Democratising Scotland's Health Boards

Bill Butler

The commitment to consult on the introduction of direct elections to National Health Service Boards was part of the Scottish Labour Party's manifesto for the 2003 Scottish Parliament elections. However, when no party won an overall majority of seats at that election and coalition government became imminent, this commitment was one of only two commitments contained within Labour's manifesto to be dropped from the eventual Partnership Agreement.

Whilst the scrapping of Labour's pledge to maintain the first-past-the-post electoral system for Scottish local government elections, made in order to secure stable coalition government with the Liberals, has been rightly the subject of great controversy and anger within Labour's ranks, the omission of consultation on direct elections to NHS Boards largely went without comment.

Within a few days of the Scottish Parliament's return after the election I lodged a proposal for a Private Members' Bill which would remedy this situation. This proposal received strong support from Labour MSPs, as well as from a number of SSP, Green and SNP members, who signed up in support.

The case for introducing a greater level of democracy, accountability and transparency into the decision-making process for local health services is long overdue and evidence to support this can be seen on a regular basis in the media. Over recent years, across the UK, we have seen candidates elected on issues surrounding local health services. Local campaigners are becoming increasingly successful in organising successful campaigns around Health Board decisions to close or reorganise the provision of health services. This mobilisation tends to develop in response to unpopular Health Board actions, rather than in advocacy of new initiatives.

The anger felt by people against these decisions is mainly generated, I believe, by the manner in which the decisions are perceived to have been made - in secret with little or no explanation, often predetermined and ignoring the views of the community and the responses to the Boards' own consultation process.
Since I was first elected I have been contacted by constituents who have expressed to me their concerns about changes made to the provision of local health services. Time and again, I have heard from people who feel frustrated and angry about decisions made by NHS Boards which they perceive to be completely against the views of the local community. I know that these feelings are felt in communities across Scotland.

In my view, there is a growing sense of public disillusionment with a system where NHS Boards can act freely in direct opposition to the wishes of the public. This has resulted in a public increasingly inclined to mobilise and organise around health issues, as witnessed by the increase in such local campaigns across Scotland. In Glasgow a "Save Stobhill Hospital" candidate was elected at the Scottish Parliament elections in May 2003. At Westminster, the election of Dr Richard Taylor, for the Wyre Forest constituency, was on the back of a campaign to restore emergency health care facilities at Kidderminster Hospital.

I don't believe that such candidates are healthy for parliamentary democracy - they are elected purely on a single local issue and people, whilst feeling strongly about this issue, are unlikely to know about the candidate's views on a whole range of other issues. It is also very unlikely that the successful candidates who campaigned on such local health issues will be able to deliver on the promises upon which they were elected. As an individual MSP, MP or councillor, elected without the support of a national political party, such representatives are isolated and largely impotent. Electing a local health service candidate does register a protest, but does not actually help the campaigners achieve their goal.

Notwithstanding the above, it is, in my view, important that local communities have a greater say in decisions relating to local NHS services. I believe that there is a better and more effective way for people to have a say in how their local health services are run, which also ensures that the decisions made reflect the views of the local community. It was with that end in mind that I submitted my proposal for the Direct Elections to National Health Service Boards (Scotland) Bill which seeks to introduce direct public elections for members of NHS Boards. Currently, members of Health Boards are appointed by Ministers or represent local authorities.

I would like to see 50% plus 1 of the members on each Health Board directly elected to represent the local communities affected by its decisions. Boards must have a proper balance between those who have expertise, knowledge and experience from working in the health service and those most directly affected by changes - the public within that health board area.

People are aggrieved that there is no direct accountability between the public and the Health Board members who decide on local policy. I believe that this Bill will address this credibility gap and reignite the public's faith in the legitimacy of the decisions taken by Health Boards.
Direct public elections would allow the public a mechanism to influence service delivery in their area. If we are to address public suspicions, there must be greater openness, transparency, and direct accountability. I believe my Bill, if enacted, would allow such an approach to thrive and prosper.
At the end of June 2004 I published a consultation document which I have widely distributed. The consultation period will end on 1st October after which I will collate and study the responses before considering the detail needed for the drafting of a Bill to submit to the Scottish Parliament for its consideration.

There are a range of questions contained within the consultation document upon which I am seeking as wide a range of views as possible: what electoral system should be used to elect board members and should there be restrictions on those who are eligible to stand as candidates; how often should members be elected and how should these elections be carried out; should the number of terms that a member can serve be limited; should there be restrictions on the campaigning candidates for the board can undertake and the amount of money they can spend on their election campaigns; and, possibly most important of all, what proportion of Boards should be directly elected?

In the spirit of the proposed Bill, I have not circulated these questions with my mind already made up and I genuinely am keen to study the responses I receive. As I have stated, it is my feeling at this time that 50% plus one of the members of each board should be elected, but I am willing to reconsider this in the light of the consultation.

I should also state that so far I have had a rather lukewarm response from the Scottish Executive, but I would be delighted if the Health Ministers were to take a more supportive position.

All the evidence I have read and heard, from individuals and organisations I have spoken to about my proposed Bill, has strengthened my view that the vast majority of the Scottish public support it. There are those with concerns about how the elections would operate in practice and I understand these and want to ensure that, when I submit a Bill to the Scottish Parliament, these concerns are addressed.

I look forward to compiling the consultation responses and making progress with the proposed Bill. I would urge Labour Party and labour movement activists to become involved. If you would like to receive a copy of my consultation document or get more information regarding my proposals, please email me at bill.butler.msp@scottish.parliament.uk

Bill Butler is the Labour Member of the Scottish Parliament for Glasgow Anneisland