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There is an in built dislike for local accountability in the NHS by the DoH. That is why Trust Boards are stuffed with a dad's army of cashiered businessmen(persons) and all round do-gooders. With public health handed to local government under democratic control it will be interesting what roles are played. If HealthWatch is populated by the retired at least they have areal interest in the quality of local health services. the question is who decides who pulls the strings in these new local bodies and will there be professionalism in their management - £20K - probably not.