J’accuse! updated – a modern approach to accountability

Accountability is meaningless when the finger of suspicion and blame can move in a week from a single “rogue” reporter to the Chairman of News Corporation. In a situation where potentially all are held accountable in this random way, no one is accountable. Caroline Oliver a friend of MAC and a specialist in effective governance writes

When things go very wrong and the question of whose head or heads should roll comes up, we have no clear answers. In other words we just don’t know who we should hold accountable for what. In the case of phone-hacking at News Corporation the accusatory finger has moved from pointing to one rogue reporter through the Chief Executive of the newspaper concerned, to the chairman of the entire group. Latterly there has even been mention of the board and particularly the non-executive directors.

Knowledge and Accountability

She goes on to add that what goes in the News Corporation also applies to the NHS. The killer point for me looking at her arguments is that ‘knowledge is not a prerequisite for accountability’. Indeed Caroline goes further, saying that knowledge cannot be a prerequisite of accountability.  Organisations are now so big and complex that this old fiction can stand no longer. We have to re-frame the question and ask is there a system for ensuring accountability and did the Chief Executive follow that process agreed with his Board and his fellow managers?

This ties up with Andrew Craig’s last blog which has attracted more comments than any other blog ever published by us. Andrew’s concern is that public engagement will merge with the communications functions – will ‘real’ engagement and participation take second place to flim flam public relations as a quick way of offering legitimacy to the ‘any qualified provider’ (AQP) mechanism?

Systemic Accountability

The link is one of due process that embraces the prospect of dissent and criticism from communities of patients, carers and citizens and does not bury public engagement in the emollient and pleasantly positive reassurances that constitutes so much PR. We have to plead guilty to having poured in the past a certain measure of scorn on ‘tick box’ initiatives whereby the system is followed without heed to its quality and outcome, but at least in these cases there is a process to be followed. And in that situation, people have a better chance of identifying the someone who has not adhered to an established accountability system.

We have had a very good example of that recently when Malcolm Alexander the Chair of the national LINks body NALM fired a rocket off to Earl Howe for a gross breach of process in the way a consultation document on Healthwatch had been circulated missing out key organisations like the Programme Board. The document’s content too was rather poor quality. The Department of Health to its credit reacted quickly by pulling the consultation off the website and apologising for the failure to involve LINks bodies. However the main point in this context is that there was both an agreed process watched over by an eagle-eyed veteran patient activist and this combination creates accountability. Malcolm’s email was sent to Earl Howe who may or may not have been aware of the circulation list of the consultation document. But knowledge was not a prerequisite of accountability – failure to observe the system in place was the lapse in accountability here. (Malcolm is still (and rightly) very annoyed about the lack of funding for Pathfinder Healthwatches but that is a story for another day.)

Not since Zola fled to Upper Norwood

Andrew’s fear for the new process of setting up the AQP process is that there will be neither knowledge nor accountability to the wider public. Both policy and execution will lie in the hands of the same narrow political and bureaucratic coterie which is not a sufficient protection because they are a ‘feral’ elite according to the recent calls in the Guardian for a 1000 strong citizen jury . The supporters of the jury initiative state their case with a power and passion that we have not since Emile Zola – the most prominent and eloquent of Drefusards -had to flee to the Queen’s Hotel, Upper Norwood.

Power, for so long hidden in the pockets of a cosy elite, has been exposed. Those who wield it have been found wanting – in scruples, in morals and in decency.

And we and Caroline Oliver would add that they have been found wanting in having a good system of accountability. Not as sexy a statement as that of the new Zolas but it takes us beyond indignation and despair to action.

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