The Conservatives' promise to end top-down reorganisations of the NHS has been undermined by the poor accountability of NHS reforms, a health thinktank has said.
A report from the King's Fund says the changes proposed in the embattled health and social care bill will not improve local accountability.
It says the governance arrangements of the planned GP consortia are weak, warns that the health and wellbeing boards designed to oversee them at the local level have few powers and worries about the scaling-back of regulator Monitor's responsibilities.
Poor accountability measures could result in lower standards, the report says, forcing the new NHS Commissioning Board to intervene in the work of consortia to drive their performance.
"Overall, we think the proposed reforms signal a shift to an over-reliance on weak and unproven accountability relationships given the extent of the government's proposed reforms; this is a significant cause for concern," the report's authors conclude.
"Given that the NHS remains one of the largest domains of public expenditure, and that there are increasing pressures on budgets in the current tighter fiscal climate, there will continue to be demands for political accountability, both for how the money is being spent and for how local services are provided, particularly where there are closures.
"Whatever the government's intentions, we may, in practice, see pressure to a return to central managerial and political accountability for providers as well as commissioners of NHS care."
Criticisms from the King's Fund come in addition to the main public debate about the role of competition in the NHS, which health secretary Andrew Lansley's proposals will effectively make predominant.
"The pause in the legislative process provides an opportunity to look again at these issues and strengthen accountability in the health system to drive improvements in performance and ensure that public money is well spent," Anna Dixon, director of policy at the King's Fund, said.
The thinktank wants a properly constituted board established to help the governance of GP consortia.
Health and wellbeing boards, which will bring local authorities together with GP consortia, should be handed stronger powers, its report says.
It also wants to see more measures to strengthen foundation trust boards and help for governors trying to oversee the performance of hospitals and their senior staff.
The listening pause ended yesterday. Professor Steve Field, who has overseen the exercise, will produce a report outlining his proposals to the coalition next week.