Page last updated at 12:51 GMT, Sunday, 7 December 2008

NHS bosses oppose election plan

By Andrew Black
Political reporter, BBC Scotland news website

Operating theatre

Most of Scotland's NHS authorities are either opposed to or have doubts about plans for direct elections to their health boards.

Some health bosses have raised concern that the proposals could destabilise boards by pulling them into party politics.

Health Secretary Nicola Sturgeon told BBC Scotland the concerns were not well-founded.

She also insisted the scheme was "massively popular".

Direct health board elections, a key SNP election manifesto pledge, was brought forward by the party in government to improve public confidence in the health system.

Ministers have cited concern that health authorities had not always properly listened to local views, but several NHS boards disagreed.

It has emerged that five of Scotland's 14 health authorities - Highland, Tayside, Ayrshire and Arran, Lothian and Grampian - have opposed direct health board elections outright.

Nicola Sturgeon
Any institution facing a quite radical change might be resistant to that change
Nicola Sturgeon
Scottish health secretary

A further five - Shetland, Forth Valley, Lanarkshire, Greater Glasgow and Orkney - have expressed doubts about the plans.

They include concerns about the "politicisation" of boards and being flooded with single-issue candidates with no interest in overall policy.

Critics also pointed out that councillors already sat on health boards, which were accountable to ministers and parliament.

But Ms Sturgeon said ordinary people should be given a say in the running of the health service which they paid for, adding: "It's also massively popular and I think it's the right thing to do."

She went on: "I don't think democracy is ever a bad thing.

"I understand and am aware of some of the concerns health boards have. I don't agree that those concerns are well-founded."

The Scottish Government hopes to pilot direct health board elections, probably with two NHS authorities, in a Bill currently going through parliament.

Test concerns

However, opposition parties are sceptical towards the plan, and could vote the legislation down.

One NHS board - Fife - backed the bill, while NHS Western Isles said it had not discussed the plans and Dumfries and Galloway declined to comment until after the pilot.

Ms Sturgeon said she was not surprised by the health boards' reservations, but said she was confident they would eventually come round.

"Any institution facing a quite radical change might be resistant to that change, but what convinces me this is the right thing to do is that the public think it's right and I believe it's right, because the NHS is a public service and it's right that it should be influenced in terms of what the public think."

The health secretary added: "In any event, if the bill passes, we will have pilot elections to test out some of these concerns in practice and then parliament would have to decide before health board elections could be rolled out further."

One of the earliest acts of the SNP in government was to reverse decisions by the previous administration to close accident and emergency units at Ayr hospital and Monklands in Lanarkshire, which had caused a local outcry.



"NHS Borders operates within the context of governmental policy and, therefore, comments submitted following the call for written evidence did not represent the views of our board, but reflected the opinions of a number of individuals."


"Although there is a spectrum of views across NHS Highland board members, overall we are strongly opposed to the principle of direct elections. The majority view of NHS Highland is that the existing arrangements for the appointment of public members to NHS boards work well."


"NHS Orkney sees no benefits in having additional elected members on its board under the system highlighted in the Bill. In small, rural areas there is a real risk that those who are elected are members of groups with particular issues, rather than having the wider interest across the whole range of health board priorities."


"We believe we can demonstrate delivery of robust internal accountability through our current non-executive members. We suspect that further, wholesale change to the current system has the potential to destabilise boards."


"NHS Dumfries and Galloway understands that the proposals under the Health Boards (Membership and Elections) Bill are to be piloted elsewhere in Scotland. Until the outcome of the pilot arrangements have been made known and our board has the opportunity to consider its position, NHS Dumfries and Galloway has no other comment."


"Ministers have set out the policy directions and NHS Fife fully supports their Bill. When the government was considering policy earlier this year via a consultation document, NHS Fife expressed agreement with the starting premise that the public does not believe NHS boards have taken sufficient account of the views of local people."


"Tayside NHS Board does not believe that the limited attempt to democratise health boards by electing some members to boards will do much to enhance the concept of mutuality. For the board, mutuality emphasises participation much more than representation."


"NHS Ayrshire and Arran would not support the introduction of this Bill. It would change and confuse, rather than increase, accountability, it would be likely to undermine the operation of a national NHS [and] there is no evidence that it would increase the quality of decision-making."


"The current local authority membership of both NHS boards and Community Health Partnerships provides a significant, democratic input to the working of these bodies. To expand directly elected health board members as proposed in the Bill would only lead to confusion and conflict between members from different 'electoral' systems."


"Elected members are unlikely to have the mechanisms in place to enable them to seek the views of the electorate and, therefore, would be elected on the basis of their manifesto. It would be difficult, therefore, for them to truly represent the local population and the risk to boards is that their input is based on particular issues and a lack of understanding about the broader health board issues."


"There are already a substantial number of mechanisms in health and in local authorities, and through health and local authority partnership arrangements, for the needs and views of local communities to be heard effectively."


"There could be possible tensions between locally elected council members on NHS boards and those appointed through the direct elections process and tensions between non-executive members appointed through an open and competitive process and, again, the members appointed by the direct election process."


"The matter of direct elections to health boards has not been discussed by Western Isles Health Board."


"The board would strongly object to diverting current resources from patients to support elections, but the cheapest method must be adopted, and the cost met nationally without detriment to patient services, either in money or staff time."

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