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Creating a new NHS England: NHS England and NHS Digital merged on 1 February 2023. More about the merger.

Current Chapter

Current chapter – Accountability

Secretary of State

The Secretary of State is accountable to Parliament for the health system (its 'steward'), including the HSCIC. The Department of Health supports the Secretary of State in this role. This involves:

  • setting national priorities and monitoring the whole system's performance to ensure it delivers what patients, people who use services and the wider public need and value most
  • setting budgets across the health system, including for the HSCIC
  • setting objectives for the HSCIC
  • supporting the integrity of the system by ensuring that funding, legislation and accountability arrangements protect the best interests of patients, the public and the taxpayer
  • accounting to Parliament for the HSCIC‟s performance and the effectiveness of the health and care system overall

The Principal Accounting Officer and the HSCIC’s Accounting Officer

The Department of Health‟s Permanent Secretary is the Principal Accounting Officer (PAO) and so is accountable in Parliament for the general performance of the health and care system in England, including the HSCIC. This requires that they gain assurance that the HSCIC is discharging its statutory duties and meeting its objectives. In this way the PAO is able to report to Parliament an informed account of the Department‟s stewardship of the public funds it distributes and for which it holds overall accountability.

The Department‟s Permanent Secretary, as the Department's PAO, has appointed the HSCIC‟s Chief Executive as its Accounting Officer (AO). The AO may be called to Parliament to account for the performance of the HSCIC. The PAO can also be held to account in Parliament since the PAO's oversight should allow him or her to assess the adequacy of HSCIC's stewardship of public funds and discharge of its duties. This assessment includes making judgments about whether the HSCIC is operating to adequate standards of regularity, propriety, feasibility and value for money (assessed for the Exchequer as a whole).

The PAO's oversight of the HSCIC‟s performance relies upon the provision of information, and processes to enable both parties to review performance.

The information provided to the Department by the HSCIC includes (not an exhaustive list):

  • reports prepared for each HSCIC board, which will meet at least six times a year in public, on performance, including in relation to finance, workforce, procurement, programme delivery, and parliamentary accountability, supported by qualitative information
  • assurance reports prepared for the board providing assessment against the objectives in the business plan, including risk management, statutory financial statements, in-year and year-end performance against budgetary controls, cash inflows and outflows on a monthly basis

The processes in place to enable the Department and the HSCIC to review performance include:

  • quarterly accountability meetings chaired by the SDS (or exceptionally, their deputy) with sponsor team and other Departmental officials as required, and the HSCIC's chief executive with appropriate members of the HSCIC's executive team, focussing on strategic issues or issues of delivery that the SDS believes it is appropriate to bring to the meeting.
  • additional regular meetings with Departmental specialists, including finance, audit, human resources, procurement
  • regular, informal contact between the HSCIC and the Department's sponsor team.

The HSCIC's Annual Report will include reference to the discharge of their statutory functions and progress made towards their objectives.

The HSCIC is responsible for the delivery of its objectives and the Department will limit the circumstances in which it will intervene in its activities. The following constraints do, however, apply:

  1. All funds allocated to the HSCIC must be spent on the statutory functions of the HSCIC if any funds are spent outside the statutory functions of the HSCIC the Department could seek adjustments to the grant in aid for running costs (administration) to compensate.
  2. The Secretary of State may remove any non-executive member from the Board on the grounds of incapacity, misbehaviour or failure to carry out their duties as a non-executive member.
  3. If the Secretary of State considers that the HSCIC is significantly failing in its duties and functions, then the Secretary of State is able to intervene and issue directions to the HSCIC. In the first instance, the Secretary of State could direct the HSCIC about how it carries out its functions. If the HSCIC failed to comply with such directions, he could either discharge the function himself, or make arrangements for another body to do so on his behalf. The Secretary of State will always publish the reasons for any intervention. 

Last edited: 24 November 2021 3:18 pm