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Local Control and Local Variation in the NHS: What do the Public Think?

The move towards greater local autonomy in the NHS offers new possibilities for services that are specifically targeted at local needs. Locally varied services will be necessary to make the health service more effective and efficient in the years ahead. But there are fears that greater local spending and decision-making power will undermine the national character of the NHS, amid public concern about ‘postcode lotteries’. This study presents the findings of a piece of original research carried out in conjunction with Ipsos MORI examining public views about variation in the NHS.

Will people respond more positively to variation in services if they feel they have control over the decisions that are made in their area? What accountability mechanisms should be introduced to make sure that the health service meets public expectations? And who should take the lead in making tough decisions about possible service cutbacks?

These questions have been made even more urgent by the dramatic downturn in the economy. Real-terms cuts in public service budgets are now unavoidable and will present a huge challenge for health services at a time when health costs are rising. This study shows that while people say they are in favour of a nationally based NHS, in practice the public supports locally tailored services. The key to allaying people’s concerns about changes to local services is making sure that decisions are transparent and fair.

This report is part of the ongoing SMF Health Project. The move towards greater local autonomy in the NHS offers new possibilities for services that are specifically targeted at local needs. Locally varied services will be necessary to make the health service more effective and efficient in the years ahead. But there are fears that greater local spending and decision-making power will undermine the national character of the NHS, amid public concern about ‘postcode lotteries’. This study presents the findings of a piece of original research carried out in conjunction with Ipsos MORI examining public views about variation in the NHS.

Will people respond more positively to variation in services if they feel they have control over the decisions that are made in their area? What accountability mechanisms should be introduced to make sure that the health service meets public expectations? And who should take the lead in making tough decisions about possible service cutbacks?

These questions have been made even more urgent by the dramatic downturn in the economy. Real-terms cuts in public service budgets are now unavoidable and will present a huge challenge for health services at a time when health costs are rising. This study shows that while people say they are in favour of a nationally based NHS, in practice the public supports locally tailored services. The key to allaying people’s concerns about changes to local services is making sure that decisions are transparent and fair.

This report is part of the ongoing SMF Health Project.

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