Health Board Elections (Scotland) Bill
Somewhat ahead of schedule and probably to no one's dismay, we move to item 4 on the agenda, which is the fourth evidence session on the Health Board Elections (Scotland) Bill. I welcome Bill Butler MSP to the final evidence session.
Several documents in the committee papers provide background for this evidence session. There is a submission from Mike Dailly, principal solicitor at Govan law centre, that clarifies Mr Butler's proposed amendment on the voting system, should the bill reach stage 2. Submissions have also been received from the Finance Committee, with comments on the financial memorandum to the bill.
We also have a further submission from Dr Gilmour that comments on Mr Butler's proposed amendment to the voting system. That should have been put on the desks in front of members.
I wish to raise a brief point of order on this item. When the Minister for Health and Community Care gave evidence last week, he was clear in his opposition to the bill. Although I disagree with his view, I think that his evidence was clear. Since then, extensive media coverage has suggested that the minister's position has changed or might be about to change. Given that we are in the middle of taking stage 1 evidence, we need the Minister for Health and Community Care to clarify his position. Is there an opportunity for him to come back to the committee and clarify whether, as has been trailed in the press, he now agrees with the idea of having a pilot scheme for electing health boards? That is relevant to the evidence that we are taking on the bill.
You are proposing that?
Yes.
I do not want to prolong this discussion, although we have a bit of extra time.
After discussing it with the clerk, I confirm that the minister is coming to our meeting on 28 November, so we can ask him to do a brief session on this issue then. It would mean extending the evidence session, but we would not be able to extend the timetable—we would have to consider our position on that day.
There might be a variety of opinions around the table. Does anyone have a view, question or concern?
Did the media report the minister directly, or were their comments about the Labour Party's proposed manifesto?
I have not read the reports in detail, so I do not know.
There have been various articles, but basically they are about a proposal from the leadership for limited piloting of the idea. The point is that if there is to be a change of position, the committee needs to know because we are expected to accept or reject the bill and the minister's evidence has a bearing on our view. If his view has changed or is changing, we need to know.
I have not seen what was in the press, but I disagree with Shona Robison. We have to consider the bill and the evidence that we have taken from the minister, the member in charge of the bill and other witnesses. I do not think that we can allow reports in the press to determine how we conduct committee business. Whether there have been issues in the press about what will be in the Labour manifesto is not relevant, and I do not know what leadership Shona Robison is referring to. We can consider only what we have in front of us and the evidence that we hear, not press speculation.
I suggest that if the minister's position has not changed, there is no point in inviting him to the committee. Could we exchange correspondence with the minister and ask him whether there is any suggestion that his view is altering? If he says that there is, he may ask to give evidence again.
So an alternative proposal is that we write to the minister to clarify the position.
I am sure that an exchange of correspondence could take place fairly quickly.
Shona Robison obviously takes a pessimistic view of her party's prospects and expects the Labour Party, after the next election, to put in place the policies that we are developing. The committee should not do a disservice to Bill Butler, and the people who have been involved in taking the bill forward, on the basis of discussions that are taking place in the context of policy development for the Labour Party's manifesto. We should not relate those discussions to what we are doing in this session of Parliament.
I understand that the discussions in the Labour Party are about what we will do when we are returned to power at the next election. Shona Robison is worried about that, but the time for her to be worried is after the 2007 election. We would not extrapolate from discussions surrounding the development of their manifestos the views of the Scottish National Party, the Liberal party or the Conservative party in this session of Parliament.
It is nonsense to suggest that we should call the minister to account. That would be a disservice to Bill Butler and the people who are here to give evidence today. We are here to discuss the bill that is before us in this session of Parliament. Only a week ago we took evidence from the minister; that evidence is on the record. I know that we are getting near to an election, but let us get serious.
We are still discussing the bill at stage 1. If the minister's mind is changing, the committee ought to know that. Perhaps we should take up Euan Robson's suggestion and ask the minister whether he sticks by the evidence he gave last week—yes or no.
Nanette Milne says that she supports Euan Robson's proposal that we write to the minister, but I am not sure on what basis we would do that. Shona Robison did not say specifically that any quotations were attributed to the minister or to the Executive. If we write to the minister, we must be clear about the basis on which we are doing that. As far as I am aware, he has not been quoted as saying anything different from what he said last week.
Clearly, we would ask the minister about his position. It is not respectful for him to say one thing to the committee on the record and to say something else elsewhere. We need to know what the minister's view is. It is also not credible for him to say one thing at this stage while promising jam tomorrow. Last week, the minister was very clear about his position, but doubt has been cast on that clarity. I am happy to accept the compromise of writing to the minister to ask about the comment that was made in the media. It would be ludicrous for the committee to ignore media comment on the very issue that we are considering.
It is media comment, not comment from the minister and the Executive.
The comments were made by your colleagues. It would be helpful to clarify whether they have any bearing on the minister's view and whether his view has changed since he gave evidence last week. I would be happy for that to be done in writing, if the committee does not want the minister to appear before the committee.
The initial proposal was that he should come back to the committee to give evidence. It is obvious that that will not be accepted. Euan Robson has suggested that the matter could be clarified more simply by our writing to the minister to draw his attention to the comment that we have seen and to ask him whether his position remains the same.
We have seen comment from whom?
Let me finish. I have described Euan Robson's proposal, which is the second option. The third possibility is for us to do absolutely nothing. Which members are in favour of writing to the minister?
You are curtailing debate, convener.
I am trying to move on to taking evidence on the bill.
We did not delay the process—your colleague did that on the basis of press reports.
I had assumed that we were all colleagues and that any committee member is entitled to raise a point of order.
You are the convener of a committee and you should not allow that committee to be used for party-political ends. We are discussing a press report that was not circulated before the meeting. No notice was given to members—even as a courtesy—that the matter would be raised, so that we could all apprise ourselves of the press report, which I believe is about a policy discussion within the Labour Party. Unlike other parties, we are not ruled by one person outwith this country. We decide our party policy through our members. Our members have discussed that party policy and they have a view. How can we hold the minister to account for that when there is no comment from the minister, from the Executive or from any member of the Parliament? If you are saying that the business of the committee will be directed by lay members in any given party and what they are reported to have said on any given weekend, it will be a long time between now and May.
I am glad that we do not make political comment in the committee, Duncan.
What is this if it is not politics?
We are all here because we are politicians.
I have suggested that there are three options. Shona Robison's suggestion is clearly not going to be accepted. Euan Robson suggested that we write to the minister; the alternative proposal is that we do nothing.
That is your role.
I am proposing it; it is up to you to vote against it.
With the greatest respect, Duncan, I could go ahead and do what I like. I do not think that your argument is appropriate. What I am asking for is the committee's guidance. I will not write to the minister in my position as convener if the committee is not happy about that.
I have looked at the piece in the press and it is just a speculative piece about what may be discussed in the Labour Party and what may be suggested for the manifesto. There is not enough strength in the article to write to the minister. We have taken evidence from various witnesses and the minister and we are going to take evidence from its proposer. The article adds nothing different. It is not specific enough; it is a bit spurious. It is just a political editor speculating about something. It is not enough for us to be writing to the minister, asking for clarification. Although the minister is mentioned, no quotations are attributed to him.
Euan Robson, it was your idea to write to the minister. Do you want to press that?
I have now read the article and share Kate Maclean's view that as there is no direct quotation it is a matter for the Labour Party to deal with in its manifesto preparation. That is the key suggestion behind the article. As far as I can tell, there is no suggestion in the article that there will be a change in ministerial policy before the next election. Now I have seen the article, if my proposal is put to the vote I shall vote against it.
Then withdraw it.
I will happily withdraw it.
Now that we have dispensed with that, I wish to make one comment, which is that any member of this committee is as entitled as any other member of the committee—and indeed any member of the Parliament—to raise a point of order in the chamber or in committee. That is a simple fact in the life of any committee.
Bill Butler, you are now in place and have heard an entertaining discussion, which may or may not contain matters that are news to you.
Good afternoon, colleagues. I thank the committee for the opportunity to speak in support of the Health Board Elections (Scotland) Bill. I believe that there is strong support across the political spectrum for the introduction of direct public elections to Scotland's NHS boards. I also believe that the case for greater democracy, accountability and transparency in the decision-making process for local health services is compelling.
I continue to believe that the best way to achieve greater accountability and transparency is through the introduction of direct public elections. The Health Board Elections (Scotland) Bill would significantly increase public involvement in local NHS services. It would involve people in the planning and delivery of health care services in their communities.
Committee members will have the information that I provided on the equal opportunities implications of the bill. If the bill is enacted, it will be possible to try to ensure that everyone can be involved.
The bill's main aim—of introducing more democracy into the operation of health boards—does not mean that I believe that all board decisions are wrong and detrimental to local health services. The undeniable problem with the way in which boards currently operate and reach decisions lies as much in public perception as in the nature of some of those decisions. The anger some people feel about certain decisions is, to a degree, generated by the manner in which those decisions are seen to be made—in secret, with little or no explanation, often predetermined, and often ignoring the views of the community and responses to the board's consultation. Many people believe that health boards' consultations are predetermined.
I do not believe that a perfect method exists for consulting the public on major local health issues, and I do not think that direct public elections would lead to everyone being happy with every decision by every NHS board, but I contend that decisions made by health boards on which there is a large democratically elected element will have much more credibility than those 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 take serious account of people's opinions. That is not happening 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 suspicion, there must be greater openness and transparency, and there must be direct accountability. I suggest that the bill, if enacted, would allow such an approach to thrive and prosper.
I have yet to hear a convincing argument as to 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.
My bill proposes that 50 per cent, plus one, of the members of each health board—a simple majority—be directly elected to represent the local communities affected by its decisions. Boards must have a proper balance between those with expertise, knowledge and experience from working in the health service and those who are most directly affected by changes—the public.
Some people I have consulted over recent months have argued that a greater proportion of health board members should be directly elected. I feel that the blend of experience and direct accountability offered by the bill is about right.
My bill supports the retention of local authority members on NHS boards. Unhappily, even with the inclusion of local authority members on each NHS board, the feeling remains that boards have failed to engage effectively with the communities they serve.
Some proposals 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 they represent and at engaging the public more directly, explaining the pros and cons of any changes to local health services clearly and openly. Only when that greater level of direct accountability and transparency has been achieved will communities feel in any way reassured that health boards really listen to their views.
If this bill succeeds and direct elections become a reality, not every decision taken by an NHS board will be universally popular, but I hope that elections will help to make health board decision making more open and more relevant.
I thank committee members and the clerking team for their assistance so far. I will be happy to try to answer questions.
Committee members have a number of questions.
Good afternoon. My first question relates to research from New Zealand and from the English foundation trust elections. Committee members have received a briefing from the Scottish Parliament information centre, from which we can see that research suggests an overrepresentation of male, retired, white professionals on boards.
How do you respond to the argument that directly elected boards might be less representative of the population they serve? Is there a danger that the lack of remuneration will result in a disproportionate number of retired affluent candidates and that making the whole board area the electoral area will reduce potential representation from minority and rural communities?
It is very unlikely that any system of election would result in the election of a body that mirrors absolutely every representative interest or section of the community. I accept that we must try to ensure, through direct elections, that boards mirror as far as possible the community that elects them.
Dr Cumming of the Scottish Health Campaigns Network mentioned the lack of remuneration in his written submission. I and my bill team, who apologise for not being here today—Mike Dailly has another engagement, lecturing at university—have considered the issue. If we are lucky enough to have the committee and the Parliament agree to the general principles of the bill, we will lodge an amendment at stage 2 not to provide for remuneration but to ensure that people who are elected to the board do not suffer loss of earnings. In that way, we would try to address the concern that Helen Eadie raised.
We can do all we can to attract people from all parts of a health board area and from all walks of life. Although we cannot guarantee turnout and decide who will be elected, the aim of the bill is to try to ensure that becoming an elected member of a health board is as attractive as possible. We want people to come forward who have an interest in making a contribution to improving the health service and becoming involved in the complex issues that health boards face in modernising the health service while ensuring that the needs and aspirations of communities are met. We will not be able to do that 100 per cent, but that is our aim.
We want to address the concern that Helen Eadie raises, which was mentioned in the submission from the Scottish Health Campaigns Network, but we do not want people to be attracted simply because they will get a large amount of cash. That is not the kind of person we want. We want the kind of person who volunteered their services to and became active members of local health councils in the past—although that is not directly analogous to health boards. That is the thrust of that part of the bill.
I want to pick up, first, on the point about the danger of underrepresentation. One of the recommendations of the Nolan committee was that we should have regard to gender, race and religion. That struck me as good. Is there a danger that we might lose that? You might repeat some of what you just said when you answer that.
Secondly, in local government, it was argued for many years that we ought to have good remuneration to attract good, qualified candidates. What difference do you see between local government elections and health board elections in that regard?
On your first point, the danger is that you might not be able to get as representative a cross-section of society as you would wish. I hope that the elections will have a high turnout and that people will be attracted to stand because they feel that they might contribute directly to work on a major area of concern. After all, people want to ensure not only that their health service is improved and modernised but that it takes into account the various concerns and issues that come up all the time in communities.
We cannot force people to come forward. In any case, it would be unfair to stipulate that there should be 50 per cent male and 50 per cent female representation, given that males account for 48 per cent and females 52 per cent of the overall population. I hope that things would even out in the course of events and that more people from ethnic minorities and with disabilities would come forward. We are trying to ensure that people are involved in the electoral process; in fact, I submitted a paper to the committee through the convener on how to encourage people who have disabilities to become involved in that process. I hope that many people from many sections of society come forward to ensure that the directly elected elements of health boards reflect a good cross-section of our society.
You make an interesting point about remuneration and loss of earnings. I do not want to have a system in which only people who are comfortably off and who come from one socioeconomic background are able to come forward to the exclusion of others who are not so comfortably off and have to work very hard for a living. I have not closed my mind entirely to your point, but I think that remuneration for loss of earnings should meet that concern.
Most of that discussion was about remuneration and loss of earnings. I want to ask about the idea of making the whole board area the electoral area. That might seem attractive if we are talking about, for example, Greater Glasgow Health Board, but many health board areas encompass one or two fair-sized cities and huge rural hinterlands. If the health board area is a single electoral area, is there not a danger that we could end up with a result that favours people from the cities and leaves people from the rural areas unrepresented? For example, three committee members are familiar with the Tayside Health Board area, which takes in the cities of Perth and Dundee as well as a huge rural hinterland that stretches from Loch Earn on one side to Kinloch Rannoch and what have you on the other side. In that case, I would have thought it likely that the people from Dundee and Perth, not those from Kinloch Rannoch, would be elected.
That is a real concern, but simply saying that it will not happen does not guarantee that it will not happen. It might well happen.
The bill ensures that people cannot stand as party-political candidates. I hope that people do not vote along geographical lines, but there is always a danger that Dundee people will vote for the candidate from Dundee, that Perth people will vote for the candidate from Perth and that others will find themselves excluded. That is certainly not the bill's intention. I hope that people will vote for those who are committed to health services and are able to contribute positively to our attempts to deal with the many complex challenges that face the health service. Such people might have been involved in health service organisations, the Muscular Dystrophy Campaign, the Royal National Institute for Deaf People, the Royal National Institute of the Blind Scotland and so on.
If the bill is passed and enacted, future Parliaments might look at it again and find that the system is throwing up discrepancies and that people are voting en bloc for city candidates. I do not think that that will necessarily happen; I think that people might be attracted to people who, through their 500-word submission, are able to prove that they have the experience to make a contribution to the health service.
That is subjective. One task that we have is to explore possible unintended consequences of the bill. We frequently legislate and find that what happens is not quite what we anticipated. It is useful to explore possible consequences in advance.
I understand that the bill covers only regional health boards. Will you explain why it does not apply to special health boards?
Euan Robson asked that question on 31 October 2006. The technical reason why special health boards are excluded is that they are dealt with under a separate section of the National Health Service (Scotland) Act 1978. That act uses the term "special health board" for the branded NHS boards, but the bill amends only the section on "health boards"—the legal name used in the 1978 act.
I thought that the point might come up. In reply to Euan Robson, Dave Watson said:
"the reason for the difference is that we are talking about national and local services. We have national delivery for the national health service and local health services, on which local judgments are made."
The geographical boards, which make local judgments and are not simply administrative units, are those that need the flexibility, although they will still follow guidelines, frameworks and targets set nationally by ministers and the Parliament.
Special health boards do not fall easily into that tier of decision making. The bill is an attempt to ensure that the 14 geographical board areas take local considerations into account and know about local needs and circumstances, while working within the framework of national targets set out by ministers.
Dave Watson also said:
"We always have a fast and loose system in relation to national and local services. That is no different for health boards than for other services."—[Official Report, Health Committee, 31 October 2006; c 3160.]
Flexibility already exists, and the bill concentrates specifically on health boards as defined in the 1978 act—that excludes special health boards.
I understand the principle of nationwide provision. If a main premise of the bill is democratic accountability, it would not be impossible to apply the rules on national elections to special health boards.
It would not be impossible, but it would be outwith the scope of the bill. I hesitate to tread even 1cm outwith that scope.
I acknowledge that.
The National Health Service Reform (Scotland) Act 2004 was passed not very long ago, and the Executive recently launched its "Transforming Public Services—the next phase of reform" consultation on the potential for reviewing how public services are run. Why did you decide to introduce the bill now and not wait to see how the 2004 act and recent consultation work out?
I support the reforms that were introduced to secure greater public participation and involvement and, whatever their opinion of the bill, every person who has appeared before the Health Committee has said that they support those reforms, because greater participation and involvement are good. I am not against that at all.
The consultation on the future of public services is also interesting. I will paraphrase, but as I understand it, the discussion document says that the process is evolutionary and indicates a direction of travel and that the Executive is open to new ideas about involving the public and communities in decisions about the speed of change. I argue that my proposal is part of the evolutionary process. It is an old idea that has been given a new set of clothes. It will allow communities to have a direct say on—and to hold people accountable for—the pace of change in the national health service. The bill, which is narrowly drawn and proposes a reasoned and reasonable reform, is not inimical to what is being discussed elsewhere. It fits in with that.
So you see it as the third leg rather than as something that comes from left field.
Yes. I see it as a stool upon which anyone could sit.
We had better hold the analogy there and not go any further.
It is always dangerous to use extended metaphors.
You mentioned the proposed voting system and community representation. I assume that you have read the supplementary evidence from Dr Gilmour.
Yes.
Why do you prefer the multimember, first-past-the-post system to the single transferable vote system of proportional representation? Dr Gilmour argues that using the latter would address the point that the convener made earlier.
I have a couple of reasons. First, the bill springs from people's concerns about consultative processes in the health service. My consultation was reasonably extensive for a member's bill and it received 160 responses, the majority of which were in favour of a majoritarian system, although I acknowledge that a significant minority favoured the STV PR system. It would be strange to argue that consultative processes in the NHS are flawed and then to ignore the response to the consultation on the matter. That is not simply semantics—it is an important point.
Dr Gilmour is right to point out that the voting system that is proposed in the bill is not the cumulative vote. It is analogous to the system that operates in certain parts of England where there are multimember wards and which was used in Scotland before 1974. It is a simple majoritarian system.
I am not saying that the proposed voting system is perfect and I have not closed my mind to any amendments that might be lodged if the bill reaches stage 2. It would be ludicrous to do that. However, at the moment, I think that the system that I propose is reasonable. It is used in community council elections and some trade union elections. If there are seven places, the top seven people get them. Of course, members might want to discuss the matter further if the bill reaches stage 2, and I am open to that discussion.
I realise that there is no perfect system, as Dr Gilmour said. Every electoral system is a compromise and has inherent dangers, but the last thing that I want to do during consideration of my bill is to go into a debate that the Parliament has already had about electoral systems in local government.
You said that there is no perfect solution and that you do not regard your proposal as a panacea. That was honest. Are you confident that directly elected health boards would improve public satisfaction? Would they restore the public's trust, which has perhaps been lost in recent years? You said that boards would still have to make difficult decisions, some of which would be unpopular. Would an overarching benefit of the bill be an improvement in public satisfaction and trust?
If that happens, it will be a significant benefit, although there is no guarantee that it will happen. I do not pretend that there are any guarantees, other than death and taxes.
Trust is important for our national health service. One reason why I introduced the bill was that I felt that a corrosive cynicism was growing that suggests that everything that every health board proposes is wrong. I do not believe that, and I do not think that many people believe it, but that point of view is spreading among the public. That is bad for the NHS and it will not help the NHS to meet the challenges that lie before it. It is bad for people to feel that they do not have a say in their national health service or that if they have a say, it is not a real say because there is no direct accountability.
I do not know whether direct elections to health boards will make people more satisfied. I have been in local and national politics for 20 years. We have all been in politics for a long time, so we know that you can satisfy some of the people some of the time and so on. I hope that one benefit of the bill would be that people would feel that they had ownership of what is decided in their name. Ownership is straightforward when representatives are directly elected—if people do not like what someone in this Parliament is doing, they can vote against them or their party, but that is not possible within the NHS board system as it is constituted. I think that having the balance of expertise and experience of those who are appointed mixed with people who have a directly elected accountability could be a positive development. That is not guaranteed, because nothing is guaranteed, but it is worth doing.
What do you think of the suggestion made by a number of boards that are against the bill that somehow the fact that there is local authority representation on boards democratises them or gives them a democratic element? Is such representation in any way adequate?
I think that having local authority representation on boards was a progressive and positive step. However, I again refer to Dave Watson's evidence to the committee on 31 October.
He said that councillors were put on health boards because, as members know, there is a need for greater joint working between the health service and local authorities and for seamlessness where it is appropriate and can deliver. He stated that local authority representation on boards
"is a very indirect form of democracy. Councillors are there to fulfil the local authority role."—[Official Report, Health Committee, 31 October 2006; c 3161-62.]
His suggestion was that very few councillors, if any, see themselves as being super-representatives for the whole health board area.
The appointment of councillors was a progressive step, and the bill would not prevent the minister from continuing to appoint councillors; it would not take that right away. I know many councillors who make a positive contribution, and they could still do so. However, it is a mistake to imagine that somehow having councillors on boards is a substitute for having a directly elected element. A directly elected element would enhance the contribution that appointees, including councillors, could make.
Much of the evidence that we have received suggests that if people are elected to health boards, especially if there is 50 per cent plus one directly elected representation on boards, national issues will be prevented from being considered and campaign groups could perhaps hijack decisions that should be taken nationally.
Also, how would the 50 per cent plus one directly elected representation on health boards be maintained when illness or something untoward befell people elected to the board?
You pose two questions. First, there is a provision in the bill to enable a postal ballot to take place when there is a vacancy. The minister would also have to ensure that 50 per cent of board members were directly elected, or a simple majority if that was arithmetically impossible—six out of 10, for example. That is the only proposed change in ministerial powers. That is how the issue would be resolved.
Tell me if I am wrong, but I think that you are talking about a concern that was raised by a number of witnesses, many of them from the health boards. I remember specifically Professor Sir John Arbuthnott talking about the ubiquitous parochial nimby or reactionary, who wants nothing to change ever. I simply do not believe that that is how the bill would work out. I cannot guarantee that it would not work out like that—that would be foolish of me—but I believe that what you suggest is a slight exaggeration.
I do not think that the 50 per cent plus one or simple majority provision would make the board monolithic—there would not be a party-political block, nor would there be a geographical or a sectional block. All sorts of different people would be involved, with all sorts of different talents, abilities and contributions to make. Like people who sit around the table at any committee in any organisation, people would make alliances with some people over some issues and with other people over others. That is the natural way in which the provisions would work.
I know that it is not directly analogous, but I was made a member of the Glasgow West Health Council as a tyro district politician in 1987, just after a by-election. I went in there knowing very little—to use a technical term, hee-haw—about how things worked. However, whenever someone goes into a new situation, they listen and training is provided. They read as much as they can and get directly involved. That is how the new boards would naturally flow. The amalgam of appointees and directly elected members on the health boards would work together because the challenges are so great and the work is so complicated that everyone can make a contribution.
I also think that there will be a necessary change in culture as health boards meet the challenge of having a new, directly elected element. Health boards have been able to meet the challenge of the public participation reforms that have been implemented over the past four or five years, and civilisation has not crumbled. They have all said that those reforms are a good thing, and I think that they are right. I believe that the directly elected element of the boards would add to that and would in no way be divisive or detract from a positive programme of implementing what is best for health service delivery in health board areas.
As you know, I am eager for there to be a balance. I start from the point of view that there is not much to balance against the clinicians and the people who tend to dominate the boards. Nevertheless, I am struggling to see how the bill would help my constituents and their communities to have a bigger say in Greater Glasgow and Clyde NHS Board, which at the moment has in excess of 50 members. You have suggested that the councillors would stay on. Who would come off the board to create the new places, or would there be additional places?
Going back to the convener's point, I am concerned not just about Glasgow and Clyde. Because of the sheer weight of the number of people involved, Glasgow will dominate not just rural areas such as Argyll, which the health board serves, but other urban areas such as Greenock. I am interested in how all the people who do not live within the boundaries of Glasgow but are served by the Greater Glasgow and Clyde NHS Board and are dependent on Glasgow for their emergency services would feed into the process.
I take the issues seriously because we were part of a board on which councillors from Paisley, for example, voted for services to go to Paisley and the Royal Alexandra hospital. They were strong and robust about that, because there was no loss in doing that. I suspect that a bit of that might have happened in Tayside, with Dundee and Perth. If we are talking about specialisation and centralisation of services, which go to the cities anyway, and if boards are dominated by city representatives, is it not in their interests to have the services that are on their doorstep built up? That is a big problem for me. I do not know how, given where we are, we will achieve the influence that we require.
The number of boards is another issue. Earlier, the committee had a long debate about what might happen in the future. There is a lot of speculation out there about boards becoming more strategic and their number dropping. Issues have been raised about community health partnerships and how they will become more important.
Who would be appropriate people? I do not know how we achieve the ideal profile, but probably the people who would end up on boards would be not the sick and needy, but the more articulate people who are already well set up. I worry about the list of proscribed people. In no circumstances should places on a board be taken by disaffected clinicians and other such people, because enough clinicians and professionals are already members of boards and their agenda already dominates.
You mentioned strong representation. Does that mean that you would be prepared to consider further at stage 2 the majority of 50 per cent plus one? Might we go from one extreme to another? Is strong representation different from 50 per cent plus one?
No. I will not go 1cm outside the scope of the bill, because if I did that, the bill would fall. I assure you that that will not change.
You talked about the appropriate people to be members of boards—I take it that you are talking about the directly elected element. The appropriate people would be the people for whom people vote. Only democracy does that. One good thing about democracy is that if people make a mistake about a person or a party, they can say at the next election, "We made a mistake and we are voting you out, because you are not representing us."
I hope that a cross-section of society would be elected. Of course, many more people do not have the time to serve on boards and would not want to put themselves forward, but I argue that they would want to have the right to say who would represent them, by putting a cross or several crosses on a ballot paper. That is not much different from the situation in local government and the Parliament. People can look at all 129 of us and say, "They're all appropriate," "None of them is appropriate," or "Some are appropriate." That is democracy.
I take your point about numbers. Mike Dailly of the bill team and I considered removing or reducing the number of executive members, such as NHS chief executives and directors of finance, nursing or public health. However, that is outwith the bill's scope, so we could not include that. However, the matter is up to the minister. If he wanted to remove the voting rights of those executive members so that they returned to being experienced and expert advisers, as they were pre-1981, that would be fine. It would be up to the minister to do that if he felt that the board number was unwieldy, which is one of the issues that you talked about—if there are far too many people on boards, nothing is ever decided. Executive members could simply hold the status of adviser.
That is no different from the situation in local government, where many well-paid experts in fields such as social work and education are senior officers who give advice but do not have a vote. Many people think that one of the anomalies in health boards is that executive members make the policy—so it is claimed—or rather, draw up the paper and then have a vote on it as well. That is a matter for the minister.
Duncan McNeil made a point about one part of a health board area having greater pull than another. As I said to the convener, I acknowledge that that is a concern. I hope that rather than voting for city or town representatives, people would vote on the basis of who was the best candidate. That is my answer.
I hear your answer and I know that you are a good man who would wish for such things. However, you are also a politician.
Is there a difference?
In Duncan McNeil's mind, there is.
Supposing that Greater Glasgow and Clyde NHS Board has 50 members—I think that it has more than that—are you telling the committee that we would need to elect 51 people to the board, which would mean that it would have 101 members?
I am not sure about your figures. The figures are quite large, but I do not know whether they are as large as that.
I think that, following the recent amalgamation, the board has 55 members, but I have trimmed the figure back to 50.
Sure. All I am saying is that that is a matter for the minister. All that the bill seeks to do is to place a statutory obligation on the minister to have 50 per cent of members plus one—or a simple majority of them—directly elected. The minister could reduce the number of voting members simply by reducing the number of executive members. That could be done—it would not be impossible.
I want to clarify what you are saying. You want to leave with the minister the decision about the total size of any health board. All you are saying is that 50 per cent of board members plus one must be directly elected, regardless of the total number of members. In other words, even if a health board had only 15 members, you would want eight of them to be elected.
That is correct. We sought to amend the 1978 act in one respect alone because we wanted to make our proposal as straightforward and simple as possible so that it would have as few unintended consequences as possible. In certain health board areas, the number of board members might be unwieldy if no change were made, but the minister could make such a change.
You said that you hoped that people would vote for the people who they thought would do the best job. Can I take it from that answer that you do not support the extension of the list of proscribed people, which includes elected representatives such as MSPs and councillors, as well as criminals?
The list is taken from the Representation of the People Act 1983, with a few add-ons. Councillors could still be appointed—there would be no problem with that. The minister could make such a decision. Essentially, the people who would be forbidden from standing for election to health boards would be people who would bring a party-political element to considerations or who were proscribed for other reasons—for example, for being criminals or for being bankrupt. It is as simple as that.
Nanette Milne has been waiting patiently.
To some extent, my question has been answered. We all know that community councils are not political organisations and that candidates are not allowed to stand as party-political figures. However, most of us have experience of knowing full well what the politics of community councillors are. That can have a significant bearing on some community council meetings and I would worry about that happening with health boards.
I think that you have answered my other question, which was about having a majority of 50 per cent of members plus one who were directly elected. You spoke about people working together on issues and forming natural alliances. To my mind, that would preclude the need to have such a large percentage of members elected. The goal of having elected representation on boards could be satisfied without stipulating a majority of 50 per cent of members plus one. However, you seem to be saying that that is not negotiable as far as the bill is concerned.
I am always open to negotiation and I like to be reasonable—I mean that honestly. However, negotiation on the number of elected members is absolutely forbidden; if we went for a greater number, such as 100 per cent, or a lesser number, such as 30 per cent, the bill would fall, because that would go outwith its scope.
The point about community councils is interesting. I said earlier that the situation with community councils is not directly analogous to the situation that the bill would create. The community councils in my constituency are varied. Some of them are excellent and make the system work, but others—I will not name them, because I will be running for re-election next year—want to be as good as they can be but have difficulty attracting people. Sometimes, the people are volunteers rather than what one might call—although I hesitate to use this old Wilsonian term—a tightly knit group of politically motivated men, and women. The serious point is that I know of community councils and other organisations in which, as part of their natural development, people tend to work together for the greater good, although that does not always happen. The bill tries to attain the best possible balance and blend between appointees with experience and expertise, either in the health service or local government, and those who would form the directly elected element, who would seek to represent the views of the whole area.
That would be better than the situation to which Duncan McNeil rightly drew attention, although I forgot to mention it in responding to him. Duncan was right that, until now, the issue has not been about who has the say; it has been that people feel that there is no say, or that there is a say only for those who are appointed. That situation has to change.
Nanette Milne's comment about community councils was interesting, because we all know of community councils for which not enough people stand to fill the posts. People have their arms put up their backs to stand and turnouts are low. I do not want to go down the avenue of the remuneration issue, as we have dealt with that. However, one concern is the possibility of extremely low turnouts. That is an issue not only for the elections under the bill—we have an issue about turnouts for all elections.
Another concern is the number of candidates who would stand for election to the boards. The evidence from New Zealand is that the system of remuneration there means that more people are likely to stand whereas, in England, where there is no remuneration, in many cases only one person stands for election. I wonder whether a situation might arise, as for example happens with some community councils, in which not all the posts are filled because not enough people are prepared to put their heads on the chopping block, as they would have to sit in the chairs and make decisions that would not always be popular. There will always be unpopular decisions. How do you respond to that concern?
I admit that that whole set of concerns and dangers will always arise. Throughout Scotland, people have been galvanised into action and campaigning, usually agin proposals, on a range of health service issues. If people were given a chance to develop, in a positive and productive way as part of a health board, the health services that people want and the modernisation that they know is necessary, they would stand for election. People would also be more inclined to think that the election meant something, because it would give them ownership and direct influence, as they would be electing board members who would be directly accountable to them at the ballot box. I believe that people would turn out, but I cannot guarantee that.
You are right that there are varying examples. In New Zealand, there was a 50 per cent turnout in the 2001 district health board elections under a majoritarian system. I am not saying that the new system changed the turnout; I think that there were other reasons why turnout fell to 42 per cent by 2004. For example, 15 per cent of the ballot papers were incorrectly filled in in 2004. There is not simply a systemic issue. There may be a downward trend in turnouts or the figures may simply have been skewed because people were not used to the system. However, people will get used to it.
There are examples from nearer home. There are five wards in which there are direct elections to the Cairngorms National Park Authority. A simple majoritarian system operates in those elections. The person who gets most votes is elected. Turnout ranges from a percentage in the 40s to 66 per cent; average turnout is 59 per cent.
Various examples of low and high voter turnout can be cited, but people will come out to vote if they think that doing so will make a real change to their lives. If my bill is passed, people will think that they will be able to influence the delivery of the health service, which is one of the most important aspects of their lives. However, it is impossible to guarantee that people will stand and that people will vote for them. Even though I am a politician, I will not guarantee that something will happen that I cannot guarantee will happen. However, I think that it is probable that people will stand and that people will vote for them.
A couple of weeks ago, the Association of Electoral Administrators flagged up to us that the cost of the postal ballot would be between £1 and £2 per person. The financial memorandum estimates the cost of running a postal ballot at around £1 per person. People throughout Scotland will be concerned that the cost could be twice that figure. Is it acceptable to take that amount of money away from health boards' budgets?
I suppose that people would be concerned if things were put in that way, but I will be fair. A range of costs is involved. Mr Pollock of the Association of Electoral Administrators said that the cost of a postal ballot would be between £1 and £2 per elector, although, to be fair, he also said that the cost could be higher than that because many imponderables are involved. The financial memorandum gives the total cost of the elections as ranging between £600,000 and £1.2 million—the figures will depend on whether there is a turnout of 30 or 60 per cent in the elections.
We should consider the detailed evidence that the Executive gave last week. At that meeting, I asked the Minister for Health and Community Care how the Executive had reached the figure of £5 million. I accept that there would be costs, but I hope that they would not be as high as the Executive has estimated they would be. If the bill is enacted, I think that the costs will be somewhere in the middle of what has been estimated.
I have asked the Executive to provide in some detail the costs of the public participation reforms that have been implemented over the past three or four years. I am not a betting person, but if I were, I would bet that those costs will be much higher than the costs that we have discussed in evidence. However, that is fine. If we want meaningful public participation, we must invest in it; such things cannot be done on the cheap. If we want democracy that works, a ballot that encourages turnout, and people to know about and participate in that ballot, that will cost cash.
In the next financial year, the health services for which the Parliament has devolved responsibility will cost just over £10 billion. It is right that such an amount of money will be spent on those services because they are a big priority for the Executive and for all of us. Even if the proposed health board elections were to cost the top-end £5 million that the Executive estimates, that would be only a tiny part of the health budget. It would be worth it if it led to people not only participating, but feeling that they have a directly accountable representative who will represent their interests. I cannot say what the exact cost will be, but I have recapitulated the evidence session arguments for various costs as fairly as I can.
There has been a restructuring of Royal Mail costs since your bill was introduced. Have you made any efforts to recalculate the costing of your bill based on the new costs, which caused us all to go, "Ouch!" when they were announced?
No, we have not had time to do that, but we are aware of the changes to which Helen Eadie refers. We will try to look at that and come up with an approximation. My guess is that the recalculated costs will be lower than the high-end Executive approximation. Other representations and submissions have been made by all health boards—seven health boards have said that the cost of the proposals is too high and would divert from front-line services. I accept that their concerns are sincere, but they are overegging the pudding.
As regards Helen Eadie's specific question, we are aware of the possible effect of the Royal Mail price restructure and we are trying our best to estimate how it will change things, but by and large, the cost of implementing my proposals would be between £1 and £2 per elector according to Mr Pollock, what is in the financial memorandum and the Executive. It will be interesting to find out the cost of the public participation reforms, because what is proposed is very good and my bill will add to that.
What would the cost be in the event of any vacancies arising on health boards? In the Scottish Parliament, if there is a list vacancy the position is filled automatically without any cost being involved, but a large cost is involved if there is a vacancy for a constituency member.
There would be a postal ballot cost for a casual vacancy. I cannot recall the exact figure, but I will write to Helen Eadie and other committee members about that through the convener.
We have probably exhausted all our questions. I thank Bill Butler for coming. We will discuss our views on his evidence later. I am advised that we will publish our report early in the new year.
I thank all committee members for their indulgence and forbearance.