Q...."and there is little or no accountability for the services
There is a huge amount of accountability in teaching, through Ofsted, SATs, performance management linked to pay scales on the upper pay spine, targets, observations, etc...."
In the health care sector, once the government have found a way of privatising the NHS, you'll look back on these as the golden days of accountability. Joe Public would be astounded at the complete lack of transparency and accountability in the private health care sector. You would be lead to believe your HCP was as qualified as the NHS workers you'd been used to but what you wouldn't see is how low the government has allowed the new private providers to set the bar on 'qualification' in its desperation to get the private 'service providers' on board.
A couple of years ago, to pre-empt a pending investigation into standards, a private company who were subcontracting services (complex scanning) to the NHS employed some private individuals to test a cross section, 100 of their employees for competence. All of these employees had allegedly been vetted by the national registration agency.
Of the 100, 8 were so incompetent, the testers felt morally obligated to report them to the registration agency to ask how on earth they'd passed? It was obvious these people had never had any training- yet the private company had happily employed them and continued to do so- until they were kicked off the register.
Such people wouldn't even have got an interview in the NHS, or had they managed to get a job (unlikely!) they'd've been found out by NHS checks and balances in 5 minutes flat.