Bill Gates and state budgets

I was surprised, and pleased, to come across the following video on where Bill Gates urges people to hold politicians to account for the budgets they approve.

In the video he makes a good point about the level of expert external scrutiny applied to the financial position of publicly-listed corporations. There is very little of this, he says, applied to public sector organizations such as the State of California.

Bringing this back to the UK for a moment, the government's proposals for armchair auditors might improve the level of scrutiny at a transactional level. But, knowing what every £500 has already been spent on is not the same as holding politicians to account for the big picture: the sustainability, or otherwise, of the public services that they want or expect to receive.

GPs are doctors, not accountants

Ann Robinson wrote an interesting article for The Guardian on 12 July (available here) setting out her view that GPs should not be expected to be accountants. I agree with that, and with much of the sentiment of Ann's article, but I differ in a couple of respects. Firstly, anyone who is responsible for spending public money should be accountable for their decisions. That means that they have to learn how to manage the money they are entrusted with. This doesn't mean that they have to be able to draw up a statement of accounts (that should be left to accountants who enjoy that sort of thing) but it does mean having an understanding of the financial constraints they work in, knowing what they want to buy (or sell) and how much it will cost.  They ought to be able to get a monthly financial report from their accountant and the should seek (and listen to) the accountant's advice albeit that the final decision and the accountability is theirs 

My second point is that commissioners and accountants are not the same thing. As I understand it, Andrew Lansley's proposals are for GPs to form consortiums and through these determine how health needs in their local area are met. There will still be a need for accountants to "keep the books" for the consortiums and presumably provide advice if a consortium is running the risk of its expenditure exceeding the approved budget. Even without seeing the detail of the proposals I find it difficult to imagine the government would not require the consortiums to set annual budgets and provide regular reports to the Department of Health of their spending against their budget. That smacks of bureaucracy but, whilst bureaucracy is oft-regarded as negative, the fact of the matter is that bureaucratic structures are good at control. And the government needs to control NHS spending tightly because a 1% over-spend would put a £1billion-a-year hole in their plans.