• In this paper, Andrew Hudson identifies the principles that should underpin a good accountability framework, and examines how the present arrangements for accountability across health and social care in England could be improved.
  • He argues that integrated care needs integrated accountability, from planning through to monitoring and external inspection and regulation, covering finance and quality.
  • The paper also sets out immediate measures to strengthen the accountability arrangements currently in place, and avoid some emerging risks.​

Download Simpler, clearer, more stable and the Health Foundation's summary and analysis.

Key findings

As care becomes more integrated and place-based, the systems that hold local providers to account are lagging behind, and remain focused largely on the performance of individual organisations.

However, unlike many of the challenges facing the NHS and local government, changes to accountability arrangements can be made relatively quickly, making it easier for stakeholders to have their questions answered, and staff at all levels to focus on the primary job of improving health and wellbeing.

To improve our understanding of how accountability might best develop in this context, the Health Foundation commissioned Andrew Hudson to look at the present arrangements. In this paper, he has drawn on his expertise and experience of operational leadership in central and local government, as well as senior roles in HM Treasury. He also undertook interviews with people working on the front line of care planning and delivery.

In the paper, he identifies six principles that underpin an effective accountability framework; it should be:

  • comprehensive and joined-up, spanning organisations and covering both quality and finance
  • clear and transparent
  • economical of resources
  • stable over time and consistently applied
  • rigorous where it matters, balanced with encouragement of innovation
  • robust to the real world.

He then assesses how current arrangements perform against these principles, and recommends actions that could be taken to make improvements, both in the short term and over time.

Further reading


Rudolf Klein

Could I have a hards copy of the accountability paper ? Many thanks.

(Professor) Rudolf Klein

12A laurier Road NW5 1SG


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