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Tim Kevan: Gordon Brown, the NHS, and the democratic deficit

Tim Kevan is a barrister and was a contributor to a recently published book entitled ‘The Future of the NHS’ edited by Dr Michelle Tempest and published by xpl Publishing.  He was national chairman of the Conservative Students from 1993 to 1994.

First it was Gordon Brown and now it’s David Cameron.  Everyone wants to set the NHS free, to take it out of politician’s hands. The idea is that this will restore faith in politicians ironically by taking the day to day decision-making away from them and allowing it to be run by professionals uninterested by short term political gain.  This approach is partially supported by a recent You Gov which followed the publication of a book The Future of the NHS which showed a two to one majority in favour of the government withdrawing from the NHS.   

However, what both the Chancellor and David Cameron seem to have missed is that the frustration with the NHS in its present form is based upon ever more distant decision-making from the people those decisions affect and his solution will only serve to exacerbate this problem.  It reflects the very real democratic deficit which exists in the NHS.  For example, when the people of Kidderminster objected to the closure of facilities at their local hospital they started a campaign which eventually led them to winning a majority of their local council seats and even the local parliamentary constituency.  However, despite all of these efforts, they remained disenfranchised.  They were unable to exert any direct control over the decision-making process which remained entirely in the hands of the Secretary of State for Health.  The introduction of an independent body is hardly going to empower people such as those from Kidderminster.  Instead, it will take decision-making one step further away.   

One solution to this problem is to introduce democracy directly into the NHS.  This could immediately be done by changing the structure of the NHS and in particular primary care trusts and other health organisations so that their boundaries coincide with local authorities.  Once this has been done, decision-making power can be handed over to locally elected politicians who can respond directly to the needs of local communities, failing which they will be accountable at the ballot box.  This would not only invigorate the NHS but it would also empower the PCTs and health authorities through the extra legitimacy.   

On a wider level, it is to be hoped that this is not the direction in which the Cameron Conservatives intend to go more generally.  It was also reported only recently that the country now has 882 different independent governmental bodies or quangoes, each of them not only taking power further away from the people but costing those people a total of £124 billion for the privilege.  If the Conservative Party wants a radical proposal for their first day in office, perhaps they could promise to abolish all quangos in their present form within 2 years and instead to hand over the regulatory functions to locally and nationally elected bodies.


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