Healthy debate
It is hard, in all honesty, to be against virtue. It can be tough to harbour doubts about democracy. Nevertheless . . .
The Scottish Government has published to Scotland鈥檚 14 territorial health boards.
Scenes of rejoicing all round? Not quite. The document itself is notably tentative: consulting on 鈥渨hether鈥 such a development should take place, rather than merely how.
And early political reaction from opposition parties is sceptical, particularly with regard to the detail of implementation.
This is a serious and substantive proposal from ministers. They want responses from the public. Where better to start than on this site?
Perhaps I might prompt discussion by listing a few of the caveats and potential problems outlined by the discussion paper itself.
Here鈥檚 one. Health boards aren鈥檛 just consultative forums. They take real decisions about hospital services. Doesn鈥檛 that argue for expertise rather than enthusiastic amateurism?
Against that, one might say that such an argument could be used to abandon elected local government.
Here's another point. Who will stand for health boards? Won't it just be people with a particular case to pursue?
Either against a development or, more likely, defending a particular hospital or service in the face of clinical advice.
And another. If direct elections are an unalloyed good thing, why not go for 100% elected boards?
Why does the document examine options ranging from a few elected members to totality? Why isn鈥檛 direct election extended to the seven special health boards which provide all-Scotland services like ambulances?
And another. Would you allow party politics in local health decisions? Or would you bar partisan candidates from standing?
Then the question of competing mandate. The object is to 鈥渆ncourage greater public and patient involvement in the planning and delivery of local NHS services in Scotland".
Yet, the consultation paper stresses that the boards will still be 鈥渆xpected to operate within national policies set by the government鈥.
Ministers have powers to remove appointed board members. The document asks whether ministers should also be able to sack elected members.
And other matters. The cost of elections - some 拢5m. What voting system should be used? Should elections be piloted? Should elected board members be paid the same as councillors (roughly double what current board members get)?
Good questions all. Over to you.
I'm 
Comments
Who on earth is gonna bother voting ?
If we can't get 50% on the Elections you are only going to get the great and the good or the one agenda people standing.
Ridiculous, the more they want you to vote the more apathy it breeds.
Just appoint good people
Great idea democracy for Boards-let s try and mirror the local government model which has all elected Councils served by "appointed officers".
Its time (to coin an electoral slogan ) to sweep away this notion of Board executive officers as being "directors".
There will have to be a transitional period of course so that existing members can serve their periods of appointment but at least we will then be in a position to show that NHS Boards can no longer be hamstrung by overly convuluted and strangling consultation periods and processes,a nd stage-managed accountability reviews.
Of course the process will throw up the "usual suspects" of ex-employees or disatisfied patients or relatives with an axe to grind-but with office comes scrutiny and if we limit terms of office appropriately and draft the qualification terms for candidates with due rigour (namely disqualifying serving councillors with conflicts of interest), a publicly accountable health service can be delivered.
- Dissolve Healths Board.
- Transfer all functions that are arguably local (GPs, Community Health Centres, Dental) to local authorities.
- Transfer funds currently spend on these functions to local authorities (but without ringfencing).
- Set up *single* Health Service for all national functions (saving admin function compared to dozens of Health Boards), with responsible Minister regularly questioned by public representatives (aka MSPs).
Much better to keep the present system and have Labour party cronies and pals nominated to sinecures paid for by the public.
Look to America where all sorts of public offices are filled by direct elections. Even Judges are elected. Direct democracy breathes life into the process, and the electorate is very responsible when it really matters. We need more direct election of officials not just in Scotland but throughout the UK.
First, I think there should be a competence requirement. To stand as a candidate people should be required to show that they have competently run some significant organisation - a business, a school, a local government department, something - before.
Second, I think that political parties should be banned from taking part in elections, perhaps to the extent that members of political parties should be debarred from standing. Not because political parties are necessarily a bad thing per se, but because we currently have a very unhealthy culture of political patronage in Scotland.
Third, I think that board members should be paid a salary commensurate with their responsibility - but that salary should carry with it a requirement to make themselves available to their constituents far more pro-actively than councilors do now.
Fourth, I think that salary should continue to be paid for at least four months after a board member has been voted out of office, to allow reasonable time to find other employment.
Fifth, I think there should be an upper age limit for candidates in line with the retirement age.
Mind you, I think all of that would be good for local government, too - although much smaller regions with many more part-time councilors would be still better.
My first thought is that it would be a good thing to have ordinary members of the public involved, whose only vested interest should one of improving the health service for everyone. Of course, like elected governments, they should have the benefit of being able to tap into the the knowledge of experts in this field. Perhaps they should have no voting rights but should be there in a consultative capacity and be able to report back to a Government committee.
However, I would like to know if any other countries have implemented this sort of arrangement and what their experiences are?
As they are the ones working in and have a great deal of knowledge in the sector, why don't they make it that only doctors, paramedics and nurses or previous doctors, paramedics and nurses can stand for election. Also, as not one of us has the knowledge they do these people should be voted for by their peers... doctors, paramedics and nurses again. This would mean that voting would be high as it would directly effect their work and those elected would have pre-existing knowledge of the sector they hope to control.
The main problem with the NHS is that the people in the NHS are not listened to, give them the voice they need to run their "business" the best they can and I think we will see huge amounts of progress. None of those elected should have party allegiance, or act on it anyway.
Business men will run it to turn a profit or to make cuts like the government want. The layman will undoubtedly make silly errors and once their goal of saving an A&E is done would be better sitting on his/her hands than get involved. Doctors, paramedics and nurses all know what can be done and what should be done in the interest of functionality and the patient... they are the logical choice, it may lead to closures but only if the experts think it is the right idea... and they are the experts.
I find myself in the strange position of agreeing with the liberals for the first time in this parliament.
Personally I think this is democratic step too far. Yes, in an ideal world we'd have the public choose the best candidates for every public office in the land but I just don't think the public have an appetite to elect these officials since most of the time there's nothing really to shout about. True waiting times etc. are important but there seems to be nothing other than a closure which can fire up the public's wrath.
So without these infrequent major situations, officials could end up being voted in on a couple of thousand votes each. Better to expand the role of democratically elected local councillors and to allow referenda on specific issues when, for example, a relevant public petition reaches 10 000 signatures.
I think the same should equally be applied to the other public services. More input from councillors and ad hoc referenda to make decisions based accurately on local public opinion.
How to remain in government without being challenged on detail ... just don't publish any!
Same problem as destroyed Britsh industry - the managers spent too much time protecting their jobs instead of doing it.
Dear Brian
Surely you either believe in democracy or you don't. Arguably health is the biggest issue that will affects any person's life (at some point(s)in their life).
To suggest one doesn't need direct democracy when it comes to local health services because it is 'too complicated' leads one to conclude that we don't need elected politicians running the country - because that is far more complex - which is of course rubbish.
Remember, the Health Board is supported by a huge staff, and expert officers attend Board meetings. Immediately post war (I think) health was under the auspices of the local council - medics have an agenda to keep key decisions to the 'experts'. But I say, any decision that affects citizens has to have a direct input, ultimately, by the people who use that service. We now do that with the legal profession - but NHS services are vastly more significant from the tax payers perspective. So why no direct democratic input?
All of the interesting questions you raise Brian were dealt with during the course of the Health Board Elections (Scotland) Bill in the last Parly session. That private member's bill (introduced by Bill Butler MSP) only lost by a very narrow margin. When I was drafting that bill I had to consider all of the questions you pose - but at the end of the day, if you belive in democracy, you need to have ordinary people taking a direct part in key decisions. It's as simple and important as that.
Demos Kratos - People Power. Do you believe in it or not?
'Health boards aren鈥檛 just consultative forums. They take real decisions about hospital services. Doesn鈥檛 that argue for expertise rather than enthusiastic amateurism?'
point taken however the 'experts' could also be voted on?
Does this not raise the question of who's democratic mandate counts most, a Minister's, in old money, or an elected Health Board Member's? The question is would Ms Sturgeon have been able to reverse the Monklands or Ayr decisions if they had been taken by an elected Board?
Mike Dailly's main argument in favour of these proposals seems to miss the point somewhat:
"if you belive in democracy, you need to have ordinary people taking a direct part in key decisions"
"Surely you either believe in democracy or you don't"
So would it be 'undemocratic' for a local health service to be answerable to the people's elected representatives in local government? Of course not.
These proposals would likely instigate a set of elections that almost no-one would vote in, and would contribute to further undermining the power of local councils, thus ensuring that public engagement with and election turnout for this tier of government stay low as well.
Some 'victory for democracy' that would be.
'Health boards aren鈥檛 just consultative forums. They take real decisions about hospital services. Doesn鈥檛 that argue for expertise rather than enthusiastic amateurism?'
with some of the decisions made by Ayrshire and Arran health board recently, directly elected members would make the board members listen to what the public want, and not just go ahead and do what the board members want and ignore the majority. Maybe they would think twice before trying to close A&E departments
I have worked closely with some NHS Scotland HEalth Boards and with the boards of other Executive Agencies. Whilst you do get some good people on them who work hard to understand the issues at hand, the reality is that it is the paid officials who have the insight into the sector and far too many of the Board members are "amateurs" who do not have what it takes to run an organisation.
Rarely will you find any of them who have got positions in industry and at best they will have a suite of other appointments that they got from the political party that they support.
The Scottish Executive has failed miserably in giving these people a proper induction into their role or in trying to enforce minimum standards for being a Board Member (i.e. specifying the type of training that is mandatory for Board Members).
Whilst the concept of bringing in elections for Board Members is flawed in many ways, this should not be used as an excuse for ignoring the fact that the current system is otally inadequate and needs to be replaced by something that encourages better quality people to become involved with these boards.
Good to see a range of views being expressed here! Hope everybody opens the Scottish Government document and expresses their views directly to the Cabinet Secretary.
I don't think there is a single, ideal answer here.
There is a big industry out there around 'public concultation and participation' - well-intentioned no doubt, but expensively spending resources that most people would like to go on direct services.
I'd agree in principle with comment 3 above.
Make all specialist services National - some are anyway.
Manage community services at local government level - as a specific 'health committee' of each Council. Ensure that key groups - doctors, nurses and patients are 'appointed' - in the same way as teaching reps and churches are represented on Education Committees.
In terms of pilots, I'd suggest that the 3 Island Health Boards are merged with their 3 Island Councils - with 'specialist hospital services' managed by neighbouring larger Boards (Highland and Grampian).
After 4 years pilot, refine and roll-out to all Scotland.
There should be significant savings in bureaucracy + additional local accountability.
For such a wee country, we don't have come up with some complicated structures!!!
You raise some interesting questions Brian, but you have a tendency to see matters in rather mutually exclusive terms. Expertise combined with a popular mandate is quite possible. Indeed, some of the posts suggest some people will specifically look for expertise before casting any vote.
For example, I would want someone on a board with real knowledge about effective consultation processes. Most boards have failed any realistic test on this area: just ask the people of Ayrshire. I would also want some willingness to engage in honest debate. For example, any publicly funded healthcare system is engaged in rationing, but politicians wont admit it. We need some intelligent and open debate about how provision is to be rationed.
is this consultation not just another example of the current SNP government going for the nakedly populist option.
We live in a world where advances in treatment are being made daily.However that treatment requires expertise..that expertise cannot be available (on the current NHS budget)in every nook and cranny throughout the country.
The SNP government know that...but don't want to be seen to be rseponsible for the very difficult decisons about hospital closure nor do they wish to spend the money necesary to maintain services at all the "local" hospitals which are threatened with closure.It would appear that they are far more willing to make the local boards the scapegoats.
What diference will there be if the local boards contain some elected members..??...If they decide against the proposed closures will the government provide the necessary budgets?
I don't think this is necssarily a question about local democracy...I think it is a question of national spending priorities and political positioning.
There should be a test of competence for all elected members. (think this should also be the case with all councilors also. I come from a family steeped in Labour and have seen from my own family the inteligence odffered to the public, its actually quite imbarasing - therefore I dont vote Labour)
Perhaps looking at how committees like the RICS RIBA and other professional Institutes would be good. As part of a competent committee member this is an asset on your CV so would be something a good professional would want to be invoived in. Im not convince it would even need to be a paid function if sold properly.
Other big news you missed Brian. There has been a Labour councilor doing something proactive as oposed to whinging and corrupt behaviour. Is this the start of something new for the Red's, perhaps the makings of a party that wants to do something for its voters? I refer to the Sunbed Bill (small acorns).
As a former NHS Board member, I was never in any doubt about my accountability to Parliament. I was appointed, after an open interview process, by the Health Minister. I could be removed from office by the Minister if they chose to do so. And I was responsible for ensuring that health care and financial targets set by the Minister were achieved. That certainly felt like democratic accountability to me.
Health Boards have to take difficult decisions and make often painful choices. They may not always get those right. But will decision-making,democratic control or, most important, patient care be improved if Boards are to be made up of single-issue campaigners elected by a tiny proportion of the electorate? I very much doubt it.
Precedent is always worth studying before new legislation. In Ayrshire the greatest noise against the Health Board's plans was made by a minority of the Ayrshire population, mostly living near Ayr, and mostly middle class. The voices of the majority living in Ayrshire were not heard, thro reticence or indifference who knows. Party loyalty has silenced the MSPs representing the majority areas and thus their constituents lose out. A good plan for the total Ayrshire population has been derailed by the actions of a selfish vocal minority. Surely elected members would play the same game and play partisan politics with local health developments, resulting in the health services being frozen in time, all major develoments opposed? The Health Secretary and some media have already confused Ayr with Ayrshire, and succumbed to a partisan view to the detriment of the majority.
Perhaps the suggestion that elected members could only be drawn from the pool of people working in the local NHS, who are also consumers/patients/clients, has some merit.
To refer to the NHS in Scotland as a, 'business' is quite simply appalling. Health Boards are not for profit trusts and as such are charged with providing health services to the public without making a profit. Allowing the public a direct say in their operation is wholly appropriate. Direct elections are the best way of doing this. This way, 'the usual suspects' from the Labour Party are not appointed to the gravy train. And why should members only be taken from 'people who have run something'? I'd rather have wee Mrs McTumshie with her bad hips than some lounge lizard, so-called businessman with their 'need to be flexible'. It's our health service and we should run it.
i've agreed so far with much that the SNP have done in goverment (indeed im an SNO member) but in all honesty, i think the idea of having 100% elected health boards is ridiculous.
I also get frustrated when i see post from poeople who are obviously completely ignorant of how health boards and indeed medical practice works by suggesting that they are apppointed by "labour cronies". They make they're decisions on what they think is best, not because its popular, but because the evidence suggests that its the best thing for patient care. Indeed i think there is a stronger argument for going the other way and goverment should learn lessons from this.
Those who suggest that it is simply for the benefit of themselves do so with absolutely no basis for their claims.
Perhaps a compromise, with 1 or 2 elected people to represent patient views would be appropriated but the fact is, the health service may be designed to cater for patient needs, but this does not means that it would be best run by patients.
Maggie Thatcher was wrong when she said there is no such thing as society. However, "the public" don't all want the same things and tend to be far from altruisic about the things they do want. Are a few elected members going to be able to change anything, given the political and financial constraints under which Health Boards currently have to work?
And isn't it interesting that at a time when the professional regulatory bodies, the GMC and the GDC are moving away from election to appointment of members, Health Boards may go in the opposite direction? Plus ca change, plus c'est la meme chose, me thinks.
One thing that troubles me about these elections is that the likely very low turnouts will produce a risk that small but highly motivated pressure groups could gain a disproportionate influence by organising their members to actually vote.
At last a shot across the boughs of the amateurs who populate our councils and committees committing as they do their regional prejudices into the policy of centralising services in their own towns and cities; people currently tempted to apply should not be put off by lack of experience or knowledge, it has never restricted the operations of the current incumbents.
Representation from all areas will present a more balanced policy and plan for future medical services to our communities.
In reality many of our councillors have never had a real job, certainly not since their original brush with council employment; I have heard councillors stating that 鈥渨e need to break the cycle of unemployment and the acceptance of provision from the state鈥, I was lost for words, for about ten seconds.
I do not suggest that we move closer to the communist people鈥檚 councils of the eastern block; but I do think it is time we had a broader representation of society in the decision making mechanisms.
Yet another reason why people are encouraged by Ms Sturgeon's creative initiative and by people I mean me!
Of course people would like a say in an individual care plan but then again we already know that individual health care plans under the bleat of the McConnell legacy were difficult to come by.
Remember the public has it's limits ...You can please some of the people some of the time but not all of the people all the time! So opinions will vary!
It took me 20 years (Doh!) to understand what my old English teacher meant - if any of us used the words "majority" or "democracy" he always interrupted: "The majority is always wrong!" Democracy is a sham, a poultice on the swelling of public discontent. How often have we heard the admonition: Well, you voted for it?
Remember the TUC block votes? Democracy? Cabinet control of local authorities? The very negation of democracy by brutal and intimidatory enforcement. People generally are attracted to strong "leadership" often by some pretty unsavoury people who are elected to serve, but opt to rule.
I offer no easy answer, but it must lie in the area of an all-party consensus appointing qualified people and letting them get on with it. Eventually we might phase out the politicians and let the most successful appointees join a national panel to run the country.
The people who shout loudest about democracy are those who would abuse it for their own ends.