The notion that the NHS should be more accountable to local communities has been gaining political traction as the government seeks to “devolve more responsibilities to the local level.”1 This is covered in two reports by the King’s Fund and the Local Government Association Health Commission.2 3

The King’s Fund’s report focuses on local accountability of primary care trusts. It suggests that the mechanisms for improvement hinge on the nature of local accountability preferred by communities and on the government’s objectives. Existing arrangements such as local government overview and scrutiny committees, local involvement networks, and requirements for primary care trusts and other services to engage at the local level could work, if refined and given time to settle in. Other possibilities include the use of citizens’ juries and more involvement of local government in decision making by primary care trusts.

The Health Commission’s detailed consideration of the entire NHS makes many recommendations. Woven through the commission’s report is a potentially radical …