ABSTRACT
Local government expenditure accounts for about a third of total public expenditure and as such is a key variable in the government’s overall designs to manage the economy. Increasing pressures to control public expenditure in general and expenditure on the health and personal services in particular have sharpened the quest for a form, or forms, of planning which would facilitate more effective and efficient responses to health care issues. In terms of the 1976 White Paper on Public Expenditure to 1979-80, there will be a virtual standstill in the planned expenditure on health and personal social services, though the plateau is necessarily at a higher level than in any period in the history of the National Health Service. Whether local democracy is threatened—by no means a novel theme in political writings over the last century—is debatable, particularly as evidence to demonstrate uniformity of levels of service throughout the country is hard to come by.
