If there is one golden thread connecting Old and New Labour, it is the commitment to the National Health Service. There is no member of the Cabinet who does not believe in the Bevanite conception of the NHS - a service providing equality of treatment free to every Briton, regardless of age, race, class, gender or geography. Despite New Labour's temporising elsewhere, we should take it at its word on the NHS.  The problem is not the shared goal, it is the means. And here the Government's lack of an overarching philosophy and political coherence is undermining its capacity to achieve the end that it wants. Promises of more spending, shorter waiting-lists and a tougher regime for consultants are all welcome as far as they go, but the problems are much more deep-seated. The NHS is suffering a gathering crisis of legitimacy. Patients and the public at large want a voice and a systematic framework in which they can trust that high quality health care is assured over time.   Yet what is on offer is an increasingly politicised service where effective decision-making is still tightly held at the centre and where some of the policies, notably the Private Finance Initiative (PFI) as it operates in health, are undermining the equality and evenness of provision that the Government seeks.   Three recent events underline the problem; more lie ahead. There is the exercise in public consultation - the so-called health census - to inform the National Plan for Health that has been exposed as little more than a PR stunt. There is the extraordinary fight to prevent the downgrading of Kidderminster General Hospital (part of a larger PFI deal for the nearby Worcester Royal Infirmary), where 19 out of 42 seats on the local district council are held by independent, newly elected councillors who, as members of 'Health Concern', are pledged to fight the plans and are bringing their protest to London next week in a street march. And there is the growing public dismay at medical incompetence, highlighted again by last week's Ritchie Report into Rodney Ledward, the Kent consultant gynaecologist and obstetrician who, over a 16-year career, maimed and harmed any number of women through botched operations.   At first glance, these cases might seem unconnected, yet what binds them together is the great accountability gap that sits in the NHS as a brooding cancer. As long as it remains unaddressed, it will expose the contradictions that beset the Government's NHS policies.   The unprecedented scale of the consultation exercise being mounted before the publication of the National Plan for Health in July is a tacit recognition of the accountability gap. The country's surgeries and supermarkets have been flooded by 12 million leaflets inviting us to identify the three key things we want from the NHS. These have to be completed and sent back by Monday at the latest, a week from start to finish.   However, as Mori's Bob Worcester has said, this is not a serious exercise in finding out what the public wants or the trade-offs it might make between varying claims on NHS resources; that would require intense quantitative and qualitative research. Rather, it is a high-profile exercise in trying to demonstrate that the Government is 'listening', even though it knows the results will be unrepresentative and profoundly compromised by the tight time-scale. But it needs to show that readiness because nothing less will do in today's democratic climate.   Automatic deference to authority is steadily weakening. We live in more democratic times, where everybody believes their voice should be heard. Legitimacy, by government, line manager or NHS consultant has to be earned. The Ledward case, together with the palpable weakness of both NHS managers and the General Medical Council alike in dealing with this rogue consultant, is another nail in that coffin.   Ledward, like Harold Shipman, may be an exception, but the reality is that the system did not catch either early enough and in today's climate such deficiencies are no longer acceptable. The Ritchie Report assembles an impressive list of reforms, bolstering NHS complaints procedures which should be extended to the private sector and calling for beefed-up powers for the General Medical Council. And the Government has responded by saying either reform is in train or it will be.   But as with the census, the larger democratic point is missed. The reason why the health ombudsman is weak, complaints procedures are feeble and regulation is delegated to the medical profession in the shape of the General Medical Council is not some accident - it is because the British doctrine is that accountability lies with the Minister in Parliament and that any other mechanism might challenge that ultimate authority. Thus the ombudsman is kept weak because he or she might challenge the authority of the Minister. There is a linear connection between British constitutional arrangements and Ledward's capacity to practise.   This doctrine is not going to be challenged by New Labour. Instead, the party rel ishes the control it confers; the centre can thus control the terms of the health debate while offering a patina of accountability through consultation exercises like the national census or patients' focus groups. This allows polices like the PFI to be protected, which would not otherwise survive the scrutiny of the democratic rough house.   Yet Kidderminster gives the lie even to this proposition. To scale down Kidderminster General so that it no longer offers in-patient beds, and diverting patients to Worcester, whose Royal Infirmary is being replaced with a PFI hospital that can only afford three-fifths of the existing acute beds, is outrageous. This is not a plan to improve Worcester's health provision that has been driven by Worcester's health needs, settled by open argument. Rather, it is a top-down scheme imposed upon the county by the exigencies of offering private contractors their appropriate financial returns within impossibly tight public-sector expenditure constraints.   Yet the democratic voice cannot be suppressed. Alan Milburn dares not visit Worcester for fear the cameras might catch him with the protesters; next week, the stakes will be higher again as they carry their protest to London. And this is not the Socialist Workers Party; this is middle England in force.   The Government really does want to deliver a better NHS. New money, new schemes and renegotiating the deal with consultants are helpful, but they will not crack the problem. To do that it must close the accountability deficit, with all that implies - delegating power, toughening up regulations, offering elections to health boards and accepting that if the PFI changes the fundamental character of the hospital service, then it must be reformed. It means nothing less than a democratic constitution for the health service, the case the commission I chaired recommended six weeks ago. Our case gets stronger by the day.