‘Increasing democratic legitimacy in health’: our consultation response

In this paper we analyse proposals set out in the 2010 NHS White Paper: Equity and excellence: Liberating the NHS.


Published: 11/10/2010

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Previous attempts to make the NHS more accountable to local residents and patients have had limited success. The 2010 NHS White Paper: Equity and excellence: Liberating the NHS outlined Government plans to make the NHS more responsive by increasing consumer power, and giving local government more influence over how health services are shaped. In this paper we analyse the latter set of proposals, as outlined in ‘Increasing democratic legitimacy in health’.

The Nuffield Trust believes in the importance of both accountability and legitimacy within a publicly funded health care system. Our analysis reveals pressing contradictions between the stated goal of more local influence, and the strong lines of accountability upwards from GP consortia to the central NHS commissioning board (now NHS England).

Among the suggestions we make for resolving this deficit are a clearer role for the local public and patients within the governance structures of GP consortia, and adequate resources so that Health and Wellbeing Boards can monitor the configuration and quality of local services

Suggested citation

Nuffield Trust (2010) ‘Increasing democratic legitimacy in health’: our consultation response. Consultation reponse. Nuffield Trust.