Official Report search · Parliament Workbench

Chamber

Plenary, 31 Jan 2007

31 Jan 2007 · S2 · Plenary

Item of business

Health Board Elections (Scotland) Bill: Stage 1

Butler, Bill Lab Glasgow Anniesland Watch on SPTV

The improvements that have taken place in public participation—I think that that is what the member alludes to—are to be welcomed. In fact, every witness who gave evidence to the Health Committee welcomed the reforms in public participation. However, I believe that we should go just a little further. The direct democratic accountability that would be introduced by the bill would be complementary to the public participation reforms that have rightly been introduced by the Executive.

There is no perfect method for consulting the public on major local health issues, so I do not believe that direct public elections would lead to everyone being happy with every NHS board decision. However, I contend that decisions that are made by health boards on which there is a large democratically elected element will have much more credibility than those that are made under the current system.

Accepting that decisions are legitimate is at the heart of representative democracy. Democracy is not always about getting our own way, but it is a way of making decisions that takes serious account of people's opinions. Unfortunately, that does not happen with NHS boards at the moment. Direct public elections would allow the public a mechanism to influence service delivery in their area. If we are to address public apprehension—and, indeed, suspicion—there must be greater openness and transparency and there must be direct accountability. The bill, if enacted, would allow such an approach to thrive and prosper.

During the evidence-taking sessions, my ears were open but I did not hear a convincing explanation of why the make-up of regional NHS boards should not contain a strong element of direct democratic accountability. Introducing greater democracy would mean more than just structural change. Introducing electoral accountability would involve patients and communities and provide an opportunity for public debate and greater access to information. The bill would lead to a sea change in the culture of NHS boards. That is a positive reform that needs to be made.

The bill proposes a simple majority of 50 per cent plus one. I admit that some people whom I have consulted in recent months argued that a greater proportion of health board members—up to 100 per cent—should be directly elected. However, I feel that the blend of experience and direct accountability that is offered by the bill is just about right.

I emphasise that the bill supports the retention of local authority members on NHS boards. Unhappily, however, even with the inclusion of local authority members on each NHS board, which is progress, the feeling remains out there that the boards have failed to engage effectively with the communities that they serve. Some proposals that are made by NHS boards are not popular with the public, but will result in improvements to local health services.

I hope that my bill will succeed in making health boards work harder at explaining their proposals to the communities that they represent, engaging with the public more directly and explaining clearly and openly the pros and cons of any changes to local health services. Only when that greater level of direct accountability and transparency has been achieved will communities feel in any way reassured that health boards listen to their views. If the bill succeeds and direct elections become a reality, not every decision that is taken by an NHS board will be universally popular, but I hope that the elections will help to make health board decision making more open and relevant.

I move,

That the Parliament agrees to the general principles of the Health Board Elections (Scotland) Bill.

Search Hansard contributions

Plenary, 31 Jan 2007

In the same item of business