Healthcare delivery
quarterly, publishing results annually and acting early when performance slips. This would turn the medium-term planning framework’s financial discipline into a living mechanism for improvement rather than a compliance exercise. Second, the MTG proposes simple and useful
transparency through public Accountability Dashboards at national, regional and local level, drawing on NHS England’s new datasets to provide one “version of the truth” on finance, productivity and outcomes. Everyone from Parliament to staff and patients would be able to see progress and gaps. Making transparency routine in this way is intended to hardwire openness into assurance rather than relying on ad hoc reporting. Third, the report argues that innovation must be judged by what is implemented and scaled, not just pilots or promises. Systems should also pilot and scale effective approaches rapidly, supported by the sort of oversight for innovation and transformation seen in BNSSG. Fourth, the MTG calls for patients and the
public to be at the centre of accountability, with every ICB and Trust embedding ongoing participation that goes far beyond attendance at Board meetings. Digital tools offer new opportunities for real-time feedback and outcome reporting. Boards should also be required to report explicitly on how they have acted on what patients tell them, creating a new contract with the public that keeps improvement focused on outcomes that matter. Finally, the report supports the ambition
of the 10-Year Plan in aligning incentives with outcomes so that funding and performance measures reward collaboration and quality. New payment models can embed
SCAN ME
accountability for outcomes rather than activity, particularly when combined with fair-shares allocations linked to population health. The ambitions of the 10-Year Plan will only be realised if a coherent and enforceable system of accountability translates national intent into consistent local delivery. The new operating model, with its emphasis on multi-year financial balance, productivity and a digital-first offer through the NHS App, provides tangible levers for change, but those levers must be used to hardwire responsibility and transparency. If the NHS seizes this opportunity, patients can receive the right treatment in the right place at the right time, supported by the best available care on the NHS. But if accountability continues to falter, the result will be deeper inequities, greater public dissatisfaction and ultimately a failed opportunity to reform.
CSJ
About the author
Barbara Harpham is chair of the Medical Technology Group (
www.mtg.org.uk), a not- for-profit coalition of patient groups, research charities and medical device manufacturers working together to improve patient access to effective medical technologies.
To download the full report, scan the QR code
March 2026 I
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