Primary care trusts and the police could be run by boards with elected representatives in a further fragmentation of local democracy under plans being considered by ministers.
The Department of Health is looking into the possibility of having the majority of PCT board members elected, on the heels of the controversial foundation hospital model (LGC, 21 February).
At the moment PCT boards comprise of a majority of non-executive directors who are interviewed for the position by the NHS appointments commission and a number of executive directors, usually the chief executive, director of finance and director of public health.
The non-executive board posts are advertised and members get paid about £5,000 a year for three of four days work a month.
Health secretary Alan Milburn is thought to be keen on the idea of elected representatives and the DoH already has a unit working on this, but he believes PCTs need time to bed down. The 326 PCTs only became fully operational last year and from this month took control of 75% of the NHS budget.
It is expected ministers will wait until foundation hospitals are set up - the Health and Social Care Bill is currently awaiting its second reading - before embarking on another round of devolving control.
A DoH spokeswoman said foundation hospitals were completely separate from any PCT proposal.
But many in local government are already linking the two, claiming the move
represents another challenge to council legitimacy.
Elected boards would represent a 'mini rival' to councils and cause 'huge
confusion' about elected bodies, one well-informed commentator said, but acknowledged they made more sense than foundation hospitals because of their budget responsibilities.
The source suggested it would be a 'nonsense' to have councils scrutinising health, a responsibility they only acquired at the beginning of the year, while having directly elec ted PCT boards.
A spokeswoman for the Local Government Association said: 'If there is a parallel mandate, what studies have shown is that it can lead to the fragmentation of local services and that is not going to be effective.'
Mike Emmerich, director of the Institute of Political & Economic Governance at Manchester University and a former Downing Street local government adviser, said: 'I am of the view that it is much more relevant to have a democratic element on the commissioning bodies, such as PCTs, than the provider (hospitals).
'But we know that voters suffer election fatigue and one does have to wonder whether having elections for foundation trusts, police boards and PCT boards is really the right way to go about getting more public engagement in policy.'
Chair of the New Local Government Network Professor Gerry Stoker dismissed these concerns: 'There is no reason why we should not have separate institutions, it may be that it attracts new types of people to stand for elections.'
He urged the government to experiment by having councillors sitting on some boards to see what 'works the best'.