New accountability framework needed for STPs

The NHS accountability framework should be revised to accommodate new models of care such as sustainability and transformation plans (STPs), a new report from the Health Foundation has recommended.

The paper, by Andrew Hudson, former director general of public services at the Foundation, said that the NHS in England “poses particular challenges for accountability” because of its size, the fact that it is taxpayer-funded and government-controlled, and due to the funding differences between health and social care.

It also said that the goal of “clear lines” for accountability has been made harder to achieve because of the new institutions and models of care and funding that have been introduced since the Health and Social Care Act 2012.

Hudson warned that the STPs were regarded with “scepticism” by local councils because of their lack of direct involvement. He noted that delivering STPs would require joined-up planning between partner organisations and lower-level organisations, and greater public involvement.

In his research, Hudson interviewed leading figures at trusts who expressed frustration about having to waste resources submitting data for “several hundred” accountability indicators every year.

But he said that creating a new regulatory body for the new models of care such as STPs risked creating another layer of assessment.

Instead, Hudson called for an overall accountability framework for integrated care that is set nationally for the length of a Parliament and locally for a local authority term – accompanied by a single set of outcome indicators covering health, public care and social care.

“There is no perfect system of accountability, nor is there one which will eliminate all risk of either financial impropriety or serious clinical errors. But a price will be paid if too many rules, regulations and procedures are put in place in search of an extra ounce of assurance,” the document said. “There is a limit to the number of hoops that 700 NHS finance directors should go through in order to reduce further the risk that one will pay funds to a relative.

“Similarly, the issue in devising a new accountability framework is not whether it is ideal, but whether it is better than what is happening at the moment, taking quality and value for money together.”

In the short term, Hudson said governance arrangements needed to be established for all STPs. Hudson also recommended using STPs, joint health and wellbeing strategies and other mechanisms to generate the integration plans required by the 2015 Spending Review, instead of starting a new process.

The government should also publish clear statements on how the health and care system works at all levels, including for Vanguards, and timetables for producing new regulations and guidance.

Lastly, Hudson recommended an independent review and streamlining of the national indicator set during this Parliament.

His report concluded: “Ultimately, any accountability framework will only be as good as the people operating it. Good systems will not protect patients or drive better performance if they are implemented in an apathetic way. But the better the framework, the higher the chance that it will be effective.

“The suggestions in this paper are designed to generate a framework that is simpler, clearer and more stable. This should enable stakeholders to have their questions answered, and staff at all levels to focus on the primary job of improving health and wellbeing.”

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