Education And Debate

The New NHS: commentaries on the white paper: Encouraging responsibility: different paths to accountability

BMJ 1998; 316 doi: (Published 24 January 1998) Cite this as: BMJ 1998;316:296

Counting and accounting in the new NHS

  1. Jonathan Shapiro, senior fellowa
  1. a Health Services Management Centre, University of Birmingham, Birmingham B15 2RT

    The new Labour government came into power in May 1997 intent on abolishing the market in health care, correcting inequities in provision, and improving public input into the planning of services. To what extent does the new white paper achieve these aims? In particular, what are its implications for accountability within the service?

    One of the key issues facing the new health team was the linkage of accountability with money. The previous regime had made financial accountability the cornerstone of its reforms; all the leverage for change, whether in the creation of freestanding trusts or the power of fundholding, was invested in tight contractual arrangements. The new government is working from the premise that contracting wrought little positive change but drove only the bureaucracy of accounting and the increase of supply led services and is determined to change the “currency” of the NHS.

    In the new white paper accountability seems to follow two separate paths: clinical accountability, …

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