Democratic control: An achievable objective?
While Godlee (1) calls for the removal of political control on the
NHS, Thornton (2) makes a case for ‘democratic control’ of healthcare
policy. This may sound an attractive proposition but does it withstand the
test of achievability within the contemporary workings of the government?
Democracy prevails in different forms. The pertinent question is what
exactly is democracy? Does the government of the day deliver democracy
untainted in its purest form?
Those of us who are able to recall the first election manifesto of
the New Labour will remember the slogan ‘’ collaboration not competition’’
– as alluded to by Mr Blair in relation to his vision for the NHS. This
was presented as the ethical if not a socially acceptable alternative to
the internal market introduced by Mrs Thatcher. Nonetheless New Labour saw
it fit to repackage the conservative idea of competition in to
Former Secretary of State for health Mr Milburn passionately believed
in the ‘third way’ – the borrowed term from USA. The principle of public
private partnership that underpinned this was subsequently introduced into
many of the public services including that of healthcare amidst fierce
criticism that such reforms are not in the long-term interest of the
nation. Opponents of such reforms have since argued that such a policy is
tantamount to privatisation by the backdoor.
Modern day politicians use the much talked ‘ health care, free at the
point of delivery’ to arouse the sentiments of the masses to gain popular
votes. Despite the accompanying rhetoric they have consistently failed to
attach any meaning to what they mean by healthcare at the point of
delivery thus creating much confusion, leading to inconsistent practices
such the postcode prescribing and inequalities in preventive strategies.
As long as politicians remain schizophrenic in their messages and
health economists continue to be ambiguous on the subject, there can never
be any realistic prospect for democratic control on the NHS (or what may
be the remnants of the NHS).
The notion that shifting the balance of power from the centre to the
local health economies (3) in itself will secure delivery is a misplaced
one. If the government is serious on this matter it must address the
fundamental issue of its own accountability to all its citizens!
1 Godlee F. Time to leave home [Editor's Choice]. BMJ 2006; 332. (1
2. Department of Health. Patients first: consultative paper on the
structure and management of the National Health Service in England and
Wales. London: DoH, 1979.
3. Department of Health. Shifting the balance of power within the
NHS: securing delivery. London: DoH, 2001.
member of council / BMA
Competing interests: No competing interests