Quangos and Local Government: A Changing World by Howard Davis

Author:Howard Davis [Davis, Howard]
Language: eng
Format: epub
Tags: Political Science, General
ISBN: 9780714643243
Google: -dbOrZXUq6oC
Goodreads: 10987577
Publisher: Routledge
Published: 1996-01-15T13:01:15+00:00

Local Choices

Local choices have always been made in the health service. As Ham has said, ‘This responsibility is not new to district health authorities, who have long been in the position of having to determine local priorities’.30 With the development of the local purchasing role this is now even more the case. Health authorities are no longer directly responsible for providing health services so that, for Ham,

What is different is that, as purchasers, district health authorities may be able to take decisions which depend less on the demands of providers than they have in the past. In so doing, district health authorities should be able to place greater weight on other factors, such as the views of local people and evidence on the cost effectiveness of different services.31 [emphasis added]

However, democratic accountability for such choices does not exist locally. Instead, it theoretically returns to the door of the appropriate minister. But, as has already been said, they are all too reluctant to accept responsibility for their appointees’ local decisions.

For some, it may be that too much democratic involvement could be to the detriment of the smooth running of the service since the involvement of elected local representatives may lead to a replication of the perceived disadvantages of local government, namely: ‘a common characteristic of local government is one of “committee-itis” and stultifying bureaucracy’,32 which would get in the way of the smooth management of the health service, especially when the service is in the midst of making difficult decisions over acute services. ‘There is no guarantee that a local democratic process could help with the massive challenge posed by the major reconfiguration of acute services now taking place.’33

But this is precisely why a locally accountable service is needed, to ensure that those difficult decisions are taken in consultation with the community affected. This does not mean that difficult decisions cannot and will not be taken but rather that an intrinsic part of the process is that decision making needs to be taken openly and with the facility to call the decision makers to account.

The assertion that difficult decisions are fudged or obfuscated by local politicians is not credible. Local politicians have to close schools, make unpopular planning decisions, shut swimming baths; often in spite of local opposition. However, in these cases the community does have the opportunity of challenging, influencing and ultimately of removing the decision makers from office if they disagree with them.

It may well be easier for difficult decisions to be made behind closed doors with the community unable to call the decision makers to account. But ends do not justify means. Indeed, sometimes it may make for a more difficult life to have open and accountable decision making, but this more arduous journey makes the end more legitimate.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.