The Commission Pages

Department of Health/NHS Executive (NHSE)

The Department of Health is headed by the Secretary of State, supported by Ministers and the NHS Policy Board. This Board is responsible for providing independent policy advice and supporting the Secretary of State in holding the NHS Executive to account for its management of the NHS. Members of the Board come from within and outside the NHS.

The NHSE is the operational wing of the Department of Health. It is headed by the Chief Executive of the NHS, who is the principal policy adviser to the Secretary of State on all matters relating to the NHS. The remainder of the board of the Executive is made up of the directors of the Regional Offices and all NHS Executive directors.

Eight Regional Offices, staffed by civil servants, act as local agents of the NHS Executive. The Regional Offices are responsible for monitoring the performance of purchasers and providers, and managing the implementation of national NHS policies and priorities, and overseeing the commissioning of regional specialities. In addition the Regional Offices are responsible for the establishing arrangements Community Health Councils.

Regional Health Authorities - RHAs (until 1 April 1996) Each RHA had a Chair and five non-executive members appointed by the Secretary of State together with up to five executive members. Two of the executive members, the general manager and the chief finance officer, were ex-officio members. The remainder were appointed by the Chair and non-executives together with the general manager. The RHA was accountable to the Secretary of State.

Accountability of the Department of Health The Secretary of State is accountable to Parliament for the actions of the Department of Health and the provision of a National Health Service.

The House of Commons Health Committee is able to examine the expenditure, administration and policy of the Department of Health and associated public bodies. It consists of a number of Members of Parliament with membership reflecting the overall number of MPs in each political party.

The public Accounts Committee of the House of Commons, supported by the Comptroller and Auditor General and the National Audit Office calls the NHS to account for the way the NHS budget is spent. The Audit Commission is an independent statutory body that audits NHS and local government spending and examines value for money in the use of resources.

The Health Service Ombudsman has responsibility and powers to investigate charges of maladministration in the NHS and will take up complaints from members of the public when these fall into the remit of the Ombudsman's office. The Ombudsman publishes the results of these enquiries and is required to report to the House of Commons Public Administration Committee.

Health Authorities

Health authorities' key tasks are:

•	Assessing the health needs of their local population
•	Drawing up strategies for meeting those needs
•	Determining local targets and standards to drive up quality and efficiency in the
		light of national priorities and guidance
•	Supporting Primary Care Groups/Local Health Groups in their area, allocating
		their resources and holding them to account

The health authority has a lay Chair appointed by the Secretary of State and a Board of executive and non-executive members. The non-executive lay members have a majority on the Board. Each health authority is accountable to a Regional Office or the Welsh Office for carrying out its statutory functions.

Special Health Authorities

Special Health Authorities (SHAs) administer some NHS services in England, for example, National Blood Authority. They are accountable directly to the Secretary of State.

Trusts

The Boards of Trusts are made up of executive and non-executive directors. The Regional Offices monitor the performance of Trusts. Trusts are required to hold their Board Meetings in public.

Primary Care Groups As sub-committees of health authorities PCG Boards are accountable through their Chair to the Chief Executive of the health authority. PCGs are required to take a number of measures, for example, produce annual accountability agreements in order to promote a measure of openness and accountability.

Commission for Health Improvement A Commission for Health Improvement will be established to oversee clinical governance. It will offer an independent guarantee that local systems to monitor, measure and improve clinical quality are in place and will be able to intervene on the direction of the Secretary of State or by invitation from PCGs, health authorities and Trusts.

Northern Ireland

In Northern Ireland the Department of Health and Social Services (DHSS) is required to secure the provision of an integrated service designed to promote the health and social welfare of the population. The DHSS's Health and Social Services Executive (HSSE), headed by a Chief Executive supported by six directors, is responsible for overseeing the delivery of an efficient health and social care service.

Four Health and Social Services Boards act as agents for the DHSS. They have a non-executive Chair, 6 non-executive and 6 executive directors. The non-executive directors are appointed by the Minister but the appointment of the Chair has to be with the approval of the Secretary of State.

Health and Social Services Trusts (HSS Trusts) provide health and social services. Each is managed by a Board that has up to five non-executive directors and a non-executive Chair who appointed by the DHSS with the approval of the Secretary of State, In addition there are five executive members who are employees of the Trusts.

Health and Social Services Councils perform similar functions to Community Health Councils in England and Wales.

Scotland

The Scottish Parliament is responsible for the NHS in Scotland. Members of the Scottish Parliament will decide how they wish to work, so it is not yet clear how they will exercise their powers to make legislation. They have, however, recently established a Health and Community Care committee.

As is the case with the Welsh Assembly, the Scottish Parliament will determine its relationship with public bodies, including health boards/authorities and Trusts. They will appoint, fund, direct and hold all public bodies to account. At the present time health boards are accountable to the Scottish NHS Management Executive and Trusts report to the Secretary of State through the Management Executive.

Wales

In Wales there is no intermediate management tier. The five health authorities work directly with the Welsh Office Health Department in policy and management areas. Accountability is via performance agreements and an annual review.

The Welsh Assembly will be responsible for decision-making but will not have primary legislation powers. They will have powers to make secondary legislation.