Ian Swanson: Change needed for NHS

Published on Monday 19 January 2009 09:07

HEALTH boards spend around £8 billion of taxpayers' money every year – yet none of the men and women making the decisions are directly accountable to voters.

What's more, according to at least one critic, no-one knows who most of them are.

That could all change, though, if the Scottish Government gets its way. MSPs gave unanimous approval last week to the general principles of a bill for direct elections to Scotland's NHS boards, although the initial plan is only to set up two pilot schemes in areas yet to be decided.

At the moment it is Scottish Government ministers who appoint a number of "non-executive lay members" to sit alongside representatives of local authorities and health bodies and senior staff on boards to make key decisions about local health care.

The NHS Lothian board, with a budget of nearly 1 billion a year, has 27 members – 11 of them "non-executive" lay appointees, including the chairman, and 16 others, mainly councillors and senior NHS staff.

The bill before the Scottish Parliament proposes boards should in future be composed in such a way that the new directly-elected members combined with the councillors make up a majority.

Former Wester Hailes GP turned Lothians SNP MSP Dr Ian McKee believes it is high time the health board was brought close to the community.

He says: "I don't know anyone who knows any of the names of the non-executives on Lothian health board."

He says they are "dedicated, public-spirited individuals with the best interests of Lothian at heart", but he adds: "We would not be surprised to meet them all at the same Morningside drinks party.

They are business consultants, accountants and academics to a woman or man. They have been appointed to represent the public interest, but how representative are they?

"How can they be approached and what do they know about the health needs of deprived areas or ethnic minorities, for example?"

The non-executive lay posts on health boards – which carry a payment of around 7700 a year – are publicly advertised and involve an interview process as with other public appointments.

Dr McKee says: "It is only when we have members of health boards who have submitted to the electoral process that we will begin to give local people real confidence in the way that their health service is run."

NHS Lothian has argued against direct elections, claiming the current mix of members works well and suggesting the proposed new system could be confusing both for the public and the board itself.

It also raises fears about single-issue campaigns overwhelming the elections.

NHS Lothian tried to block West Lothian Council's appointment to the board of John Cochrane, former NHS Lothian head of procurement, who was elected as a Save St John's hospital campaigner at the last election.

Giving evidence to the Scottish Parliament's health committee, NHS Lothian chairman Dr Charles Winstanley said: "If single issues were to dominate board business and squeeze out debate on other issues, that could be destabilising."

Other opponents of direct elections – which includes doctors' organisation the British Medical Association – claim the move risks politicising health boards.

At the start of last week's debate, Health Secretary Nicola Sturgeon set out simply the case for elections: "There is a real democratic deficit in the operation of our health boards. Too often, the public feel shut out of the big decisions that health boards take daily and which account for significant sums of public money.

"Sometimes, that exclusion from the decision-making process leads to deep-seated alienation from the decisions that are reached."

The bill's objective, she continued, was to allow the public voice to be heard at the heart of the decision-making process.

Parliament approved two pilot schemes costing an estimated 2.86m. They will start in 2010 and run at least two years.

Livingston SNP MSP Angela Constance says: "It doesn't surprise me health boards are resistant to the idea. After all, you would not expect turkeys to vote for Christmas, but I'm optimistic change is on its way."

Labour former health minister Malcolm Chisholm, MSP for Edinburgh North and Leith, backs the pilots.

He says: "People felt they were not consulted at an early enough stage. It seemed more of a formality than a process that was going to influence anything."

The bill proposes elections by postal ballot every four years, using the Single Transferable Vote as at council elections, although each board area would be treated as one giant ward.

The Government also plans to extend the vote to 16 and 17 year olds, while the new directly elected members would get the same level of remuneration as the current non-executive members.