Steve Richards: Who exactly will we hold to account?

Cameron and Clegg champion localism. But at the Treasury they worry about letting go of the purse strings

One of the most important divides in British politics is between superficial policy makers and those who dare to think more deeply. When he was at his peak as Chancellor, Gordon Brown used to complain of his rival in No 10, "Tony never reads the papers". Brown was not referring to the newspapers. Both of them read newspapers too assiduously. He meant the policy documents which as Chancellor he pored over from five in the morning. Brown became too burdened by detail, but that was preferable to announcing policies without thinking through the consequences.

This happens most often when policymakers head for the crowded terrain marked "public service reform". The populist policies belong to the superficial wing. "Give power to the people" cry leaders who skate on thin ice. Who could be against such a proclamation? After all, no one is going to be elected with the opposite message. David Cameron and Nick Clegg wrote a joint article yesterday in which they put the broad case. They do so with conviction, but it is possible to be principled and still be muddled. Their emblems are the reforms of the NHS announced by Andrew Lansley yesterday and of course Michael Gove's "free schools". Gove was in a rush to announce the list of schools that would not be renovated – so impatient the list has been re-announced five times – but wait for the frenzied fanfare that will greet the appearance of new schools free from bossy "interference" as parents are "empowered".

On the surface the changes to the NHS are more attractive. Big budgets and significant powers will be devolved to the busiest interface, the one between GPs and patients. Those aloof bureaucrats will be kept at a distance, or even more of a distance than their current anonymity provides.

The problem arises from that deceptively dry term "accountability". Most of the blazing rows that erupted between Blair and Brown over public service reform related to this single issue. Blair was not especially bothered about the complex lines of accountability. If providers wanted to run a school or hospital and parents or patients were satisfied, that's all that mattered. Brown raised questions about those who were not satisfied and pointed out that if the cash were raised nationally, taxpayers would not accept surplus places or schools and hospitals going bust.

I am told that in a more subdued way there are echoes of these exchanges in the coalition. Cameron and Clegg are champions of localism. At the Treasury there are worries about letting go of the purse strings. Watch for tensions between the Treasury and radical public service reformers in No 10 and the Cabinet Office. They may prove to be as potent as those already highlighted between Conservatives and Lib Dems.

The Treasury is right to cross its figures. It is demanding cuts of more than 25 per cent from some departments while the NHS is getting a rise. If most of the NHS budget is devolved to GPs, it is not entirely clear to whom they will be accountable. Independent boards can't hold 500-600 GP commissioning groups to account. What happens if GPs fail to rise to expected standards? What happens if budgets are misspent? Will some services not be offered? Are GPs in the best position to know which consultants offer the best services?

There are many outstanding and innovative GPs. But there are also some who opt for the quieter life. It was only the intervention of the last government that brought about weekend openings in most surgeries. Left on their own most surgeries would have continued to work on the assumption that people fall ill on a weekday. Cameron and Clegg dismiss actions from the centre, but the centre raises the money and is bound to take an interest in how it is spent.

The Lib Dems had an interesting proposal that partially addressed the issue of accountability. They called for elections to Primary Care Trusts, the local bodies that oversee the provision of health care and are now being abolished. Instead Lansley proposes an independent NHS board that in theory would be free from political interference. But the Government has already made a major political decision in relation to spending on the NHS. It will not and should not turn away once the money is handed over to GPs. The independence of the NHS board will be challenged when evidence emerges that money is being wasted. Lansley cannot in these circumstances stand up and say the waste is nothing to do with him. He is part of a Cabinet that took the decision to ringfence NHS spending.

The same dynamics apply to "free schools" and in ways that call into question the coherence of the Cameron/Clegg vision of empowerment. Schools do not function in a vacuum. Their procedures have an impact on neighbouring schools, the pupils that make up the intake of the school, the teachers that are attracted or deterred from taking up posts. City academies were a striking act of centralisation. They are accountable to the Education Secretary, not local authorities. "Free schools" will diminish the role of local government further. They will be accountable to parents. But what about the parents who fail to get into the sparkling new school freed from burdensome responsibilities to the rest of the community? Where do they protest?

Each apparently simple innovation has consequences. The term "consequence" is also deceptively dry. The sale of council homes was liberating for some tenants. A consequence was a chronic shortage of affordable rented accommodation that remains an issue three decades later.

There will be positive consequences from the coming reforms, as there were after the sale of council homes. But longer-term negatives are rarely addressed by governments in a hurry. I can already see Cameron, Clegg, and Gove visiting the first "free school"; but I doubt we will hear much about nearby schools with rebuilding programmes cancelled and intakes limited to those who failed to get into the prestigious, newly established school set up by parents affluent enough to have the necessary spare time. Similarly we will hear much about GPs with an entrepreneurial streak, relishing their new financial responsibilities. Those who find it hard enough to accomplish existing demands, let alone future ones, are unlikely to get a royal visit from Cameron, Clegg, and Lansley.

The coalition seeks to de-politicise policy areas where it spends buckets of taxpayers' money. The level of spending means it cannot do so and in the end will not want to do so.

s.richards@independent.co.uk