Thursday, 16 April 2009

Briefing Note – Pilots for Directly Elected Health Boards SNP Spring Conference 2009


NHS health boards have responsibility for the management of local health services and around £8bn of public money. Currently board members are unelected which has led many to decry its ‘democratic deficits’: that is, a health service delivery system which lacks accountability and substantial public engagement.

The willingness to reform health boards is nothing new, however. In 2006 Labour MSP Bill Butler introduced a Members’ Bill on this same issue which subsequently fell at stage one, with 55 for and 64 against.

Reigniting their original support for this measure, the SNP successfully acted on a 2007 manifesto promise to ‘introduce direct elections to health boards’ and provide ‘accountable healthcare’.

The bill to pilot these elections recently passed stage three (see below) and means that:

o The constitution of the health boards now includes ‘elected members’ and for the first time ‘sets out on a statutory basis’ the membership of local councillors on Health Boards. Together these members ‘must amount to more than half the total number of members’.
o They will be two pilot areas which have yet to be selected.
o An independent evaluator, which will be in place before the elections, will assess the effectiveness of these pilots.
o Specifically looking at: the level of public participation in the elections, levels of engagement with patients and other stakeholders, and the cost of holding the election and ‘estimated cost of holding future… elections’.
o A roll-out will only take place if the above has been satisfied and if the order has been laid before and approved by the Scottish Parliament.
o The voting age would be extended to sixteen year olds for these elections which will take place every four years via STV. The ballot will take the form of an all-postal ballot.

The Bill (as passed) can be accessed here.


• On 25 June 2008 the Executive Bill was introduced by Nicola Sturgeon MSP
• The Bill passed stage one on 15 January 2009 in which the Health and Sport Committee was the lead committee.
• Following amendments the Bill passed stage two on 4 February 2009.
• After a debate the Bill passed stage three on 12 March 2009.


As a party and Government the SNP are committed to the democratisation of health boards. The following statement by Health Secretary Nicola Sturgeon MSP aptly summarises their motivation:

…there is a real democratic deficit in the operation of our health boards… The bill's clear objective, therefore, is to allow the public voice to be heard and listened to at the heart of the decision-making process… We believe that democracy is a good thing and that opening up NHS boards to the public through elections will deliver better decision making and, ultimately, even better services than those we already enjoy.

This move is part of a wider narrative, as outlined by the ‘Better Health, Better Care’ report, to create a ‘mutual health service in which ownership and decision making are shared’ with the public and staff.

Notwithstanding the genuine motivation to democratise health service delivery, the successful completion of this manifesto promise is excellent ammunition for both the party and the Government in a time when they are being criticised by opposition for not fulfilling other manifesto promises – for e.g. classroom sizes.

Barry McCulloch, CSPP Policy Officer

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