Democratic engagement in the local NHS

Any examination of democracy in the health service is troubled by confusion and complexity. In this essay, Dr Sally Ruane of the Centre for Health and the Public Interest writes for Democratic Audit about the recent history of patient and public involvement in the NHS, and those elements of the health system lying outside the NHS. Dr Ruane identifies the barriers to democratic engagement and sets out ways in which accountability can be strengthened, particularly through Healthwatch and local authorities.