Health Committee, 24 Oct 2006

Meeting date: Tuesday, October 24, 2006

Official Report 241KB pdf

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Health Board Elections (Scotland) Bill: Stage 1

Item 2 is the first evidence session on the Health Board Elections (Scotland) Bill, for which we have allocated an hour. We will hear from six senior representatives of area health boards, the Scottish health council and the Convention of Scottish Local Authorities. I welcome Sir John Arbuthnott, chair of NHS Greater Glasgow and Clyde; Professor William Stevely, chair of NHS Ayrshire and Arran; and Robert Anderson, interim chair of NHS Lothian, who I understand has been in the job for only two weeks. Is that correct?

It is three weeks.

Right.

I also welcome Richard Norris, director of the Scottish health council; Councillor Pat Watters, president of COSLA; and Jane Kennedy, team leader in health and social care at COSLA.

A number of documents have been circulated to members of the committee. The bill is intended to democratise Scotland's area health boards through the provision of local elections. It proposes that a simple majority of health board members be elected directly by postal ballot.

In the call for evidence we focused on four issues, on which members will focus this afternoon also. They are: support for the general principles of the bill and, specifically, direct elections to health boards; omissions from the bill; the quality of consultation and the implementation of key concerns about the accountability of health boards; the practical implications of implementing the provisions and any alternative approaches.

The bill would have no other impact on the constitution or operation of health boards or the powers of the Scottish ministers. I would be grateful if all members and witnesses could bear that in mind when they ask and answer questions. The meeting will be long because there are many items on our agenda and I do not want us to drift off into discussions that are not relevant to the job in hand.

My first question is for all the witnesses to answer in turn. Do you support the bill—yes or no—and why?

I have submitted evidence on behalf of the board, which does not support the bill.

My reason for not supporting the bill is based on my four years' experience as chairman of NHS Greater Glasgow and NHS Greater Glasgow and Clyde, which was a period of rapid change. Much has changed in health boards under the headings of accountability, public involvement and democratic representation and responsibility. I understand the nature and purpose of the bill and I have some sympathy with it, but we have intelligence to share with the committee under those headings, which will indicate why we do not support the bill.

The health board that I represent is not in favour of the bill.

The board thought that in taking on board the principles of the bill we would risk ending up with something that was no longer a national health service, which could lead to inefficient and ineffective provision of health care. I am happy to amplify those comments.

NHS Lothian's submission hedged its bets a bit, but, if you read between the lines, you will see that we do not support the bill.

We feel that fairly recent developments, such as the implementation of community health partnerships and the coming into being of public partnership fora, have still to bed in. We believe that, through both those avenues, the public will have a role to influence the future shape of the service.

After internal discussion, we in the Scottish health council decided that we did not want to give a view on whether we support the bill. However, it is fair to say that we have some concerns about the bill's impact on regional planning, which we are keen to encourage among boards. Also, as others have said, the current system is fairly recent and is still bedding in.

The policy of COSLA is that we do not support the bill.

Our main reason is that we believe that democratisation of the public services is vital but needs to be discussed in total. The bill would simply tinker with part of the public services. We also believe that any change to how we organise the public services must be able to deliver improvements. We fail to see how the bill would demonstrably improve the public service.

Does Jane Kennedy want to add any comments?

I would just echo what Pat Watters has said.

We will move to questions from committee members.

My questions are for Pat Watters. When COSLA leaders discussed the bill, they decided that they were not in favour of it. First, what is the justification for requiring that the delivery of important services other than health, such as social work and education, be controlled by directly elected individuals?

Secondly, the COSLA submission states:

"The matter is one that requires to be considered in the wider context of public sector reform, and particularly the current debate initiated by Tom McCabe".

Does COSLA think that, in future, in the context of a different structure for delivering public services, health services could be delivered by directly elected individuals, or does it think that the idea just does not have any mileage?

Our view is that we need to consider how the whole public sector fits together. We have an opportunity to look at how we deliver public services in Scotland as a whole. We should not take out one part of the public services in considering proposal X, because we might end up doing something entirely different when we look at the whole picture.

For instance, why does primary care need to be part of the health sector when hospital care is entirely different from primary care? Does primary care naturally fit in with the health service? How do we enable local communities to become healthier? How does that fit in? Local authorities have a role in delivering healthy communities, but that role has been sectioned off so we end up in competition with others.

Our main objection arises from our view that we need to look at the whole picture rather than just part of it. If we look only at bits of the public services, we might find that they do not fit when we try to put them together. We need to look at the whole picture of how the public services are delivered and who delivers them. The idea of having fewer, rather than more, organisations involved would be attractive to me.

Has COSLA taken only a temporary position on the bill until it sees what happens with public services in general? At the moment, the health service stands out as the major public service that is not governed by a directly elected body. Even the police and fire service boards, which sometimes have boundaries that are coterminous with those of health boards, are made up of directly elected people. At this stage, I am not necessarily in favour of or against the bill, but the health boards seem to me to stand out as the only such organisations that are not governed by directly elected bodies.

Health boards have had elected members only within, I think, the past three years. There is an analogy between health boards and police and fire service boards, but police and fire are firmly local government services and, as such, they should be administered by elected local government members. That is where the analogy ends. Only two health boards—Fife NHS Board and Dumfries and Galloway NHS Board—have coterminous boundaries with the police and fire boards. The other police and fire service boards are joint boards that include members from several local authorities. For instance, the Strathclyde area covers several health board areas as well as 12 local authority areas.

Partnership between local authorities and health boards is vital. We can see how that is being delivered. The comment was made that the health service is a national service rather than a local service. We need to examine how the health service interacts with local services such as housing, education and social work services, which have been mentioned. The relationship that we have built with the health service through the joint future agenda should be encouraged. That would not necessarily happen as a result of the bill.

I have two questions, the first of which is to Pat Watters. Do you not have two contradictory policy papers? A COSLA policy paper says that quangos that are advisory committees need not be elected bodies and can comprise professionals who give sound professional advice, but that when major public spending is concerned, directly elected politicians should be involved, to be accountable for that spending. How does that sit with the position that you adopt today?

I have no problem with directly elected politicians forming the majority on health boards throughout Scotland.

You are happy to support directly elected politicians on all health boards throughout Scotland; you are just not happy with the bill.

I do not think that we should have direct elections to health boards; I made a distinction between that and having directly elected politicians on health boards. I am an elected politician and if I were a member of a health board, I would represent my constituents just the same on that health board.

I am sorry—I am missing the difference and I am being slow on the uptake.

You ask whether I support direct elections to health boards and what the difference is. I support having directly elected politicians—there are many in this room—on health boards and making them the majority on health boards.

Do you support holding elections at the time of local government elections to elect politicians directly to health boards?

I do not want to paraphrase Pat Watters out of place, so he should correct me if I am wrong, but I think he is saying that he has no difficulty with councillors or parliamentarians spending part of their time as members of health boards. However, he does not say that they should be separately elected to health boards. Is that right?

Yes.

Pat Watters has no problem with elected politicians being members of boards.

That is helpful.

What is Helen Eadie's second question?

Members know that I am a passionate pro-European. We can look at some of our European partners, such as Denmark, where looking after the entire health budget is part of the remit of all local politicians. How would that work in Scotland in relation to reform of how we deliver public services, which you have talked about, and how might it fit in with direct elections?

Health is a responsibility of local government for many of our European partners, including Finland. It operates extremely well. Before the 1970s, health was a responsibility of local government here. After then, health and local government were separated. I do not think that, as a local politician, I should say how Hairmyres hospital should be run. Clinicians are far better at deciding that. The correlation and interaction between us and primary care bode well for better co-operation between primary care and the rest of the public sector through local government.

What are other panel members' views? I notice that, in its evidence, Greater Glasgow and Clyde Health Board has underlined the "national" in "national priorities". I find something wrong with that, because the balance with local priorities has not been given. The interest in the discussion concerns locally elected politicians, so I ask witnesses to embrace that in their answer.

I am happy to do that. The two sets of priorities are closely related. I welcome the opportunity to respond and follow up what Pat Watters said.

As a result of the formation of the community health partnerships and community health and care partnerships, 43 locally elected politicians—I totted up the figures on the train across—now either sit on our board after being appointed to it, or sit as chairs or members of community health and care partnerships, or sit as members of community health partnerships. The idea that—

Could I just clarify—

Please let Sir John finish. You can come back in later.

The point I was trying to make is that we are becoming closer and closer to those who are involved in shaping and delivering local policy. The whole idea of community health and care partnerships and community health partnerships is to ensure that we deliver improvements through primary care policies—such as anti-smoking policies—all of which are directed towards making our communities healthier. I really welcome the fact that we are doing that in partnership with locally elected individuals.

You gave a figure of 43. Is that 43 across Scotland?

No, it is 43 in our health board area.

Before I became interim chair of NHS Lothian, I chaired the community health and care partnership in West Lothian, which is quite an interesting model. Four councillors from West Lothian Council are on the partnership board, as are four representatives of NHS Lothian. That partnership is opening up all sorts of new opportunities for working together and breaking down barriers across services. The model is due for review in 2007. It will be interesting to see how the review turns out, but the early signs are very positive.

I want to ask about the politicising effect of electing people who are not on councils, but before I do so I want to pick up on something Pat Watters said, because it nearly blew me out of my seat. Correct me if I am wrong, but I thought I heard you wonder whether primary care really needed to be part of the health service. I hope that I did not hear you correctly because, having worked in the NHS for many years, I would—

Can I just—

This is important.

It is an interesting discussion but we can perhaps have it later. I do not want our discussions just now to get taken down alleyways.

I want Mr Watters to clarify the matter now in case I continue with the wrong impression—

I do not want us to have a long discussion about this, but I think that that was what Pat said.

Yes.

Right. That is what he said, Jean.

Well, I have a major problem with that.

I cannot understand why people would think there was politicisation. I have read comments to the effect that it would be politicising to have elections for people who are not councillors. At the moment the Scottish Government is Labour and Lib Dem, and it is usually Labour and Lib Dem councillors who sit on boards, although it might well be different in some places. How would people feel if the dominant parties in government were different? Would you hold the same views if the Scottish Executive was Scottish National Party and Conservative?

Pat Watters will never live so long as to see an SNP and Conservative Executive.

But hypothetically—

No, Jean, I am sorry—I do not see how this is relevant to our discussion.

It is—

I suggest that it is not. Pat's views on the myriad possible combinations of parties in future Executives are neither here nor there. Please come on to a question that is more directly related to the bill.

Honest to goodness. Right. I think it was Sir John Arbuthnott who suggested that elections could encourage single-issue candidates who would not represent people in the full range of services. What single issues within medicine are you thinking of? Are you thinking, for example, of people with diabetes, or people with chronic pain?

I was not thinking in terms of individual long-term illnesses or conditions. We are talking hypothetically, because we do not know how the system would actually work, but it is quite possible that an activist who wanted, or did not want, something to happen in their area could become an elected member of a health board. As a result of all the legislation and advice on governance that Governments have given us, we are expected to work as a team. Such a person might say, simply, "I am totally opposed to the proposal and unless what I propose happens in my area, I will not support the health board." There could be great difficulty if there were a group of such people.

I can speak without prejudice because I am in my final year as chairman and the situation I have described will not affect me, but I can imagine that future chairs would find it very difficult. I am talking about corporate responsibility, governance and team working. Partnership is essential in running big public services; in my case, we are responsible for £2.3 billion of public spending.

It is said that if people do not do their jobs properly, they will be fined. How many people have been found to be not up to doing their job on a health board and hauled over the coals for it? That came out in evidence.

If you are referring to specific evidence can you—

It is definitely in the information we were given; I will try to lay my hands on it.

It is in the submission from NHS Greater Glasgow and Clyde at the top of page 3.

Pat Watters knows more about that than I do. The accountability of local councillors for their work is very precise and there are penalties if they do not do it right. Whether someone is a member of a health board or an elected member of a local authority, they are subject to the Scottish commissioners who, each year, review complaints against people who are alleged not to be doing their job properly, to have some special interest, to be trying to bend the rules, or whatever. There is a public document that shows when that happens, what the penalty will be, the number of committees missed and so on. A system exists, and I have given you an adequate and accurate description of how it goes.

Without prejudice, almost all such cases seem to involve local councillors of some sort. I think I know of only two health board individuals who have been investigated in that way.

I have two questions. One is specifically for Mr Anderson, the other is more general.

Behind the bill is the perception that the public are not held in very high regard by those who sit on health boards. The evidence that we have heard so far bears that out. I draw attention to point 4 in Lothian NHS Board's evidence about the practical implications of the proposed provisions. The part I am talking about is entitled "Disenfranchisement" and it boils down to the

"risk of confusion with papers being received away from polling stations",

the fact that electors could be interfered with by third parties,

"40% of adults are estimated to have a reading age of nine or less",

and there could be

"Public confusion about the differing systems particularly by some elderly people".

It makes me wonder why we allow people to vote at all. Does that type of evidence not highlight and confirm the perception that health boards have a bit of a patronising attitude towards the public they are supposed to serve?

The evidence you quote was in response to a question about what the practical implications might be. In my two and a half years at NHS Lothian, the board has set great store by the views of the people of Lothian and has gone out of its way to consult and talk to them. Earlier I mentioned my work with the community health and care partnership. Part of that job involved going out and talking to the public and patients. As interim chair of NHS Lothian, I intend to continue with that; it is vital that we listen to what people have to say.

Do you accept that with the right information and explanation of voting systems, people who have got to grips with the different voting systems that they use for voting in different levels of government would get to grips with health board elections? Does the evidence underestimate the public's ability somewhat?

I do not think that I would ever underestimate the public's ability.

Perhaps the evidence could have been better worded.

I have a more general question for the health board representatives—[Interruption.]

Meeting suspended.

On resuming—

I understand that we have been given the all-clear. We will reconvene quickly as I understand that Pat Watters has to leave at 3 o'clock.

I was about to ask about alternative approaches. Beefing up the role of non-executive directors is a common theme in the health boards' evidence, but Pat Watters from COSLA proposed the alternative of removing primary care and placing it in local government control. What is the health boards' view of that proposal?

I do not think that that is a good idea. Health boards try to balance the need to get care as close to communities as possible—which involves considering the provision of care, including primary care—and the need to ensure that specialist care is available to meet specialist needs; that specialist care might be more centralised than local. It is easier to strike the right balance within a single organisation. If two separate organisations tried to achieve that balance, it would not happen as readily.

The pathway is a continuous one and the continuity is vital, especially in urgent areas such as cancer diagnosis.

The public regard the NHS as one continuous service that includes primary care, secondary care and tertiary care.

I return to accountability and the suggestion that direct elections would politicise health boards. We know that health boards are accountable to ministers and to the Parliament, but I am not convinced that there is accountability down the way. Pat Watters says that the fact that there are elected councillors on health boards provides accountability to service users, but I would like to know how councillors are appointed to health boards. Perhaps Pat Watters can help me with that.

To give an example from the old days when I was a councillor, my council's appointees to health boards all came from the administration and not from other parties, regardless of the expertise in the other parties. I do not know whether that is how the system works today, but that was politicisation and I was concerned about it. I would welcome clarification of the current situation.

Jane Kennedy will correct me if I am wrong, but I think that it has to be the leader of the authority or the chair of its social work committee who is appointed to the health board. The role cannot be delegated to anyone else.

The briefing from the Scottish Parliament information centre covers the experience of other countries, including New Zealand. I do not know whether any of the witnesses from the health boards has a detailed knowledge of how things work in New Zealand, but it has had direct elections to health boards since 2001. Do you have any information on the experience of your counterparts in other countries?

The information from SPICe was new to us. We would have to look into the matter to see how things work. I think that the briefing suggests that the New Zealand system works in bits, but I could not say.

No one else has an opinion.

No other committee members have indicated that they want to speak, so I go to Bill Butler. Bill, Pat Watters has to leave at 3 o'clock, so if you have questions for him you might want to ask them first.

Thank you. I hope that our COSLA colleagues do not take this as a slight, but I do not have any questions for them. I will direct my questions to colleagues from the health boards.

First, I have a simple question for the health board chairs. Do you accept that, under the bill's provisions, NHS boards will remain accountable to ministers and the Scottish Parliament? I think that that is a yes-or-no question.

I am sorry, but you will not get a yes or a no from me. Although there might be a line of accountability to Scottish ministers and the Scottish Parliament, it is much more difficult to hold an elected body to account in the way in which health board members are currently accountable to the Parliament.

Do you accept that that is a value judgment? My question was straightforward and direct. Do you accept that, under the bill's provisions, NHS boards will remain accountable to ministers and the Scottish Parliament? That is a yes-or-no question, I am afraid.

You have had my answer.

Sir John?

The answer is, "Yes, but." If you do not want to hear the but, then—

I will come to that.

I will allow you to hear the buts.

I do not mind the buts, but I wanted to start off with that simple question. I did not realise that it would cause such controversy. Mr Anderson?

Let us go back to Sir John. He wanted to qualify what he said.

The point was made earlier about the increasingly regional dimension of the health service. Although Bill Butler's bill would do as he said, we are saying that you have to be careful that you do not throw out the baby with the bath water to introduce a change that is seen as dealing with a problem that might not quite be the same as it was. If you endanger the national element of the health service, where boards are held accountable by ministers and by the Health Department for the implementation locally of national and regional policies, you could be interfering with the delivery of health services in a way that is counterproductive. I am asking the committee to bear that in mind.

Do you accept that, under the terms of the bill, boards will still be required to deliver—I quote from your submission—

"national targets, guarantees, strategies, initiatives and policies",

and that, at the moment, boards respond anyway to local needs within those guidelines or within that framework? If they did not respond to local needs, would they not simply be administrative units? That question is for all the chairs of the health boards.

Again, it depends on how things fall into place. I have tried to give a picture of the considerable effort that we have made to deal with what was alleged to be a democratic deficit, through the involvement of locally elected politicians in local authorities to a large extent in our community health and care partnerships and community health partnerships. They have chairing duties, which makes them directly responsible to the people who elected them. I hope that Bill Butler agrees that the spirit of that is good.

If we have a completely different cohort of people who are elected in a different electoral process, we have to ask what the link is between those directly elected people, the locally elected members of our local authorities and the local and nationally elected members of our Parliament. There is a constitutional element there that we have to think through. If the locally elected people who are in a majority said, "Well, actually, we're not beholden to any of that and we think that this should happen," the delivery of the national and regional policies, which you began by saying was our duty, could become quite tortuous.

I echo what Sir John has said. It seems to me that at some point down the road there would be the kind of scenario that has been suggested, which would leave the local agenda at odds with the national agenda in a way that could damage the level of care available to a local community. It is a risk. That is not to say that the present system is perfect, but it is better than the one that is being proposed.

We have a national framework of policies and targets, which gives the guarantee of service to the population, but we also have a series of diverse communities with different needs. Part of the potential success of community health and care partnerships is the ability to focus in on those local needs. I am asking for that experiment, if that is what it is, to be judged next year, at the right time.

Are community health and care partnerships and the proposals in the bill mutually exclusive? I would see them working in a complementary fashion. Would they inevitably be antagonistic?

I do not think that I am saying that.

Do you fear that they could be working at cross-purposes?

I am not a constitutional lawyer, so I do not know, to be honest.

I accept that you have expressed a sincere point of view, but I think that you are overegging the pudding somewhat. I accept that improvements such as "Patient Focus and Public Involvement"—the title rolls off the tongue—regular meetings between ministers and NHS boards, the annual review meeting and meetings with local councillors from 2001 are all good things. However, according to a Scottish Executive survey,

"73% of the public felt that they had little or no influence over the way the NHS is run. This was up from 57% in 2000."

Are you disappointed about that?

I am glad that you said that "Patient Focus and Public Involvement" rolls off the tongue, because it does not always roll off my tongue. PFPI was introduced after 2000. The procedures that culminated in the formation of community health and care partnerships and CHPs are only now in place. My colleagues are saying that there will be uncertainty about the future if we change the system again.

We now have a database of more than 3,000 people from the community in the NHS Greater Glasgow and Clyde area who are in almost daily contact with us. They can get any information that they want from us at any time. Each edition of "Health News" goes out to 300,000 people. Between 200 and 300 people come to our health events, which take place three or four times a year. The level of public engagement has ratcheted up tremendously. The most valuable contact does not come through what people say in surveys or opinion polls. We have a team of people who use their shoe leather to go round shopping centres, bingo halls and so on, where they ask thousands of people what they think are the issues in relation to particular health care centres. We get fantastic interaction from those exchanges. I am not arguing for my position in the future. I am simply asking the committee to take care not to unpick what happens at the moment, because we have worked hard at it.

Over the past three or four years, we have seen probably the most dramatic change that has been suggested for the health service for some time. That change was agreed by the Parliament—there is a national policy. Undoubtedly, the way in which the policy is implemented locally has caused a great deal of concern in a number of communities. That does not mean that the policy is wrong. The fact that people feel that they have less influence does not mean that local decisions are wrong. It will take some time before we see the outcome of the policy. I can think of other examples of policies where there has been great initial public hostility but people have come around to recognising that the changes were for the general good.

I recognise the perception that exists and am disappointed about that. Sometimes we have not been as good as we ought to have been at explaining to the public exactly what they will get out of the changes in the long term. That is an issue for us.

We are getting better at implementing change, in partnership with members of the public. I am disappointed with the figures that Bill Butler quoted for public opinion. However, if we asked the people who are engaged in public fora what they think now and again in a year's time, the picture would be different.

I do not disagree with what you have said about greater public participation. That is good—it is progress. However, it strikes me as strange that the public are still dissatisfied, and in even greater numbers. Could it be that public engagement is seen as good and as an improvement but that people want the essential feature of democracy, which is direct accountability, at least for an element of health board members? Do you agree with Voluntary Health Scotland's submission, which states that progress toward patient focus and public involvement

"could be accelerated by introducing a further"—

and more directly accountable—

"means of promoting local voices"?

I hear what Voluntary Health Scotland says, but I do not agree with it.

The problem is fairly straightforward. I am not persuaded that having elected people sitting on health boards will necessarily change public perception over a period.

Neither am I.

Some members of the public want a referendum on specific issues—that would make them feel that they had voted in favour of a change and got it. However, we cannot run a system in that way.

I am pleased that Bill Butler mentioned public voices. We are at a crucial stage of developing a new children's hospital in Glasgow. From the outset, we have included the voices of a group of people who are not able to vote—children. The children, who are between the ages of 11 and 15 and who have all been in hospital for long periods, have had a hugely important role and have told us what services they think children in hospital require. That group of kids went to Aberdeen, by themselves, looked at a new hospital there and came back and told us what they think works and what does not work—in their view, not everything there works. That kind of advice is invaluable, but that is not covered by the provision that Mr Butler suggests.

I do not disagree with much of what the gentlemen have said. I do not disagree with involving people who are below the age at which they can actively vote or become candidates—one aspect of the bill is that people would be able to stand for election at 18. The bill would not prevent such engagement.

Convener, do I have time to ask a couple more questions?

We have very little time—the minister is waiting.

We must not keep the minister waiting.

To interpret Sir John Arbuthnott's words, he talked about a kind of ubiquitous activist who would be—

I was speaking hypothetically.

Yes. You suggested that having such parochial people on boards would lead to stasis in the health service—nothing would happen and no difficult decisions or hard choices would be made. I know that you did not mean your comment to be taken in this way, but is that not in essence an anti-democratic argument? Do you accept that difficult decisions are made every day in local government and the Parliament? Why should not a locally elected health board with a democratic element, working with a minority of appointed people, be a balanced and reasoned way of progressing the health service? Are you not all doom and gloom?

Absolutely not. Like any leopard, I cannot change my spots. I have just written a report called "Putting Citizens First", which dealt with Scottish democracy and voting. I believe firmly that our electoral and constitutional processes should, first and foremost, serve the needs of citizens. Those needs should be served in the same way by health boards. You said that you do not necessarily disagree with us—I do not think that we necessarily disagree with you, but my counsel is that, in considering the measure, one must be aware that it might become destabilising for reasons that you or we have not fully thought through.

Perhaps that was the conflict that faced the framers of the reform acts of 1832, but I understand what you are saying.

Professor Stevely, do you want to have a go at answering the question?

I return to the point that I have tried to make more than once, which is that I believe that we are trying to run a national health service that takes account of local needs. The democratic process puts you people in place to ensure that the overall national policies meet with democratic approval. The local authorities then become involved in providing local input. The risk of conflict between the local and the national is a risk that is not worth taking. Although there is some merit in the proposal, if we were to take the steps that are set out in the bill, the risk of conflict could arise.

We have set in train a series of reforms. We need to give them time to work.

I have one last question to put, convener.

As long as it does not go on for too long.

I will be very quick. Do you think that there is a danger that, if the bill is enacted, the legitimacy of health boards could be affected by low voter turnout? There were indications in your evidence that you thought that that may be the inherent danger in the proposal. Do you have any evidence for that view?

The evidence that I gained in writing the report on voting systems shows that there is no continuing upward trend in people's interest in politics as reflected by their voting intentions. To come back to the New Zealand evidence, the outcome depends on the conditions under which the vote is carried out and how voters are registered. If voters have to register and are expected to vote, the turnout will be reasonable. If the vote depends on a volunteer turnout, the outcome will be something like 11 per cent. A huge risk would be posed if we were to take the latter route.

It is inevitable that elections will be required to fill casual vacancies of one kind or another. My concern is that the turnout for those elections could be even lower than for the regular cycle of elections where at least a concerted attempt is being made to elect a group of people.

The issue goes more widely than the national health service; it affects democracy in Scotland and the United Kingdom. We need to look carefully at how we can increase voter participation in elections across the board.

Would it surprise you to learn that, under the scheme for elections to the Cairngorms National Park Authority, which was created by the Parliament, turnout in the five directly elected wards ranged from 48.8 per cent to 66.4 per cent? Does that encourage you?

I am encouraged by anything that increases voter turnout.

Snap.

Very diplomatic. Notwithstanding the fact that we lost a little bit of time as a result of the fire alert, we need to move on. The minister is waiting. I thank the witnesses for coming before the committee. We will have further evidence-taking sessions on the bill, which you can keep your eye on.