Policy discourse and rhetoric that preceded the Health and Social Care Act (HSCA) 2012 suggests the Act was intended to further embed issues relating to accountability, transparency, and engagement with service-users. Close analysis suggests economic imperatives and independent expert authority are promoted to a greater extent than previous reforms, while stakeholder engagement and accountability appear weakened in crucial areas. To show this, the article considers two important and underexplored activities under the HSCA: reporting and other types of stakeholder engagement measures. These two activities are important because they support the way crucial NHS functions are carried out. The article contends that the policy discourse and rhetoric underpinning these activities does not reflect the statutory reality.