Formal links between local government and district health authorities were severed by the Government under its market-led changes three years ago. With more than two-thirds of NHS budgets now under the control of quangos, the lack of accountability is widely seen by critics as a key failure of the shake-up.
A Labour consultation paper, due out in October, is expected to outline a range of options for giving users of the service, and their locally elected representatives, more say in the running of local health services.
As the Government invited applications for the fifth wave of NHS trusts, David Blunkett, Labour's health spokesman, said Labour would end their self-governing nature. Interviewed on BBC Radio's Today programme, he said: 'When we are in government we will obviously want to avoid enormous expenditure on change, but we are determined to bring the health service back under democratic control.'
Later, he told the Independent: 'We may have to introduce a completely new structure in order to give local people a more powerful voice, and that may mean a local government input.'
Dr Sandy Macara, chairman of the British Medical Association, said last night: 'The idea of giving local government a role in NHS decision-making has an honourable pedigree . . . We would welcome a national debate about how we restore local accountability.'