NHS organisations have rebuffed a call for councils to hold the power to hire and fire trust chief executives.
Local Government Association chairman Sir Simon Milton (Conservative) said trust directors and local police commanders should be 'accountable first to local people through their council'.
'Where my constituents are asking why hospital infections are going up, then I want the ability to put the concerns of people first,' he told a conference of council leaders and chief executives.
An LGA spokesman said the idea was for councils to decide the fate of chief executives at the helm of poorly performing trusts. This was needed because the current scrutiny system designed to ensure health services were accountable to local government lacked teeth, he said.
Council leaders should also be involved in recruiting trust chief executives, he said, but stressed local authorities would not interfere with 'professionals doing a professional job'.
The LGA said the proposal was in line with prime minister Gordon Brown's pledge to improve accountability in the NHS.
A concordat between central and local government signed last week includes a commitment to work together to increase 'democratic accountability' in the health service.
But the NHS Confederation hit back. Policy director Nigel Edwards said further NHS reorganisation was 'the very last thing patients need'.
'There is little evidence of any public appetite for changing the accountability mechanisms in the NHS,' he said.
Instead he said the focus should be on improving overview and scrutiny committees and developing new ways of involving patients and the wider public in trusts' work.
NHS North West chief executive Mike Farrar said the NHS did have to look at ways to improve accountability if it was serious about world class commissioning.
'Primary care trusts have got to think seriously about where they get legitimacy from,' he said.
'If you're spending half a billion pounds of taxpayers' money you have got to have a strong relationship with local people about how you spend that money.'
He said increasing accountability through local government was an option but added 'it's not one I would necessarily prefer'.
'We know that turn-out in local elections is poor and there is a question about whether through local government we'd actually be getting the legitimacy we need,' he said.
Other options included increasing doctors' influence in shaping local health policy as they were trusted by the public, and membership schemes already being tested by some PCTs.
Mr Farrar added that simply having a proper debate on legitimacy in the health service could help to build better relationships with local government.
The LGA has launched a health commission chaired by King's Fund chief executive Niall Dickson which is expected to look at governance and accountability. It is due to report in July next year.