- This paper explores the many meanings of democracy, seeks to define some criteria for assessing whether or not there is a 'democratic deficit' in the NHS, and examines the policy options that have been put forward for making the NHS more 'democratic'. The first section analyses the various ways in which 'democracy' is understood and develops a set of criteria for testing the democratic credentials of government institutions. It then looks at central governance and the need for central accountability in any service funded out of general taxation. The next section looks at the possibility of local democracy in the NHS, and the justifications and problems associated with introducing formal local accountability into a national service. The following section looks at whether individual choice can act as a substitute for democracy, and finally, the implications of the recent white paper for the NHS are reviewed.