Published: 17/04/2003, Volume II3, No. 5851 Page 22

The welcome delay to legislation on foundation trusts presents an opportunity to look at the unintended consequences of the government's proposals.

The time should be used to resolve the awkward questions that arise from the government's plans.

What options are there for making the NHS more locally and democratically accountable without undermining basic national standards or progress in reducing health inequalities across the country?

What mechanisms can balance and reconcile the legitimate, but potentially contradictory, aims of maintaining national standards and objectives, while responding to local needs and conditions, as articulated by local service users and their elected representatives?

Can greater local NHS democracy be introduced without the foundation trust model and its inherent risk of giving rise to self-perpetuating elites?

Could greater direct and representative democracy within the existing primary care trusts better promote accountability across the whole health system, rather than just - as the government seems to want - focusing excessively on the acute sector?

Next month, the Democratic Health Network will publish its 'green paper', (www. dhn. org. uk) containing practical options that it hopes will answer these and other questions to realise an NHS that achieves nationally, but listens locally.

Fiona Campbell Co-ordinator Democratic Health Network Local government information unit