BMJ  2007;334 (13 January), doi:10.1136/bmj.39091.552940.47

Editor's Choice

Editor's choice

Routine reporting

The first 150 words of the full text of this article appear below.

UK health care is suffering from what Will Hutton calls the "delivery paradox" (doi: 10.1136/bmj.39080.574699.47). Although standards of care are improving, public satisfaction is falling. This is important, says Hutton, because public dissatisfaction threatens could support for the universal public delivery of health care, which is fundamental to the NHS.

What's to be done? Hutton's solution won't suit everyone. It's called distributive democracy and goes completely counter to the current tide in the UK towards ever greater centralisation (despite the government's rhetoric of decentralisation). Hutton argues that general elections and party democracy can't respond to users' needs at a local level or on a day to day basis. Instead he advocates making our public institutions as responsive to citizens as the best private companies are to their customers. Health care should, he says, follow the BBC's lead in applying a "public value" test for everything it does. Clinical judgments . . . [Full text of this article]

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