Audit Commission an irritant and distraction to NHS, claims report

4 Oct 01
The Audit Commission's role in auditing the health service comes in for some sharp criticism in a new report published this week.

05 October 2001

Value-for-money work 'fails to engage with the dynamics of the NHS' and may soon be eclipsed by the rival auditors of the Commission for Health Improvement, according to a report by the Nuffield Trust.

The Audit Commission is even accused of being an irritant to hard-pressed health managers and distracting them from their priority work of delivering a public service.

The commission's national studies – for example on the care of the elderly and children – are valuable, the report says. But the audit body succeeds neither in improving effectiveness in the NHS nor in making its working at local level more transparent.

Its 'management letters' to trusts and executives are said to be over-diplomatic and too cautious in tone, needing considerable decoding before their meaning emerges.

The study, Audit in the NHS, was written by the veteran social policy analyst Rudolf Klein, an emeritus professor at the University of Bath, and Patricia Day, a senior research fellow there. It is based on interviews with health executives and audit staff.

The Nuffield Trust, founded in 1940 and distinct from the Nuffield Foundation, acts as an independent health think-tank.

Its criticism may cause some gnashing of teeth in Vincent Square. The Audit Commission – like the National Audit Office – has taken upon itself the role of changing behaviour inside local authorities and the NHS. But no one seems to have asked, the report's authors say, whether working with an organisation to make improvements 'is most appropriately carried out by auditors'.

The Audit Commission should be judged on whether it adds to the accountability of public sector bodies, they say. They suggest it links up with local authorities – using their scrutiny powers – and with the health select committee of the House of Commons, as a way of making the NHS more visible to outsiders.

Its national studies could be used by MPs to inform their questioning. This 'would give the Audit Commission a national platform and give the health committee an instrument of inquiry'.


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