Hansard

Because it is the national health service. Week after week in this chamber I hear from members about postcode prescribing, about boards not doing what they should do, about waiting times and about cancer targets. The resources for those boards are voted on by this Parliament. The bill would remove the centrality of the NHS and create a competing mandate. The bill does not address that point.

The bill's proposals would lead to uncertainty about who is responsible for monitoring and improving performance, for making hard decisions in the interests of patients and for planning tomorrow's health service.

There is a risk that the bill would have serious consequences for boards, patients and communities. The Health Committee recognised that. Its report refers to the New Zealand model of governance arrangements, which I agree is potentially relevant. The issues are complex and we would wish to give such a proposal careful consideration. However, it is not reflected in the bill and we are advised that amendments along those lines would be beyond the scope of the present bill. As I have made clear, we should not in any case seek to change NHS governance arrangements in a hurry and without proper consideration, dialogue and consultation. That is why we have shown our willingness to look further at piloting the concept.

My second reason for opposing the bill is that, as the Health Committee recognises in paragraph 85 of its report, it risks putting difficulties in the way of implementing the important national policies for which the Executive has a mandate and which the Parliament has already debated.

We need look no further than "Delivering for Health", the implementation of which represents a vital step in the NHS's progression. At the moment, we are deeply engaged in that work. With all respect to everyone who is directly involved, the task of working through those changes is difficult enough, without our making it even more difficult by electing boards in the manner proposed.

It is worth noting that the Health Committee has accepted that directly elected members on NHS boards might undermine the NHS's national element. As it stands, the bill risks fragmenting our national health service and will make it increasingly difficult to ensure that key national policies that are vital to our local communities are implemented. That undermines the vision that we all share for the NHS in Scotland of having equitable services that are available to everyone on the same basis throughout the country. It risks introducing an unacceptable postcode pattern of delivery; could cause real problems for initiatives to reduce health inequalities; and could mean that services such as mental health that have a lower public profile and services for learning disabled people have less of a priority.

Simply electing people to a board would not remove the need for tough decisions to be taken. Such decisions would still have to be made, and public concern about them would not magically disappear with the introduction of direct health board elections. Boards would still need to inform their public; to persuade them that it is right to modernise services; to improve efficiency and effectiveness; and to ensure that services are safe and sustainable. I am worried that the proposal to elect a majority of board members runs the risk of increasing dangerous short-termism and self-interest in how NHS services are looked at, and might ultimately put patients at risk.

My third reason for opposing the bill is that it will do nothing to sustain and promote the improvements in NHS performance that we have witnessed over the past five years. For example, the service has managed to get on top of the long waits that used to dominate our debates about it. Moreover, the tremendous strides in providing more vital operations such as hip and knee replacements and cataract operations have been achieved through rigorous management and planning and by boards working together across boundaries. I do not believe that the bill would benefit patients and the public by improving performance further. On the contrary, the risk is that boards would be distracted from that task.

Fourthly, the proposed elections would cost money and time. The Health Committee has accepted that its costs would be well above the estimates that were provided by the bill's promoters and we must be very careful about diverting resources away from patient care.

Fifthly, the bill would not—to put it simply—do what it says on the tin. It would not promote effective public engagement and the involvement of patients and service users in our NHS, even though that is what those who support the bill seek to achieve. I make it very clear that we strongly support the effective engagement of the public and patients with NHS boards in planning and delivering services and that our track record in that respect is very strong.