We aim to bring about a change in the organisation of the Health Service to ensure that everybody employed in the local delivery of health services is accountable to a single body which is democratically elected and accountable to the people it serves. In the process many of the changes in NHS policies, governance and management since 1974 should be reversed once and for all, and then central government should keep out of the local management of the NHS.
The democratic accountability will ensure in time that policy, on who should be treated, for what conditions, how, how quickly, and where, will be based, up to the current limits of medical skill and knowledge, only on the community's values and priorities, and that the elected representatives will be close enough to their constituents to ensure that policy is kept up to date and that justified grievances are speedily resolved. There need to be national standards, founded in sound principles on which medical interventions are appropriate for public funding. Where possible the most effective treatment for each individual patient should be identified and used.
There needs to be an end to the exaggerated deference to professionals, which most organisations have dropped, and which in the Health Service can leave people who are denied treatment uncertain whether it is because no treatment would be likely to succeed or because somebody has unaccountably classified them as low priority.
Democratic accountability will only be fully achieved if the elected body is able to raise local taxes when it is satisfied that services satisfying the community's values and priorities can only be delivered by increasing the resources provided for them.
The present split between purchaser (later described as "commissioning") and separate providers for hospital and community health services blurs accountability for any service failures and can lead to suspension of essential treatment of people moving from hospital into the community. For this reason, however the staff and resources may be managed, they all need to be accountable to a single democratically elected body which can solve problems across the management structures.
The [existing] Community Health Councils (CHCs) are designed to ensure the accountability of health service staff to their communities. Not all CHCs have tried to achieve this accountability, as their lack of powers makes it difficult to attract change agents as members. When they have tried to assert influence, they have been held back by having neither formal responsibility nor the sanctions available to an employer even to require attendance to respond to questions and concerns. Even if they were not held back by lack of powers, their not being democratically elected by the whole community would be a severe limitation. CHCs were replaced by various complementary bodies, each with limited powers.
The boundaries of the area electing the democratic body should be as local as practical to achieve the necessary accountability. They must include a hospital or group of hospitals providing the main specialties and all the people who would look first to those hospitals for service. If this requirement matches an existing local authority, it would be appropriate for that to be the democratic body. If the appropriate boundaries are different, a separate body will be needed, but in this case it must either be directly elected or include all the district or county councillors from its area, to ensure that every citizen has an elected representative on the body.
Prepared 1998
Updated 2006