Published: 17/11/2005 Volume 115 No. 5982 Page 15

Locally elected health boards would commission NHS services and hold trusts to account under policy proposals being explored by the Liberal Democrats.

About 45 'local NHSs' would be established in a system which mirrors Denmark's and 'devolves decision-making to the people directly affected by it', Liberal Democrat shadow health secretary Steve Webb said during a lecture organised by the NHS Confederation.

The system would be co-operative, with local boards sharing best practice in a 'culture of openness' rather than competing against each other in a world of patient choice, payment by results and contestability, Mr Webb said.

Foundation trusts would be abolished because their governance role would be adopted by health boards.

He accused the government of 'worshipping at the altar of markets' and creating an NHS which encourages secrecy, where managers think: 'If I do something clever I am damn well not going to tell you about it because you might copy me and take my business.' Mr Webb said: 'The citizens of Denmark like a health service that is very devolved and very locally accountable. It is drawn from the bottom up rather than central government telling them what to do.' Health boards would be elected every four years in a system which would 'reinvent local accountability' and members would become experts on health issues, he said. They would spend time on other boards to encourage the sharing of ideas.

'Members are accountable to the public. They stand on the platform and say: 'These are our priorities.

This is our record in overseeing local healthcare', and the trusts and chief executives are answerable to that board.' Mr Webb said the NHS needed 'key hole surgery', but under Labour it was getting 'amputation with a rusty hack-saw'.

'You may well say to me: 'For goodness sake, the last thing we need is another re-organisation' and I would have sympathy with that, ' he added.

'What's the alternative? If you think the system is going seriously in the wrong direction and incentive structures and outcomes are wrong you can't just say: 'Sorry, we'll just leave things to settle down'.'