The evening of the England-Portugal Euro 2000 match was not an auspicious time to hold a debate, even in the House of Lords. But Lord Harris of Haringey managed to attract around 20 peers, including soccer-loving health minister Lord Hunt, to discuss NHS account- ability.

Lord Harris - better known as Toby Harris, former director of the Association of Community Health Councils in England and Wales, current Greater London Authority member, and holder of myriad other public posts - addressed what he called the 'democratic deficit' within the NHS.

His starting text was New Life for Health , the report of political commentator Will Hutton's Commission on the National Health Service. Lord Harris agrees with its diagnosis - the lack of democracy and accountability in the NHS - but disagrees with its cure - that the NHS should become an autonomous public corporation.

'If it's a public corporation, the response from the minister, any time anything is raised, will be, 'That's a matter for the chairman of the NHS'- it's difficult to see how the structure would be more accountable than the present arrangement, 'Lord Harris told HSJ .

Instead, he believes the NHS should receive a fresh injection of democracy. Patients or at least a 'lay presence' should be a 'dominant' part of all the key NHS institutions, including the General Medical Council.

There should also be a reformed, independent 'one door' complaints system.

The NHS should be overseen by a board, involving not just ministers and managers, but independent lay members appointed on Nolan principles of fairness and transparency. This board would be accountable to a strengthened Commons health committee, and a specially created Lords health committee.

More controversially, Lord Harris calls for an integration of NHS regional offices with the nascent regional bodies being set up around the country. In London, this would mean the mayor choosing the chairman and board of the London NHS region. 'Citizens ought to be determining who runs our NHS, 'he says.

He also points out that a precedent exists - in London the mayor has already appointed the members of the regional development agency (a task carried out by the secretary of state for the environment, transport and regions elsewhere in the country).But it doesn't stop there; democracy should filter down even further, says Lord Harris. He suggests that health authorities should be run by a directly-elected commissioner as a means of re-establishing links with the public.

He is not worried about HAs becoming a partypolitical battleground. Experience elsewhere shows that while parties initially dominate such elections, in time voters choose individuals they trust to do a good job - a phenomenon which, he admits, characterised the London mayoral elections.