Source · Select Committees · Public Accounts Committee
Recommendation 12
12
Rejected
Department rejects claims of excessive NHS management layers or unclear accountability structures.
Conclusion
The Department acknowledged that there were different sides of its approach to holding the NHS to account. It recognised that if there was a problem arising in a local authority it may fall to the Department to address, whereas problems in local trusts would be the responsibility of NHS England.29 The Department did not accept, however, suggestions that there were too many levels of NHS management, that there was duplication at national level, or that lines of accountability could be clearer and sharper.30
Government Response Summary
The government explicitly disagrees with the committee's finding/implied recommendation regarding NHS management levels and accountability, defending the existing structure as articulated by Parliament and detailing its effective oversight mechanisms and performance monitoring.
Government Response
Rejected
HM Government
Rejected
5.1 The government disagrees with the Committee’s recommendation. 5.2 While the department approaches all its work in a spirit of continuous improvement, the government nonetheless disagrees with the Committee's recommendation. Parliament has itself articulated the respective roles of the Secretary of State and NHS England in the NHS Act 2006 as subsequently amended (most recently by the Health and Care Act 2022). 5.3 The department maintains effective oversight of NHS England, including over urgent and emergency care and the actions being taken to address the impact of the pandemic and long-term sectoral challenges under the Delivery Plan for recovering urgent and emergency care services. 5.4 The Secretary of State for Health and Social Care is accountable to parliament and the public for health and care and sets objectives NHS England must seek to achieve through the mandate to NHS England, last published in June 2023. This is assessed annually, bringing together governance for performance against individual objectives in the mandate. The mandate for 2023-24 includes the achievement of urgent and emergency care recovery ambitions. 5.5 NHS England has responsibilities for the oversight and support of health service providers and intervening in the case of poor performance. The NHS Oversight Framework details the overall principles, responsibilities and ways of working for oversight, including the key metrics and factors NHS England will consider when determining support needs, and the circumstances in which it considers formal regulatory intervention may be necessary to address issues. NHS England has also implemented an urgent and emergency care tiering performance and improvement approach to support the delivery of recovery ambitions under the delivery plan, providing targeted support to challenged systems and ambulance trusts on performance issues. 5.6 The department maintains close oversight of NHS England’s delivery of emergency care recovery ambitions, including through regular ministerial progress meetings, ongoing engagement with No10 and regular stocktakes led by the Prime Minister. This oversight is underpinned by clear metrics agreed in the Urgent and Emergency Care recovery plan. Headline commitments to improve ambulance and accident and emergency waiting times are closely monitored through official public statistics and a wide range of management information. This informs discussions with the NHS on how to work together to address underperformance.