Review

Brief looks at the NHS

PUBLIC LAW AND HEALTH SERVICE ACCOUNTABILITY
Diane Longley
Open University Press, 1993

It is paradoxical that the government’s efforts to make health services more responsive to the ‘consumer’ have resulted in them simultaneously becoming less responsive to the communities they serve. Indeed, the recent suggestion that the NHS be floated free of direct ministerial control as an ‘agency’, thus shedding any last vestige of democratic accountability to parliament, threatens to push the ‘legitimisation crisis’ ever higher up the agendas of NHS managers.

It is precisely these issues of public accountability and responsiveness which Longley explores in this book, from the perspective of an academic lawyer. Her focus is on the part that the law should play — through what she terms the four ‘law-jobs’ — in ensuring that health services are, and remain, accountable to the public.

Inevitable, much of the text is devoted to describing the legislative and administrative framework of the 1991 reforms, and the implications of these changes for public accountability. Equally inevitably, given the speed with which health service policy now seems to appear, much has changed since the book was written, and many of the arguments about, for instance, the role of health authorities and GP fundholders, now seem commonplace.

Nonetheless, the discussion is useful and broad-ranging. Particular highlights include a very clear explanatory section on the role of the Audit Commission, and a review of attempts by individual patients or their carers to challenge the lack of provision of services in the courts. As Longley notes, there is little in the British experience to suggest that the courts see any role for themselves in enhancing public accountability in public services.

Longley is at her best when she is on home turf, explaining the relevance and use of the law to protect the public interest. Where she is in the territory of health economics or health policy, she seems less sure-footed.

The issue of the lack of accountability in public management is not going to go away, but whether we can rely on the law to correct the gaping ‘democratic deficit’ remains to be seen. The jury is still out.