involvement of politicians, civil servants and managers in health care. Localisation, GP empowerment and patient choices will be the new priorities.
Accountability in the NHS: Implications of the government's health reform programme seeks to inform the debate around the nature of accountability relationships in the NHS and how these will change under the reforms. The authors identify five types of accountability most relevant to health care - by scrutiny, management, regulation, contract and election.