ABSTRACT
The demise of traditional public accountability structures in the National Health Service (NHS) of the 1990s represents for many its ‘dark ages’. The aggressive tribalism of its medical, financial, nursing and para-medical professions has never been so much in evidence. Having been confined to the inner sanctum of Department of Health meeting rooms, conflicts of interest have never been so visible locally. Self-determination is one important principle right at the heart of the process. It is an attractive principle offering the prospect of moving away from the dependency culture and paternalism that has traditionally plagued the NHS. Health care with its essential healing element is as much a spiritual experience as it is a technical activity. The relationship between people at times of illness or disadvantage is profoundly personal. It depends crucially on their feelings and the values they bring to the encounter.
