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Public Policy and Administration
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Local Government and the NHS: Accountability in the Hollowed Out State

Allan Bruce

Glasgow Caledonian University

Allan McConnell

Glasgow Caledonian University

The aim of this paper is to compare and contrast accountability within local government and the NHS in the UK. There are it seems a plethora of analyses which deal individually with each of these components of decentralised government, but few purport to compare and contrast the concept of account ability as it applies to both. A key theme of the analysis is that in spite of a number of differences between regimes of accountability in local government and the NHS, there are crucial similarities. These similarities need to be located within the political economy of the 1980s and the 1990s.

The authors use Rhodes' concept of 'the hollowing out of the state' for consid ering the changes that have permeated local government and the NHS. The hollowed out state is conceptualised as a shift in the balance of power within the state towards the centre rather than as a weakening of the state, as the language may imply. This has had a crucial impact on accountability. In terms of the public services which are delivered under the auspices of local government and the NHS, it has meant that the centre has been attempting in effect to reconstitute the concept of accountability in accordance with its own predilections

Public Policy and Administration, Vol. 10, No. 3, 15-28 (1995)
DOI: 10.1177/095207679501000302
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