ANNEX: NHS ENGLAND ACCOUNTABILITY ARRANGEMENTS
Accountability to the Department of Health
1. NHS England is accountable to the Department of
Health for the delivery of its mandate. The mandate, which is
set by the Government every year and developed in consultation
with NHS England, defines the objectives that NHS England must
seek to achieve.
2. NHS England's accountability to the Department
is formalised in a number of ways.
· Every two months the NHS England Chief
Executive and Chair of the Board attend an accountability meeting
with the Secretary of State. The meeting is high level and strategic,
and covers standard items such as finance as well as focussed
discussion on particular services or issues as required. The meetings
also consider NHS England's performance against its mandate objectives,
looking at specific mandate objectives in turn. The agenda and
minutes of the Secretary of State meetings are published by the
Department.
· Every month the senior departmental sponsor
at the Department meets with the counterpart directors at NHS
England for a routine accountability discussion on current work
and areas of risk, and in addition to this there are weekly meetings
at official level.
· NHS England is also held to account for
the delivery of a number of Prime Ministerial priorities which
pre-date the mandate, and progress on these is reported and discussed
with the Department on a monthly basis.
Accountability to Parliament
3. NHS England is held to account directly by parliamentary
select committees. These scrutinise the Government and its arm's
length bodies to see whether they provide effective public services
which give good value for public money. NHS England is required
to give evidence of its plans and activities relating to inquiries
set up by the Public Accounts Committee, the Health Select Committee,
the Public Administration Select Committee, and any others with
inquiries involving the commissioning of health services in England.
NHS England is also required to respond to select committees'
recommendations to show how and when they will implement them
as appropriate, and implementation is monitored through HM Treasury
and DH regular assurance processes.
4. NHS England also provides replies to parliamentary
questions and to other MP correspondence, and its performance
is monitored regularly, including formally once a quarter by the
Department of Health.
Publication of annual report
16. NHS England produces a set of consolidated accounts,
which incorporates the results of all clinical commissioning groups.
In turn, the Department of Health produces consolidated accounts
incorporating all of its arm's length bodies (of which NHS England
is the largest), and, therefore, all NHS bodies (including clinical
commissioning groups), in the Department of Health Group Accounts.
17. Under the National Health Service Act 2006 (as
amended), the Department of Health has directed NHS England to
prepare for each financial year financial statements in the form
and on the basis set out in the Accounts Direction. The financial
statements are prepared on an accruals basis and must give a true
and fair view of the state of affairs of NHS England and of its
net expenditure, changes in taxpayers' equity and cash flows for
the financial year.
18. In preparing the financial statements, the Accounting
Officer is required to comply with the requirements of the Government
Financial Reporting Manual issued by HM Treasury and in particular
to:
· observe the Accounts Direction issued
by the Department of Health, including the relevant accounting
and disclosure requirements, and apply suitable accounting policies
on a consistent basis;
· make judgements and estimates on a reasonable
basis;
· state whether applicable accounting standards
as set out in the Government Financial Reporting Manual issued
by HM Treasury have been followed, and disclose and explain any
material departures in the financial statements; and
· prepare the financial statements on a
going concern basis.
19. NHS England also produces an annual report which
is published alongside its annual consolidated accounts. The annual
report sets out NHS England's assessment of the extent to which
it has met the objectives set out in its mandate and business
plan, and how it has discharged certain statutory duties, particularly
those around inequalities, patient involvement in planning its
commissioning arrangements and service quality improvement.
20. The document is laid before Parliament and is
subject to parliamentary scrutiny which can include that by select
committee. NHS England's Annual Report and Accounts for 2013/14
were laid before Parliament and published on its website on 22nd
July 2014. NHS England is required to hold an Annual General Meeting
(AGM) when the public may hold it to account on the content of
the document.
21. The Secretary of State is also required to conduct
an annual assessment of NHS England, and to lay this before Parliament.
This was done for the first time for 2013/14, and laid before
Parliament in July 2014.
Accountability to National Audit Office
22. On an annual basis, the Comptroller and Auditor
General of the NAO audits the Financial Statements of NHS England,
as well as the information in the Remuneration Report. This involves
auditing, certifying and reporting on the Financial Statements
in accordance with the Health and Social Care Act 2012. Through
the audit, assurance is provided that the statements are free
from material misstatement. Sufficient evidence is also gathered
to give reasonable assurance that the expenditure and income recorded
have been applied to the purposes intended by Parliament and the
financial transactions recorded in the statements conform to the
authorities that govern them.
23. The NAO services the Public Accounts Committee
by carrying out studies into public services which may inform
subsequent hearings. These may focus on the value for money of
specific services, follow ups to earlier studies to check progress,
or wider landscape studies and cross-government overviews which
may include NHS England as a case study. These provide the means
for NAO to undertake detailed scrutiny areas of NHS England's
work, to analyse work in progress and its impact on patient outcomes
and to suggest areas for the Public Accounts Committee to examine.
Accountability to patients and the public
24. In everything it does NHS England considers how
its plans and actions will affect the patients and the public
whom it serves, particularly with the aim of improving their outcomes
and experiences of healthcare. Engagement with the public is very
important and demonstrated for instance through:
a) holding Board meetings in public with a live
stream on the NHS England website;
b) convening a regular Citizens' Assembly as
well as the AGM; and
c) being committed to transparency and openness
about plans and actions.
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