Final Report > Chapter 22: The Culture of the NHS > Looking to the future > A culture of accountability

A culture of accountability

31 Along with a commitment to a culture of openness should be a commitment to accountability. By accountability, we do not mean a system which relies exclusively on an approach where an individual or group is picked out and blamed, as if that was enough to remedy a particular problem.

32 The prevailing culture within the NHS is a culture of uncertainty. There is an obscurity, intentional or otherwise, from the point of view of the patient, as to who is responsible for, and thus accountable for, what. Two particular problems flow from this. First, in a large and complex organisation, which operates on very many levels, from national to local, it is not difficult for responsibility to be attributed to others. It can be laid at the feet of an amorphous Department of Health, or a particular technician working `at the coal-face', or at a myriad of points in-between.

33 The second problem is that this state of affairs is simply unfair to those who work in the organisation. They do not know to whom they should go, with what problem. The frustration builds up and the organisation, and the patient, suffer.

34 It follows that for the future, there needs to be a clear articulation as to who has responsibility for what and thus is accountable for it. This is not intended as a device to tighten the mechanisms for blame. It is a necessary prerequisite for an organisation to function effectively, to be able to assess its performance and respond accordingly and thereby to serve the interests of patients.