Why is it OK to have democratic accountability for leisure services and social care but not crime prevention, public health or dentistry? As public services are devolved, why aren’t we creating greater local public accountability?

Healthcare varies across the country. Each county or city has different health needs, priorities and outcomes. The same is true in policing. Crime statistics vary between police forces – assaults and burglary rates are variable.

This variation is broadly acceptable as each part of the country has different needs and therefore should set different priorities. Clearly national minimum standards remain essential – on cleanliness or the availability of drugs, for example. In policing the manner in which evidence is collected and handled should not vary and nor should basic protocols and procedures on the management of suspects.

But there is clearly room for variation in services. The country is not homogenous – it is diverse – differences exist between rural and urban communities and between areas with high elderly populations and those with a younger demographic. Each area has different needs and the delivery of services should reflect these needs.

But how do you manage this diversity and who makes the decision to prioritise paediatrics over drug treatment and, importantly, who is accountable for that decision, and to whom are they accountable?

At present, if you object to the decisions made by your primary care trust there is little you can do about it beyond writing letters to all and sundry. The same is true of the police authority – who answers to whom for the decisions they make on police numbers or crime prevention?

This is not so much about public involvement in the design of services as democratic accountability for policy decisions. If the non-executive directors of PCTs and board members of Police Authorities had to seek election every few years they would be forced to explain their decisions. They would need to publicly explain why they felt that X priority was more important than Y – why they didn’t introduce more community support officers, or decided to invest in a sexual health awareness campaign. As a citizen I could then agree or disagree with their decisions knowing that at some point in the future I will be able to cast my vote accordingly.

The ballot box would rapidly change the culture of these bodies. An elected mandate would lend authority to board members to question senior officers – not over operational detail but on policy and priorities. A police board chair would become a significant public figure – publicly accountable for the actions of his or her service. No longer would the Board members be obscure individuals drawn from the narrow pool of retired civil servants, accountants and councillors. They would have a democratic mandate from the same citizens for whom the services are provided.

The Lib Dems are proposing elected health boards. Labour should do the same and demonstrate that progressive politics means greater public accountability. The Tories have rejected the idea – and claim they wish to keep politics out of health and policing. They don’t understand that health and policing are intrinsically political, as are all public services. What they mean is that they wish to keep democracy and accountability out of local services whenever possible. Labour should seize the initiative and make the case for more, not less, democratic accountability.