Democratic control is essential

If healthcare had been deemed too important to leave to the politicians, as advocated by Fiona Godlee [1], we would never have had a National Health Service. Its birth was a deeply controversial political act. Just because we happen to be living through a period of political consensus which believes that healthcare should be tax funded, free at the point of use, and available for all regardless of the ability to pay, it doesn't mean it was ever thus or will be in the future.

A recent visit to the United States brought powerfully home to me what happens in a society where healthcare is not viewed as a right for all citizens. While millions go without insurance cover and liberal pressure groups wring their hands, there's little political will for radical reform.

Discussion and debate about the future of the NHS requires democratic political means. As others have said much more eloquently than I, the most difficult choices in any society are not those between good and evil but between two goods. In any system where staffing or financial resources are limited and where demand is potentially unlimited, tough choices have to be made. Markets or networks? Competition or collaboration? Comprehensiveness or safety net? Patient focused or doctor driven? With or without complementary therapies? All these are contentious issues; we all have a position to take on them, and each affects our health and wellbeing and that of our families and our communities. Democratic checks and balances are the best way to ensure we continue to move the NHS in the right direction, not the creation of a barely accountable technocracy that would place all power in the hands of professionals and bureaucrats.