The chief secretary to the treasury, Andy Burnham, recently advocated reforms that the NHS has been crying out for: breaking down artificial divides in public services, sweeping away process targets and giving freedom for local innovation by pushing money down to the lowest level. His goal? Personal public services and proven value for money.
SocietyGuardian's Peter Hetherington set out similar goals of bringing the "local" back into government and making public services accountable. However his solution, some form of "democratic onslaught" on the NHS, entirely missed the point.
If we are serious - as the NHS and our local partners are - about accountability and quality, we need to be clear about the problem we are trying to solve. The public care deeply about the NHS and they want it to be better. They worry about waiting times, cleanliness, geographical variation on prescribing drugs, the way they and their family are treated and how easy it is to access services, whether that's a GP appointment or a car parking space.
They are also sceptical about political involvement in the NHS. In a Mori survey, we asked people who should make decisions about which treatments and medicines should be provided in a local area. Some 70% said clinicians, 23% said local managers, and 6% said local councillors.
The NHS needs and wants to be more accountable to the public. It is currently accountable through the secretary of state, through all the bodies that regulate it and report to parliament, and to local people through overview and scrutiny committees run by local councils. This is not enough for a highly personal service.
The NHS Confederation has today published a report, Principles for Accountability, which sets out the way forward for NHS organisations to create properly local health services. Local systems must be transparent, inclusive, and sustainable, and as Burnham recognises, flexible enough to react effectively to the changing needs of local people. This will enable primary care trusts to do a better job in making what are often difficult decisions and working to address long-standing health inequalities.
It would be simplistic to presume that a prescriptive national model will ever deliver local solutions. Trusts know that improving their relationships with local government patients and the public can deliver real change. A recent survey of our members shows this is one of their top priorities. Local organisations need the freedom to establish accountability arrangements that are designed for - and thus genuinely appropriate for - the area they serve.
Providing better and more accountable services for patients will not be achieved through another major reorganisation of systems. What is more, the latest accountability arrangements put in place by the local government bill, Local Involvement Networks (Links), are not in place yet. It would be sensible, not to say refreshing, to wait to see how these work before calling for yet more unproven change. With all the change no wonder the public are confused about accountability!
Our members want local people to question the services they provide, but they also want them actively involved in the design of the service in the first place. They want an end to top-down management from the centre. So we welcome the Local Government Association's creation of a health commission, and the prime minister's call for greater local accountability.
We will debate with our members and give all the support and ideas we can to ensure that, in the heat of debate, what patients really want remains at the heart of this agenda and that we do what is shown to work. Evidence-based policymaking is what the public deserve and should demand.
· Gill Morgan is chief executive of the NHS Confederation
