Letter

A vote for democracy

Dear healthmatters — David Hunter’s article (An opportunity to put health before health care, issue 10) put the case for local government taking over the purchasing of health and social services.

Since the general election if has become clear that the ‘NHS reforms’ will accelerate and that there will be an increasing number of pure purchasing health authorities without any directly managed providers. Some DHAs are considering merging with FHSAs as joint purchasing consortia. The unification of this function with local government would overcome the tripartite split present since the inception of the NHS.

The providers in this model would be independent of local government and a different system of management co-ordination would be required to maintain the integrity of the NHS - coming full circle back to Hospital Management Boards within a Regional framework!

There has always been a democratic deficit within the NHS and bringing health strategy and purchasing within local government is attractive. It is not clear from his article why Hunter refers to the ‘alleged virtues’ of democratic accountability while also pointing to the ‘values and political judgements’ inherent in purchasing health care.

The virtue of democratic accountability is not some mysterious organisational efficiency but political legitimacy. When difficult choices are having to be made and services rationed it is clearly of value that those responsible for making the decisions are democratically accountable to the community who will feel the impact. Currently the Secretary of State for Health is the sole democratically elected representative in the NHS structure.

More local democratic control will not overcome the problem of under-resourcing of the health and social services. Centralisation of power and financial control has been a trend under the Conservative government. Central constraints have long been present on NHS funding, and the same is increasingly true for local government.

Despite these reservations democratic accountability is an important political question in the health service and the option of bringing the purchasing function within a local government framework should be seriously considered as one structural part of a wider movement to empower people. In any health strategy empowerment of individuals and communities should be an essential part of striving for Health for All.

The Socialist Health Association has attempted to keep democratic accountability on the political agenda and it was with some sadness that we noted that the only political party to have ‘democracy in the NHS’ in its manifesto was the Liberal Democrats. We hope that the Labour Party, which has accepted the principle of democracy in the NHS, will develop firm proposals for future manifestos.