Evidence to the Scottish Parliament Health Committee on the Health Board Elections (Scotland) Bill

 SHA Scotland welcomes this opportunity to submit a response to the Health Committee regarding the Health Board Elections (Scotland) Bill. The SHA was founded in 1930 to campaign for a National Health Service. We are a socialist organisation committed to the NHS and have a long history of support for creating a more democratic NHS.  

This is reflected in the SHA Scotland charter principle: 

·        SHA Scotland supports an extension of democratic accountability at all levels. This is more than simply electing representatives, important though that is, to public bodies. It means encouraging full participation in decisions with a statutory duty to involve users, staff and the community. It also requires genuine freedom of information, effective communication and transparency of all contracts and partnerships.  

SHA Scotland therefore supports this Bill as we believe it provides an effective means to achieve greater democracy for health boards in Scotland. 

We address the key questions in the call for evidence below. 

 

Do you support the general principles of the Bill and the proposals for direct elections to NHS Area Health Boards?

 SHA Scotland supports the general principles of the Bill. We believe that health boards should be open, transparent and democratically accountable and should encourage active participation from users, the community, staff and their trade unions.  

We believe that democratic structures help create health boards that are more open and transparent in their dealing with the public. Scottish Health Board expenditure was almost £7 billion in 2004/5; Local democratic accountability is essential for expenditure of this level. Government at all levels must explain and accept responsibility for its actions. 

There are and have been many high profile campaigns about hospital closures and related issues in Scotland that demonstrates clearly that members of the public not only want to be part of the process of planning health care in there areas but that they are willing to give up their time to do so. A recent example was the Lanarkshire Health Board consultation over A&E units. These campaigns also demonstrate that the public is sceptical about current consultation processes and do not believe that they are meaningfully involved in the decision making process. 

In contrast to the current arrangements direct elections provide an opportunity for the public to participate in and influence the policy making process. It will allow individuals to become board members, create a debate about health care in local communities via the election process and make boards directly accountable to the people they serve. But most importantly we believe that direct elections will help change the culture of health boards from organisations that are perceived as being top down ‘we know best’ organisations to one were the public are partners in the development of health care. 

We also believe the Bill will complement recent legislation including the Freedom of Information (Scotland) Act 2002 and the NHS Reform (Scotland) Act 2004 that promotes the involvement of service users.  

SHA Scotland also believes that this Bill will introduce greater democratic accountability while still retaining NHS expertise. It offers the prospect of developing genuine local partnerships with greater understanding of the complex issues facing the NHS in Scotland among the public. It is essential that a longer term dialogue is developed with communities so that they better understand the challenges facing health care in Scotland. At present this is largely limited to proposals to close facilities that inevitably engender knee jerk reactions to individual proposals. 

 

Are there any omissions from the Bill that you would like to see added? 

SHA Scotland would wish to see further radical changes to health board structures. However, we recognise the limitations of the scope of this Bill and understand that these would need to be tackled by other legislation.

 

What are your views on the quality of consultation, and the implementation of key concerns about the accountability of NHS Health Boards? 

Bill Butler’s consultation on this Bill indicated widespread support for direct elections to health boards. We recognise that there will be opposition from the health establishment who have little experience of democratic structures. None the less we would urge the Health Committee to take this opportunity to change the culture of the NHS in Scotland. 

The public rightly have concerns about decision making and accountability. There is a general perception that consultations are a cover for decisions that have already been made and that the needs of local communities have not been taken seriously. Direct elections are not a panacea for better consultation but it is an important step towards meaningful, deliberative involvement.

 

Have you any comment on the practical implications of putting these provisions in place and the consideration of alternative approaches? 

SHA Scotland believe that by using established electoral arrangements including those used by local authority and National Parks this Bill offers a practical and cost effective way of making health boards accountable to the communities they serve while maintaining professional and staff expertise. 

We believe the policy memorandum sets out fairly why this approach was adopted and we support the practical provisions proposed. 

Conclusion 

SHA Scotland supports this Bill as an effective means of developing greater involvement of communities in their local NHS and ensuring that quangos that spend large amounts of public money are more democratically accountable. 

 

SHA Scotland

June 2006