ABSTRACT
The development of ‘self-management’ is an important part of the process of achieving effective integrated nursing teams. It is, however, inevitable that the issues of accountability and risk become prime concerns when devolving management and budgetary responsibility. The approach in Oxfordshire has been developmental and, from the start, efforts have been made to learn from the experiences of others. To help fill the gap identified by the Trust in 1995, a manual of procedures and protocols was produced to provide information for effective decision making and risk management. Community nurses are funded through Hospital and Community Health Services allocations. In the first instance, teams tended to retreat and cut ties with many other practices that they may have worked with quite closely in the past. This was very noticeable when it came to covering for sickness and maternity leave cover. An accountability framework should establish exactly what is meant by freedom to ‘manage the budget’.
