ABSTRACT
Government ministers and health service interests have seemingly been stung by the criticism of a lack of public accountability at a local level. Public accountability in the health service is far from adequate. The health service is structured on the principle of sets of appointees watching, cajoling and interacting with other sets of appointees. Health authorities are doing more than simply managing health services at a local level. Local choices have always been made in the health service. Local democratic governance could be achieved by giving local authorities the responsibility for the commissioning of health services and this is something for which a number of people have argued. Public accountability for health services should involve more than simply allowing for the periodic questioning of the appropriate Secretary of State. The principle of public accountability needs to be embedded within public services but is currently seriously lacking and is being eroded at an ever-increasing rate, including within the reformed health service.
