ABSTRACT
The Welfare State in general, and the NHS in particular, were explicitly designed as the weapons to fight a specific problem at a particular time – the insecurity caused by free markets in the 1930s. For politicians the conundrum has been how to court patients and public alike within the framework of their own ideologies. By 1974, however, ministers saw a need to represent the public and the patient in the system, introducing the community health council (CHC) as a complaints measure, and allowing elected local council members on to health authorities. In the absence of direct representation on health bodies, the Government has claimed that patients can exercise their voice throughout the contracting process. If democratic forms of voice contribution and accountability were promoted, one consequence would be to increase the politicization of the system.
