Health and Sport Committee

Meeting date: Tuesday, December 17, 2013

Official Report 420KB pdf

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Subordinate Legislation

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Health Boards (Membership and Elections) (Scotland) Order 2013 [Draft]

Welcome to the 36th and final meeting in 2013 of the Health and Sport Committee. I remind everyone to switch off mobile phones, BlackBerrys and so on. In saying that, members might use iPads or other tablets to access their papers for the meeting.

The first item on the agenda is an affirmative instrument, the draft Health Boards (Membership and Elections) (Scotland) Order 2013. As usual with draft affirmative instruments, we will have an evidence-taking session with the cabinet secretary and his officials, followed by the formal debate on the motion.

I welcome Alex Neil, the Cabinet Secretary for Health and Wellbeing; Robert Kirkwood, the corporate business manager of the national health service in Scotland; and David Wilson, a solicitor in the food health and community care division of the Scottish Government.

I invite the cabinet secretary to make a brief opening statement.

The draft Health Boards (Membership and Elections) (Scotland) Order 2013, which is before the committee today, will, if approved by the Parliament, revoke the pilot order that was made under the Health Boards (Membership and Elections) (Scotland) Act 2009. That order led to the piloting of health board elections in the Fife and Dumfries and Galloway health board areas in 2010.

In taking forward the policy with Parliament following the 2007 election, we sought to address the levels of participation and engagement between boards and the communities that they serve. After an extensive consultation, we worked with others in the Parliament and introduced legislation that allowed the piloting of direct elections. As part of that original legislation, we also agreed with Parliament that a robust process should be put in place to ensure that no roll-out of the pilot could take place without proper consideration. Those measures included a requirement for the pilot scheme to be independently evaluated, to give us a vital independent view of its impact. The pilot also had to last for at least two years before any evaluation reported, to ensure that it had an appropriate time to become established before any judgment was made. Further, there could be only one pilot, to avoid any moves to continue to change and modify board structures, which could have proved to be an unhelpful distraction.

The election count took place on 10 June 2010. From 60 candidates in Fife and 70 in Dumfries and Galloway, 12 and 10 members, respectively, were returned. In December 2012, two-and-a-half years after the elections took place, the independent evaluation that was carried out by the London School of Economics, working with the University of St Andrews, was published. That evaluation made it clear to me that we should not continue with the rolling out of the programme.

We also carried out alternative pilots at the same time as the Dumfries and Galloway and Fife election pilots. Those alternative pilots were successful in attracting a far greater number of applicants from different spectrums and demographics of Scottish society than was the case under the previous system. In Grampian, for example, we received 90 applications for the appointments, which compared with the eight applications that we received under the previous process. Building on the success of the alternative pilots, many of the approaches that were used have been replicated by other boards during their appointment rounds.

The increase in the diversity of appointments to health boards will contribute to better participation and engagement. It is my intention to build on the successes of the alternative pilot approach and to continue to encourage boards to be more flexible and inclusive in their approach to appointments.

For the reasons outlined, I believe that we should not roll out the health board elections and that, under the terms of the legislation, we should terminate the pilots accordingly.

I have a couple of questions to ask, as a member for South Scotland—and Dumfries and Galloway is obviously part and parcel of South Scotland. My questions are primarily on the costs of the elections that were held in NHS Dumfries and Galloway. What were the costings, and how much would it cost to roll out the health board elections across all health board areas in Scotland?

The cost of the pilots was in the order of £2.5 million. The independent evaluation estimated that it would cost £12 million to roll out the elections. We think that that is an underestimate. The cost of the local elections in Scotland last year was £16 million to £20 million, depending on what is included in that cost. We believe that the £12 million estimate is quite an underestimate. Even at £12 million, that money would have had to come out of the health and social care budget. My view is that there are higher priorities for £12 million than rolling out direct elections to health boards.

My other question relates to the governance arrangements that will be put in place. When do you think you will appoint the new non-executives to the pilot health boards, and how many members will there be?

Early in the new year, we will start the process of advertising for new members for Fife and Dumfries and Galloway. I always want to ensure that there are significantly more non-executive board members than executive members. I am therefore anxious to ensure that we move reasonably quickly to do that in the new year.

We will take into account experience elsewhere, particularly in Grampian and Lothian. The current exercise in NHS Lanarkshire to deliberately try to recruit a more diverse spectrum of people on to the health board by advertising specifically to have members of underrepresented groups, including women, ethnic minorities and disabled people, has proved quite successful in terms of the number of applications. We believe that we will be able to fill the two positions in Lanarkshire with people from underrepresented groups. When we come to advertise the positions in Fife and Dumfries and Galloway, I want to use the opportunity to ensure that people from underrepresented groups within society are encouraged to stand, and that, provided they are up to the job, they are appointed to the board.

I think that you said in the Parliament last week that the people who were directly elected will come off the boards at the end of this month. If I hear you right, you are advertising to replace them, starting next month. How long will the gap be between the present members leaving and the new appointments being made?

The usual timeframe to recruit new people is two months, from the time when we advertise the positions to appointment. It will be done timeously and speedily. It so happens that we still have a good complement of members on both the boards concerned, so it is not as if we are down to the last half dozen members or anything like that. The boards are sufficiently well staffed up as far as the board membership is concerned.

However, the issue is not just about the number of people on the board; it is also about the balance, particularly between the executive and non-executive members, and I am keen to ensure that there is always a very strong preference and majority for non-executive members.

Why, then, did you not decide to run the elected members up until they would be replaced by the appointed members that you are now advertising for? Why leave a gap?

Actually, a lot of it has to do with the terms of the legislation. Under the legislation that was passed by the Parliament, I have had to take a decision to lay the order, otherwise I would have been duty bound by the legislation to rerun the elections in Fife and in Dumfries and Galloway in 2014, and that is where the timing issue has come in. I have allowed those members to serve for as long as I could under the terms of the legislation, but the legislation does not allow me to continue with that, beyond the laying of the order.

Could the appointments have been advertised earlier to allow appointments to be made at the end of the month, to prevent a gap?

It would be presumptuous of me to predetermine what the Parliament will decide on that matter. I give respect to the Parliament. The Parliament might decide not to agree with me and not to pass the order, in which case I would have spent a lot of money advertising positions that I could not then fill.

Could you not have taken the order to the Parliament a bit sooner? That is what I am trying to say.

If I had done that, the period of office would have come to an end once the order was in effect, so I felt that this was the best timing and I do not see any significant gap between the elected members demitting office and new recruited members taking office. As I said, neither board is short of board members.

To clarify, are you saying that, the moment the order is passed, those people cease to be members? Could you not have put a date in the order or put an order to Parliament that would have come into effect two months hence to allow that space?

I also wanted to ensure that the elected members, who have served for a period of time, did not have their period of office cut short unnecessarily, because I felt duty bound to them. I anticipate that some of those members will reapply for board membership under the normal procedure.

I do not think that you quite understand what I am driving at. I am not talking about their term of office being cut short. Are you telling me that there has to be a two-month gap regardless, because of the way in which the legislation is set up?

The legislation is worded in such a way that things have to be done in the way that I have outlined. If I had made the order earlier, it would have created a period of uncertainty. Let us suppose that I had made the order six months ago and had said that the members could continue to serve until the turn of the year. In that case, the authority of those members would have been grossly undermined. I wanted to bring the order to the latest date that I possibly and reasonably could so that we did not undermine the authority of those board members while they were serving.

So it is not a surprise to them?

I do not think that it should be. Anyone who reads the evaluation—certainly anyone I have spoken to in the health service, irrespective of whether they are board members or have other roles—will take the universal view that, if you have £12 million to spend, it is far better to spend it on service provision than on rolling out elections.

I apologise for not having read the evaluation. I am not here to oppose what you suggest, but it would be interesting to know what other lessons you have learned from the experience. You have presented the financial objection to continuing with the arrangement, but it was certainly a major policy plank—almost a flagship policy—that you advocated in the past. I am not criticising people for changing their minds, but I would like to know in what other ways the arrangement did not fulfil your expectations.

10:45

First, the alternative pilots actually did a better job of addressing the issue of underrepresented groups on boards. I am determined to get more women, disabled people and ethnic minority representatives on to national health service boards, and that did not happen. Secondly, the turnout in the elections—particularly the 10 per cent turnout—was disappointing and makes questionable the extent to which the election reflected public opinion.

My third point is something that I noticed in some of the decisions that have been made. I do not want to go into a lot of detail about this, but one of my concerns, which was not highlighted in the evaluation, is that when candidates who live in one part of a big geographical area—both Fife and Dumfries and Galloway are fairly significant geographical areas—are elected on the back of support from their locality, sometimes they see their role on the board as being to fight for resources for their area, rather than to look at the big picture of the total board area.

I am sure that Malcolm Chisholm, as a former health minister, would be the first to agree that we cannot risk the balkanisation of health boards and have someone from Glenrothes think that they are on a board to represent Glenrothes. They are not. They are there to represent the board area in its entirety and the point is that they have to look at the big picture, which is the entire Fife area, Dumfries and Galloway area or Lanarkshire area. Since the evaluation, and in the 15 months that I have been in this job, I have noticed the possibility creeping in of people taking a different view and seeing themselves as being in a position to represent a particular locality, rather than look at the big picture and the overall board position.

Even without that, the right decision is not to go ahead with rolling out the elections, but that is another reason why that is the right decision.

That is really interesting. I do not think that the fundamental reason was to get underrepresented groups on the board. I suppose that it was seen at the time by some people as an answer to the problem of meaningful public involvement in health decisions. If it has not proved to be the kind of panacea that some people thought that it would be, have you developed other forms of improving public involvement in health decisions?

I will give you a two-pronged answer to that. First, as I have said, we are using the lessons learned from the alternative pilots in Grampian and Lothian and what is going on in Lanarkshire in co-operation with the Commissioner for Ethical Standards in Public Life in Scotland, which is deliberately designed to ensure that we get underrepresented groups on the board of NHS Lanarkshire.

The second point is that, in any case, we need to look at ways of improving the governance and accountability of health boards and we need to take account of the implications for public accountability of the integration agenda and the shift in health board areas of responsibilities to the new partnerships. Early in the new year, I will issue a consultation document on ways to improve the governance and accountability of health boards in Scotland.

Nanette Milne has the next question.

My question was covered by Rhoda Grant.

As there are no other questions, I will proceed to agenda item 2, which is a formal debate on the affirmative Scottish statutory instrument on which we have just taken evidence. I remind members that they should not put questions to the cabinet secretary at this point—this is a debate—and that officials may not speak in the debate.

I invite the cabinet secretary to move motion S4M-08580.

Motion moved,

That the Health and Sport Committee recommends that the Health Boards (Membership and Elections) (Scotland) Order 2013 [draft] be approved.—[Alex Neil.]

Motion agreed to.

I thank the cabinet secretary and his officials for their attendance and wish them a very merry Christmas and a happy new year.

I reciprocate and wish you and the committee all the best of the season. I hope that Santa Claus will be good to each and every one of you.

Thank you.

10:49 Meeting suspended.

10:50 On resuming—

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National Health Service (Travelling Expenses and Remission of Charges) (Scotland) (No 2) Amendment Regulations 2013 (SSI 2013/327)

Agenda item 3 is further consideration of subordinate legislation. We have four negative instruments to consider.

There has been no motion to annul the regulations, and the Delegated Powers and Law Reform Committee has made no comments on them. There are no comments from the committee. Does the committee agree that it has no recommendations to make on the regulations?

Members indicated agreement.

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Food Safety, Food Hygiene and Official Controls (Sprouting Seeds) (Scotland) Regulations 2013 (SSI 2013/333)

There has been no motion to annul the regulations, and the Delegated Powers and Law Reform Committee has made no comments on them. There are no comments from committee members. Does the committee agree that it has no recommendations to make on the regulations?

Members indicated agreement.

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Health Boards (Membership) (Scotland) Regulations 2013 (SSI 2013/334)

There has been no motion to annul the regulations. The Delegated Powers and Law Reform Committee has drawn the Parliament’s attention to the instrument on the general reporting ground. Details are in annex B to paper 7, on pages 10 and 11 of members’ papers. There are no comments from committee members. Does the committee agree that it has no recommendations to make on the regulations?

Members indicated agreement.

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Food (Miscellaneous Amendments) (Scotland) Regulations 2013 (SSI 2013/336)

There has been no motion to annul the regulations, and the Delegated Powers and Law Reform Committee has made no comments on them. I invite comments from members.

This is perhaps an ignorant question, but what is a lagomorph?

A lagomorph?

Does anyone know?

I know what it used to mean—“I laidimorph on a Friday when there was no work.”

Somebody could write to Nanette Milne and let her know.

It is obviously something that produces meat, but I do not know what it is.

Have we got any answers? No? We are scrambling about. A bit of notice of that question would have been appreciated—it would have saved a lot of red faces.

We will move on. Apart from that, there are no comments on the regulations. Does the committee agree that it has no recommendations to make?

Members indicated agreement.