Sunday, November 10, 2013

Minister capitulates to establishment over health board democracy

The Scottish Government has announced that it is to abandon the idea of directly elected health boards in favour of a return to appointees who can be removed my ministers. A bold attempt at introducing a small element of local democracy has been strangled by government that is increasingly prone to centralise services and undermine local democracy.

In the 2007 election, the SNP pledged to introduce elected health boards, citing concern that health authorities had not always properly listened to local views when considering changes to services. Scottish Labour also agreed to support the pilot elections held in Fife and Dumfries and Galloway in 2010, in which 16 and 17-year-olds were allowed to vote for the first time.

The turnout was low, with fewer than one in five voting in Dumfries and Galloway, and one in ten in Fife. However, this was the first time people were asked to vote and there was only limited promotion. An independent assessment of the pilots found that it is possible to successfully hold direct elections for NHS health boards and members of the public are prepared to stand in considerable number. It also buried myths about politicisation, although it also found that elected members were more willing to challenge officials. No wonder the health establishment was so opposed!

Now Health Secretary Alex Neil has capitulated to those interests, he said: "This pilot project was designed to ensure that the views of local people about their NHS are heard effectively, and to encourage them to be more involved in how the health service is run. These pilots have demonstrated that the most effective approach was a pro-active approach from boards to advertising and recruiting to posts. I am confident that these new measures will help to increase public engagement and improve local accountability. I am confident that these measures will help to increase public engagement and improve local accountability more effectively than when we tested direct elections as part of the pilot."

Sadly, there is little evidence to support this view. Officials and the health establishment’s patronising top down approach to public engagement has eventually worn the new health minister down.

Of course directly elected health boards are not the only way of extending local democracy into NHS Scotland. Other options include greater local authority involvement up to and including the creation of unitary authorities. Reform Scotland has recently argued for the merging of councils and health boards. However, they also argued for fewer and more remote councils. A point well argued by Lesley Riddoch in the Scotsman, who points out that we have the most remote local democracy in Europe. Its not apathy, wrong size governance is to blame.

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