Official Report 309KB pdf
Item 2 is oral evidence at stage 1 of the Health Boards (Membership and Elections) (Scotland) Bill. I welcome our first panel of witnesses. They are Dr Dean Marshall, chair of the Scottish general practitioners committee of the British Medical Association; Rachel Cackett, policy adviser for the Royal College of Nursing Scotland; and Dave Watson, Scottish organiser on policy for Unison. After reading the written evidence from the BMA and Unison, I was tempted to open with a debate, to allow each organisation to make its case before taking questions from members. We may try that at some point, because a face-to-face debate would be quite useful; I am sure that we will get to that. I invite questions from members.
My first question is addressed to the witness from Unison. I note that you support the general principles of the bill. My question concerns the issue of equality. I understand that elected members of boards will not be paid, whereas appointed members will. In New Zealand, elected members are paid 24,000 dollars a year for 30 days' work. Is it fair and reasonable that elected members should not be paid for doing the same job as appointed members, who will?
You would expect me, as a trade union official, to respond that there ought to be some equity on the issue. We favour payments being made to people, regardless of the capacity in which they serve—for us, that is an equality issue that relates to access. If reasonable payments are not made, there is a risk that retired, wealthy people who can afford to serve on health boards will be able to do so but people who are more representative of the wider community will not. We have no difficulty with the suggestion that payments be made to people who serve on health boards and similar bodies.
Is it a condition of your support for the bill that all members of health boards should be paid equally for the job that they do?
It is not a condition of our support for the bill, but I would go so far as to say that we would have no difficulty with such a provision if the bill were amended in that way.
Do you support the provision that allows an elected member to be sacked and the minister to appoint someone in their place?
No, we do not. Our view is that elected members are elected members in the same way as local councillors are and they should be dismissed only on similar grounds—that is, the usual misconduct provisions would apply. That is a difference between elected members and appointed members.
That might just be another condition of your support for the bill.
I did not say that we agreed with every aspect of the bill; I said that we agreed with its principles.
I thought that you might have some difficulty with that and I hope that you might have some difficulty with my third point. I represent the Highlands and Islands. Highland NHS Board, which we would think of as one ward, covers the area from Caithness down to Campbeltown and across to Nairn and the Cairngorms and includes 30 islands. It would be difficult for residents of Coll or Tiree to make themselves known. As health board members, they could be faced with a day to travel to a meeting in Inverness, a day for the meeting and a day to travel back. Given that the population centre for Highland NHS Board is Inverness, it is perhaps reasonable to assume that many of the people who would wish to stand for election to the board would come from there, which would disfranchise people who might wish to contribute to the health board but for whom that is impossible because of travel time, for geographic reasons and because of cost. How would you overcome that geographic, cost and time difficulty, which many people will face in an area such as the Highlands?
In a previous existence, I was a union organiser for the Highlands, so I am well aware of the geographical challenges and the travelling. However, those challenges also apply at present to appointed members of any health boards that cover an area as large as the Highlands. We favour whole-board elections, but we have said that we are in favour of splitting up the elections in rural areas, of which the Highland NHS Board area is clearly one.
Do you mean splitting the area up into the three community health partnerships—or four, as it is now with Argyll and Bute CHP?
That is best decided in the Highlands, not imposed from Edinburgh, but what you suggest would certainly be a possible way of doing it.
I have a question for the BMA. I asked the bill team about the BMA's evidence on the New Zealand elections—the BMA's approach is perhaps not quite as sceptical as mine, but it is on similar lines. The bill team said that
From the evidence that we have, the people who have been elected seem to be quite happy but, as you say, the population seems turned off by the whole thing, given that the number of candidates has fallen significantly. Also, asking people whether they are happy with how things have gone is not really a great way of assessing impact.
I am simply using the words that the officials used.
So am I. People seem to be happy with the process but, as far as we can see, the outcome has not been measured properly. That is what we are concerned about.
Those questions were directed specifically to Unison and the BMA, but do any of the other witnesses want to come in on that point?
The numbers that are given in the briefings for voter turnout in New Zealand—which started fairly close to the election turnouts that we would expect here—are set in the context of a general election turnout that often tops 80 per cent. Therefore, we are talking about only half the number of people who would vote in a general election turning out to vote in a health board election. If that was transposed to Scotland, we would be looking at a very low turnout for health board elections. I am wary of simply transposing the results from another culture, but it is worth making clear that that is the context for voter turnout in the New Zealand health board elections.
The concern is not just voter turnout but the fact that half as many candidates put themselves forward for election in 2004 as in 2001. I understand that figures are not yet available—at least, we do not have them—on the numbers of candidates in 2007. That perhaps supports Unison's point about the spread of candidates that might come forward.
It is difficult to draw comparisons between different electoral cultures, but I suggest that we should also consider the interest in health board issues in Scotland and the campaigns that have taken place. I think that the broader interest in debates about the health service in Scotland might be reflected in people's interest in extending democracy to the health service.
My question draws on the submissions from the Royal College of Nursing and from Unison, but I have other questions for the BMA later, so Dr Marshall need not feel left out.
I welcome that question as, for us, that issue is key to the discussion of the principles of the bill at stage 1. The bill and the consultation paper state clearly that the proposals are designed to improve engagement. Although the principles of the evaluation that is mentioned in the bill are vague, it is clear that the evaluation will be about participation of the public and patients in decision making within the NHS. I know from hearing previous evidence to the committee that accountability is a key issue for committee members, but that is not how the bill is drafted and it is not the basic principle of the bill. The bill states clearly that accountability will remain with Scottish ministers.
Our position is that we do not believe that direct elections are a panacea for public engagement in the NHS. We have argued strongly that other initiatives—some are in the pipeline and others are proposed—would improve participative engagement. By engagement, I do not mean the exercises that some health boards have held in recent years, which were not participative at all. We would like those other initiatives to go ahead as well.
Oh, I do not know.
That point is being disputed sotto voce.
Others might argue with that point, but I am more tactful—
I was referring to other countries.
The reference was to other countries, I am being told in a postscript, rather than to democratic Scotland.
Even councillors have been known to engage in citizens juries and other such arrangements. They get elected and participate and engage, so it not an either/or question. We can have direct elections and be accountable to an electorate as well as engaging and participating between elections in a variety of ways.
We certainly share the concerns that Rachel Cackett has expressed on behalf of the RCN. We also support public engagement and more transparent decision making, but we do not think that this is the way to do it.
To turn your statement round, perhaps there had to be a petition and demonstrations because there was no public engagement.
Absolutely, but do we believe that having elected people on a board would have made a difference? There is no evidence that such elections solve the problem.
I thought that you were saying that the public already have a route to change things through petitions and so on, so why do this.
No. We fully accept that there is a problem, but we do not think that the bill is the answer to that problem, nor is spending close to £20 million the way to solve it.
Alongside the other measures that the Government wants to put in place and those that the previous Government brought in, there is one other difficulty with the bill. If the evaluation is focused entirely on the pilots—and I hope that there will be more discussion about the evaluation if that is what the decision whether to proceed with elections is to be based on—how will it decide whether it is the elections or all the other measures that have been taken that have improved participation? The evaluation needs to set its nets wide at the beginning and understand the relationship between the increased power of the CHPs, the work of the public partnership forums and the participation standard alongside the proposed elections.
I am quite taken by the idea of looking at outcomes and not processes, and the RCN's evidence says that that should be placed at the heart of the evaluation. I am also quite taken by the fact that you gave specific proposals for conducting the pilots in three different health boards, which would give a true comparison and allow better analysis and evaluation to be done. In light of that, I was also taken by a point in your evidence that was also made by other organisations, particularly those concerned with disability and equalities issues. How can we ensure that, in practice, it is not only those who, as you state in your submission, are
Certainly. We are keen to see more detail on the proposed evaluation before the bill process moves on. The bill is about piloting elections before the roll-out order is made. We are clear that the proposals in our written evidence for a tripartite approach are just our ideas. We feel strongly that having alternative pilots would allow a much bigger discussion.
I wonder whether I might ask a question of Unison as well, convener.
Certainly. Is it on a different subject?
No. It is connected to this subject. I note that Unison said in its written evidence that it was not in favour of having any pilots. I wonder whether the Unison witness can comment on that. In doing so, he might give regard to the situation in Sweden and Denmark because I understand that health is a local authority function in those countries. That is another interesting example that the Parliament should perhaps consider. Perhaps there could be a visit to Denmark for the convener.
I would love to go, but I will not get it. Every week a member suggests a trip, but we are just not getting anywhere with that. I do not know why. However, keep trying for us.
I would go for New Zealand if I were you.
Careful.
Well, frankly, democracy is a strange beast. If we open up a Sunday newspaper, we might find a few views about people around this table.
Some of us are feeling vulnerable, so do not go any further.
I am doing my best to be tactful, but I am obviously not being successful.
I do not think that you picked up on my point about the system in Denmark and Sweden.
Sorry.
I, too, must have missed that in Mr Watson's vigorous response.
We are not in favour of that kind of solution; indeed, in 1948, Aneurin Bevan fought hard against it. We feel that the NHS is big enough in itself. Indeed, that is another reason why we are not much impressed by the argument advanced by the Convention of Scottish Local Authorities and local authorities that they should have the monopoly on local democracy. Health boards are large beasts, and the health service deserves to have its own democracy. It has never been our position that it should simply become a sub-committee of local government, and that view holds for the proposed structure.
On the proposal to have councillors on boards, COSLA says that councillors represent the people in their area—and I might well raise that point with its representatives—whereas you argue that they are seen as representing their council.
That is a very important point. I can think of many issues on which I have personally engaged with council representatives on health boards. It should be pointed out that councillors were brought on to the boards not in an effort to promote local democracy but because local authorities have important health functions that, quite rightly, have to be joined up with the NHS's work. The best example of that work is probably joint future, but there are many others.
Thank you for putting that on the record.
I have two broad questions, the first of which directly follows on from Mr Watson's comments. The issue of governance is pretty fundamental to the bill and, although your views on the matter are clear, I think that we should test them a little. For a start, Government officials made it clear to the committee that all this is not about accountability. Secondly, although there are proposals to change the composition of health boards, there is no proposal to change the corporate governance arrangements.
I could not agree more that democracy is not just about electing people. I know that you have been to events that we have run where we have explained our broader views about public services and what we mean by democracy. Democracy should be about direct elections where that is appropriate, but we are also talking about broader participative engagement—we prefer the term "deliberative engagement"—of communities in the decisions of all public bodies.
That is a fundamental change.
It is a significant change. It is an important change. If you want to call it "fundamental", I am comfortable with that.
Come, come. We are agreeing about lots of things; let us not fall out about that. If you change a health board to a model where the only voting members are persons who have been elected to it and have no connection with the experience and knowledge of the affair, it would no longer be a board. I think that you are right; I am not disagreeing with you. You are proposing changing the health board model fundamentally to a local government model. I am not saying that that is necessarily wrong, but we should not try to fudge that. At the moment, the structure of corporate governance is more akin to a company structure, whereby the executive directors are persons who are believed—I choose my words carefully—to have some expertise in and experience of the subject with which they are dealing, and the non-executive directors are there to hold the executive directors to account. I do not want to fall out with you, but I think that what you are proposing is a pretty fundamental change. I do not dismiss it.
Sure. It is a significant change, particularly in that area, but we are not saying that the only people who should have a say are the directly elected members. We are suggesting a halfway house. There would be people appointed for their expertise; clinical and staff representatives; and directly elected people. The only people who we are saying should not be voting members are the paid officials of the health board.
Would you apply that to all walks of life?
Not in all walks of life. As a general principle, the present structure was a wrong move for a public service. It was introduced a few years ago, well before the Scottish Parliament was put in place. It became a trendy thing to do, in an attempt to ape the private sector. However, public services are not the same as market services—the values, ethos and structures are different. We cannot copy the market-tied provisions of a company and put them into a public service. The two are different, which is why, frankly, that approach has had its day. Having said that, we do not suggest that there should be direct elections to every quango in Scotland. Elections have been introduced for the national park authorities, which control a good deal less public money than health boards but, for small national quangos, it might be difficult to have direct elections. We might have to consider other ways of instilling greater democracy and participation. We want to consider a variety of options but, at present, direct elections are probably the best option for health boards.
My next question is for the British Medical Association and Royal College of Nursing witnesses, although Mr Watson may also want to respond. I have sympathy with the view that a raft of measures are already in play to improve public engagement in delivery of the health service—the composition of CHPs and community health and care partnerships points in that direction. However, I am not sure that such measures deal with concerns about the composition of health boards. We are back to the fundamental issue of the corporate governance of health boards. Regrettably, although all the measures to which the BMA and the RCN have referred will make fundamental differences to public engagement, they do not in any way touch on the public's perception of the legitimacy of certain non-executive members of health boards. There is a feeling that the composition and corporate governance of health boards might be improved if the qualifications of more board members derived from their legitimacy in having been directly elected by local people. There are some suggestions, not just from local authorities, that the number of councillors on health boards should be increased.
In a way, I disagree with Mr Finnie about our proposal, as we say clearly that we are in no way against considering how members of the public are represented on health boards through non-executive directors. It will be no surprise to members to hear that the Royal College of Nursing also disagrees with some of Mr Watson's points about the future governance of health boards. We have made it clear that we are willing to see members of the public on health boards; indeed, they already are.
Before Dean Marshall answers, I want to press Rachel Cackett a little further. Do you disagree with those who say that there might be merit in increasing the number of local councillors on boards, rather than engagement being achieved in some other way?
Through the concordat, local councils are now responsible for delivering a number of outcomes that might once have been regarded as being within the remit of public health agencies—the concordat contains a lot of health outcomes. It is therefore clear that councillors have an important role in delivery—that role might even border on the executive functions of health board members such as the nurse director. There has been movement towards joint delivery.
I share Mr Finnie's concerns about the corporate responsibility of boards. BMA Scotland does not deny that a problem exists, but we say that the bill is not the answer to the problem. We do not think that it will improve public engagement or make decision making more transparent. There is no evidence that it will do so. We are not saying that no changes are required to the way in which health boards are structured, but the bill—or the significant amount of money that might be spent on it—is not the answer.
The trouble with being one of the last members to ask a question is that Ross Finnie has already asked it.
Bid early for the next panel, Jackie.
I will.
We are getting a little away from what I had thought this discussion was to be about. I do not think the bill proposes a change to the voting arrangements.
No—but if we are discussing improving participation, engagement and accountability, the question is legitimate. The bill will affect the composition of boards.
As I have said, the BMA has issues with what happens in health boards.
Is the issue that Jackie Baillie has raised among them?
Absolutely. However, I still cannot see how the proposals in the bill will change such arrangements. From examples in other countries, we can see that the people who would get positions on boards would not be the people we really want to engage. The people we would get would be the people with time on their hands and the financial means to do it.
I agree with much of what Dr Marshall said. It took a long time for nurse directors to become executive directors of health boards. They bring to boards their great expertise and promote the views of the staff with whom they work. The policy memorandum makes it clear that directors of nursing will continue to play their role: nowhere in the bill have I seen anything to suggest a change to their current role, except in respect of their part in the composition of a slightly changed board.
It might make it more transparent.
If the process is transparent, how would taking the vote away from one or another member improve transparency? Boards simply need to make it clear how votes are cast.
In some cases, the electoral ward area could be quite large. I am concerned about that. One need only consider the size of Highland NHS Board's and Greater Glasgow and Clyde NHS Board's areas. Many people in those areas do not fit the stereotype that you perhaps have in mind. In my area, 20,000 people take a very active interest in what goes on in their local health service—they come from all walks of life. You have to believe me on that.
If elections were broken down into groupings, a small pressure group could be elected and bat for one small area. The case for whole-board elections addresses that risk. We are talking about small numbers of directly elected members whose role will be slightly more strategic than that which local authority members have traditionally played.
There are risks either way. I return to the equality issues that we raised in our submission. If an electoral ward is too large, how will people know who they are voting for? How will people living in Lochgilphead feel engaged if they are represented by someone who lives in Wick? If the point is engagement, the proposal comes with its own problems.
The size of wards is important, but even small wards would not make a great deal of difference. If we have small wards in the Borders, people from the bigger towns of Galashiels and Peebles may still end up making decisions about a community hospital in Jedburgh.
There is no longer a community hospital in Jedburgh.
I was giving an example. When I mentioned the Borders, I was aware that you represent the area, convener.
I return to an issue that Ross Finnie raised. The underlying reason for the introduction of the bill is that the public are not only users and potential users, but owners of the health service. For that reason, they should be represented on health boards not just as users, but as proprietors.
It is possible at the moment for any member of the public to put themselves forward for membership of a board. As you said, at the moment only a certain group of people seem to do so. Health boards are multimillion-pound organisations, so we must ensure that board members have the skills to work with a multimillion-pound budget and to make the necessary decisions. There are more people in our communities who could take on that role than do so at the moment. What has happened to the current process to cause only the people such as those whom Ian McKee described, who are already part of the NHS, to apply for board posts? It would be interesting to find out how many members of the general public know that they currently have that option. I suspect that not many do, as it is not well publicised or advertised.
I would echo Rachel Cackett's comments; the issue that she identifies is important. Being involved in a democratic organisation, I know that as soon as one is elected, one is seen to have lost touch with the real world and the grass roots.
The training needs of people who are appointed must, however, be the same as those of people who are elected. Do the people who are appointed magically come into possession of those skills?
That is not really the point that I was trying to make. The New Zealand experience suggests that the people who currently put themselves forward for appointment are the same people who will put themselves forward for election, which means that the boards would continue to come from a fairly small pool of people who already possess a certain level of skill that can be built on through board training.
Some people who are elected to Parliament and to councils need to be upskilled. Would you suggest that people should be appointed to Parliament or councils rather than elected?
It is always difficult to talk about elections to a bunch of elected members.
I should point out that we come from pretty much the category that you have described—we have lawyers, accountants, economists and so on sitting around this table.
Not me.
Helen excepted.
One of the points that I wanted to make earlier about equality was that, unless you can meet people in their own environments and bring them up to a point at which they are able to stand for election to Parliament or to a health board, there is an unfair playing field. No one feels that any electoral system in the world has yet dealt with the issues of gender equality, race equality, lesbian, gay, bisexual and transgender equality and so on, because it can be hard for people who are affected by those equality issues to stand.
One of the central issues is people's view of public services and the role of the public in the democratic running of those services.
We are not going to get agreement on that, so let us move on.
I have another couple of questions, convener. First, how are people chosen for public partnership forums? Is the choice democratic, and how representative are they? They will have a big influence on health care. Secondly, what influence do they have on overall health board policy and secondary care policy?
I will take the second question first. At the moment, the answer is that they have zero influence because of how the structures work. CHPs were introduced to create a more bottom-up approach, to engage the public and to allow them to influence how health boards make decisions. The structure exists, but it has never been properly implemented. We have conducted surveys of doctors who are involved in CHPs, and they have provided no evidence that partnerships influence matters at board level, because the system works from the top down. Basically, the boards tell them what to do and give them all the difficult jobs that they cannot resolve themselves. However, that is not a reason for saying that we should just get rid of them. We should be making the CHPs work—
I have not suggested that we should get rid of them.
I am sorry. I did not mean that you had—I am saying that the structure exists but that we need to work with it. Patient participation workers try to engage members of the public by going to local meetings and trying to get people involved. When they work well, they succeed in engaging a variety of different people. In my area, that includes people who are not the usual suspects, which is interesting. That level can work, but the problem is at the next step up, as CHPs do not have any chance of altering health board policy. We should do something about that, rather than work the other way round.
At the risk of sounding like a woman who is being paternalistic, I agree with what Dean Marshall has just said in that the structures are not right in all PPFs. Unless those structures, which this and the previous Government have been committed to, are given the teeth that they need to make a difference and be influential, they will never succeed. They will not be developed—as we have suggested would be a good way forward—to ensure that the people at the grass roots who have real commitment to, and interest in, what happens to local services can make their voices heard at board level. We are keen that some of the work during the pilot period should examine the structure of a PPF and its relationship with both its CHP or CHCP and the board. At the moment, voices do not pass in the way that they should in many PPFs.
We strongly support PPFs. They currently make a limited contribution, but they provide an opportunity. As we have said, democracy is about the opportunity to engage at different levels, and it is right to engage people in the limited way that, as Dean Marshall indicated, some people want to participate. Others may be prepared to participate in the wider sense, which is true for all our democratic institutions. However, that is not a substitute for having a say at the top level in the organisation, which is the whole point of having democratic levels at each stage.
Nobody has raised this issue, so I want to challenge the panel on the role of the Scottish health council. The BMA says that the council's role is
We had the same view. Local health councils were disbanded and a new body was developed that was going to do all such things. However, as the convener said, it seems that a box is simply ticked to say that consultation has happened. There are no challenges on whether the consultation was appropriate or whether people were informed about what was going on.
You are saying that there could be reforming and strengthening of the various branches that are supposed to increase public participation and make the public feel that they are being listened to. Strangely enough, all the decisions in the example that I used were taken as if there had been no consultation; in other words, it looked like a fix.
Absolutely. I return to the comment about being paternalistic. The medical profession feels just as disengaged from the consultation process. It would be a fine thing to have the chance to decide what we want to do, but everyone whom the consultation is meant to cover needs to get involved and to give their opinions. That said, because of the way in which health boards run consultations, they are paying lip service to those opinions. What has happened in Glasgow is the prime example of that.
Mary Scanlon may ask a short supplementary question. There will be a short break after it is answered, as we have had quite a long session. I want everyone to know that, in case you are getting a little weary.
Given all the points that have been made about potential candidates, what do you think about 16-year-olds standing for election to health boards?
We are in favour of extending the franchise; in fact, we are in favour of extending the franchise in parliamentary and local government elections. At 16, people pay taxes, they can fight in the Army and so on, so why should they not vote? Engaging people would provide an opportunity to build greater understanding of democratic institutions, particularly at the level in question. We are in favour of extending the franchise more broadly, and we think that the bill presents a good opportunity to get younger people more involved in the political process.
Do the BMA or the RCN have any views on that?
No.
No.
Thank you very much for that extensive session. I suspend the meeting for four minutes.
Meeting suspended.
On resuming—
I said that there would be a four-minute suspension, and I meant four minutes.
Absolutely.
You may ask a question after Ross Finnie. Ian McKee is not here yet, so he will ask questions at the end.
As I listened to the previous panel, I was concerned that, although much is being done to improve engagement, there is still a perception that an insufficient number of non-executive members of health boards—as opposed to bodies that filter into those boards—are able to understand or properly represent the public at large. In its evidence, COSLA clearly states that there is an argument for increasing the number of democratically elected local authority members of health boards. That is also South Lanarkshire Council's position, although it is not West Lothian Council's position, so we can have a healthy debate on the matter.
When COSLA's health and wellbeing executive group discussed the issue, many views were expressed on how we should achieve a more democratic and publicly accountable health board system. However, it was clear that the current system was acceptable to no member in the room. Some wanted directly elected boards and some wanted an increase in council representation, but everybody wanted more elected people at the table—no matter how—with voting rights, rather than unelected executive members with voting rights. Perhaps it is because we come from local government that we find it strange that an officer should be able to vote on a report that he or a member of his staff will have prepared, as a staff member will prepare a report for his director in the way that the director wants. That is a strange anomaly in the health board system.
I will build on that and return to what a previous witness said. COSLA's view is certainly not that local authorities should have a monopoly on local democracy. If that were the case, we would have a resounding consensus on health board elections, but committee members will know that COSLA's member councils have reached different perspectives on health board elections. That must frame our response to the committee, because we must present a balanced view. COSLA has agreed a view on some issues, but not on others.
My comments are partly based on my experience over the past seven or eight years of briefing two senior elected members in South Lanarkshire to be members of health boards: Greater Glasgow and Clyde NHS Board and Lanarkshire NHS Board. They have taken their role as board members very seriously. At no time, particularly in the early years as they developed their knowledge and experience, have they taken the view that they are there to get the best for the council. They genuinely have taken the view that they are members of the board and, on sensitive issues, the maturity of their approach has been helpful to everyone who lives in the local communities. They have a local mandate, they live locally and they see people in surgeries. They see the wider role of local government in relation to health and wellbeing. The issue is not only the delivery of services; the joint future initiative is about how we deliver services well to the public, but local government has a much broader interest in health and wellbeing, which the councillors I have briefed take seriously.
I will give some background information on the situation in West Lothian. I do not know whether committee members are aware that West Lothian Council has a coalition administration that includes three members who were elected on the single mandate of saving St John's hospital. Therefore, we are perhaps unique among local authorities. That has helped to shape and mould our council's response to the committee.
I do not know how many of your other directly elected members were representatives of the 80 per cent of care that is delivered in the community. It is an interesting point, and might make the other, single-issue councillors equally representative.
In West Lothian Council's view, a minimum of 51 per cent of board members should be elected members. The benefits and merits of having appointees to the board aside, our issue is with officers having voting rights. The council's view is that, on balance, it is better to have a majority on the board being elected members, although we accept that there may still be appointees among the board membership. We disagree with having officers with voting rights.
Your written submission says:
Sorry—
Page 1 of the council's submission says "100%".
I apologise. The response that I have before me says that we are keen to have a minimum of 50 per cent plus 1 board member being directly elected to the—
I cannot hear you clearly. Could you move your microphone?
My understanding of the council's response is that we seek a minimum of 50 per cent plus 1 being elected to the board.
That is not what it says in the paper that we have.
My apologies. I have a different paper.
So you seek a minimum of 51 per cent—
Fifty. Yes.
But you want it to be 100 per cent elected members. I am trying to follow this—I have jangling in my head, you see.
Our starting point is a minimum of 51 per cent, acknowledging that an element of the board could be made up of unelected appointees. The 100 per cent figure takes it to one extreme.
Are we clear?
Yes.
If it is clear, that is fine. I will read the Official Report afterwards, because I got lost just now, although that is my fault.
Although we want a majority of elected members on boards, the executive members have an important role to play. The health board will sometimes deal with technical or clinical issues. It is appropriate to have the executive members' expertise at the table, and it is probably appropriate that they are allowed to vote. Local government and COSLA consider that the structure is far too top-heavy at the moment, with the non-elected element far outweighing the elected element at board meetings. The elected-member element, even if members were all to join together on a certain issue, would have no way of outvoting the non-elected element. I know that to my cost from my experience as a member of Argyll and Clyde NHS Board. About 70 to 75 per cent of members were executive members rather than local councillors.
So you are broadly in favour of those elements of the bill that require the majority of places to be held by non-executive members.
Yes.
That is the view, but there is no consensus on a fundamental overhaul of the composition of health boards to make them entirely directly elected. We did not achieve consensus on that, so COSLA could not support it.
I wish to pursue Ron Culley's last point with Graeme Struthers. According to West Lothian Council's paper, its optimal position is
As you point out, there could be issues with going to the extreme of having 100 per cent elected members, for example about how that would be perceived and about the emphasis being placed on local issues, and we acknowledge those. However, a number of members on West Lothian Council were elected on a single issue, and our experience is that what you suggest has not transpired. It is a concern, but it has not been our experience. Therefore, I would not be concerned about the potential impact on the national health service.
You say that three local candidates were elected as a consequence of the situation regarding St John's hospital.
That is correct. Yes.
However, the electoral ward for your area would be substantially larger than the area that the hospital covers.
It would cover the Lothian area.
Indeed, and the prospect of such people getting elected might diminish as a consequence.
Yes.
NHS Greater Glasgow and Clyde covers a huge area—Ronnie McColl and I have been through the wars there. Does the panel have concerns about the electoral ward area being the same size as the health board area?
Our proposal was for the ward size to be the same size as the local authority area. We had concerns about reducing the size to the size of local wards. Of the local authorities in the NHS Lothian area, the City of Edinburgh Council is the largest, but East Lothian Council, West Lothian Council and Midlothian Council are also in the mix. We thought that that would be an appropriate geographical allocation.
Thank you. That is helpful. It is in your written submission.
I share those concerns. My local health board is NHS Greater Glasgow and Clyde and if the electoral ward covered the whole health board area, there might be nobody elected from the Clyde area. Personally, I would like to follow the model of the national park authorities. For example, the Loch Lomond and the Trossachs national park is very large and was split into electoral wards. That is the only way in which to ensure local democracy.
It seems to me that the principle behind CHPs is to build local communities. In South Lanarkshire, they are organised into four localities within the local authority area, which builds engagement and capacity at a local level. That seems to make a bit more sense. In our written submission, we comment on the concerns that exist about that larger geography. Across Lanarkshire as a whole we have different communities, from urban to rural, and it would be difficult to get representation from them all.
I have one tiny point to take up with South Lanarkshire Council, which has the anomaly of Cambuslang and Rutherglen being part of NHS Greater Glasgow and Clyde but receiving services elsewhere. I am conscious of similar but small anomalies in different health board areas. The Boundary Commission for Scotland has recommended that small changes to health board boundaries should be considered to regularise those anomalies. Do you agree, especially in the context of the Government's saying that it intends to make no changes whatever?
To be frank, views on that have changed over the years. The key issue for local people and local members is being able to get good-quality services from the health service. Some of the issues in the past were more administrative and were to do with planning and policy rather than the delivery of services. We have seen changes anyway, over the past few years, and, to all intents and purposes, the NHS CHP for South Lanarkshire, which covers all the localities, including Rutherglen and Cambuslang, is now responsible for the delivery of services.
Thank you.
We did not take a view on the size, but it makes sense that people should know the voting areas. We should try to align all our voting systems, including those for Westminster and Holyrood, so that people vote for the same area each time and know the area that is being represented.
That would be a bit difficult, and of course the current boundary changes are going in completely the opposite direction.
I was interested in South Lanarkshire Council's submission, which says:
We should take a fairly simple approach to it. If we change the constitution and expect people to participate in health board elections, they will be the same as any other elections, and we will have to ask what arrangements will be made to ensure that people who are out of the area when an election takes place have a say in its outcome. I suggest not a sophisticated solution but that we recognise the technical matters to do with the administration of the elections, which are important to people. People will want to ensure that they have the opportunity to register their vote.
We spoke about international experience with the previous panel of witnesses. In our papers, we have seen experience from Saskatchewan in Canada, New Zealand and a little bit from Australia. I know about Denmark, Sweden and other Scandinavian countries, which do not treat health like a sub-committee of the local authority, as previous witnesses have said. Has COSLA or have any of the individual local authorities considered what happens in other countries about local authority responsibility for health? The budgets are big, particularly in Denmark, which I have visited. Will the witnesses comment on the international experience?
I do not think that local government has any grand intention to build an empire around health at this minute.
At this minute? You may regret having tagged that little phrase on at the end.
We are committed to closer partnership working between local government and the health service. Our firm view is that there are structures in place that facilitate that process, such as community planning partnerships. They, of course, are broader than local government and the health service and bring in other interested parties such as the police and fire services. Through the single outcome agreements, there is a clear way for local community planning partners to work together to deliver for local communities. As we have discussed, a large part of that is to do with health outcomes. It is now recognised that not only the national health service but all the community planning partners should contribute to improving health in communities. That is beginning to be recognised in national policy that has been agreed between COSLA and the Scottish Government.
So it is not a takeover.
No.
As I said earlier, the broader role of local government in health and wellbeing is important. Services that are delivered through leisure or housing channels and the regeneration of communities are key to how we improve the health of Scotland in the longer term. We have not had any discussions about that approach to things.
Denmark also has regional authorities, which are much bigger than our authorities in Scotland, and it is clear that that has an impact on the approach to the issue in the Danish system. We ought to make more such international comparisons, particularly with our European partners—we have something to learn from one another.
West Lothian Council has not examined any of those other models. We have a successful CHCP partnership with NHS Lothian, which has been running for more than three years. We are quite comfortable with the model that we have just now for meeting the requirements of the communities that we serve.
So West Lothian Council is one of the good guys, but we do not know who the bad guys are in the CHPs that are not working. Nobody has named anyone.
And I am not about to.
I know you are not—I threw out the fishing line, but nothing got hooked.
I will follow up some of Ross Finnie's points. From the evidence that we have received, the committee has discovered that four local authorities out of 32 were in favour of direct elections. Does that tally with the responses that COSLA received? Those four authorities include Graeme Struthers's council, of course.
There were various views. Some councils were not fully in favour of direct elections—there was a halfway house. There are very mixed views in the responses to COSLA, but the overriding issue is that the system that is currently in place should not be in place in the future. That is our position.
The committee received responses from four councils that were in favour of direct elections, six that were against, and six that were unclear or wished to make no comment. Does that more or less reflect the responses to COSLA?
I do not have that information to hand just now, but I am more than happy to re-examine our responses. It sounds about right, but we are happy to send the information on to the committee.
Thank you.
I would like some clarification on a point that Ross Finnie raised. COSLA's submission states:
We did not take a view on the number of local authority members. The mix of local authority members and directly elected members does not matter, as long as the number is greater than the number of executive directors who are not elected. The principle is that there should be a greater number of members who have been elected in some way than non-elected members.
So it is a case of shifting the balance.
Yes.
You are looking for an increase there.
What gave the game away, Mary? Was it the expression on Graeme Struthers's face?
I am being put in a difficult position, but I will answer as best I can.
You will have to learn to be a politician and keep a straight face for difficult questions.
Absolutely.
Ten out 10 for diplomacy.
I will try to put my poker face on for this one. We have three council members who were single-issue candidates, but it is important to point out that they are part of, and support, the minority Scottish National Party administration. We have a complex situation in West Lothian. Initially, there were perhaps concerns about what the election of those members on a single-issue mandate would mean for their roles on the council and the health authority. However, their mandate has not affected their roles, which is down to the individuals themselves.
So although they stood as single-issue candidates, they were obviously aware that that they had broader responsibilities.
Absolutely.
That is helpful.
The election of single-issue candidates to a board to represent particular communities could distort board matters for the duration of their membership. That is not to say that such board members could not develop wider interests, skill and expertise and contribute more fully. However, at the point of their election, matters could be distorted.
Would single-issue candidates be an obstacle to the change that is necessary? Would their election be detrimental to progressing health care?
We did not intend to imply in our submission that that would be the case. However, there is a risk that single-issue candidates could distort the election process because of strongly held feelings in a community or board area about a particular issue. That situation could change the dynamic and deter people who might otherwise have stood and been elected.
I understand. My final question is one that I have asked before. You will know that all councillors are basically equal, at least from the payment point of view. How would a directly elected member who was paid only for their bus fares feel if they were sitting beside an appointed councillor member who was paid for doing the same job? Would that be fair? How would it work?
At the most recent council elections, the decision to remunerate elected members was intended to ensure that a wider range of people would stand as candidates and be elected to councils. There are sometimes issues with volunteers. For example, if someone is a carer, support care must be provided to allow them to get out and participate in the life of their community, and—this is particularly important for someone on a low income—essential costs, such as bus fares and lunches, must be covered. It seems to me that it would be fair to look at such issues across the board and to treat everybody in the same way.
I am really just asking what your view would be if half your councillors were paid and half were unpaid. How do you think they would feel about that? They would all have the same responsibilities and be expected to give the same commitment. In fact, they would all have a democratic mandate, rather than just being appointed. How would that situation affect morale?
There is a good tradition of volunteering, and people give a lot of their time now. However, you are right that people would take a different view. You would have to be careful to guard against that.
What do other witnesses think?
I speak as an elected member, but COSLA has not discussed the issue. However, it might become a problem because a directly elected member of a health board should get the same recompense as somebody who was appointed through the council system. It is probably more incumbent on us to ensure that directly elected members are looked after because they could have more training to do than an elected member who comes through the council system, as they would have access to in-house training in their council. A member of the public who was elected to a health board might have to put more time into getting up to speed on the issues, particularly if they were a single-issue candidate, because they would obviously have to vote on more than that single issue, and would need training and expertise to be able to do so. Remuneration must be considered.
We do not want inequity between those who are remunerated and those who are not; neither do we want lack of remuneration to be a barrier to those who are considering standing as a candidate. We support equality around remuneration.
The clerks have passed me a copy of the policy memorandum to the bill, which states, under the heading "Membership and Accountability", that
That is not what I read.
The forthcoming regulations will distinctly not say that. Dr Ian McKee and I picked that up at the Subordinate Legislation Committee.
I am obliged to hard-working committee members who sit on other committees—the Subordinate Legislation Committee shines again on the details that we need.
My understanding is that such members will not be not paid.
Thank you.
The other issue is that elected members could be sacked by the minister.
I am obliged to Subordinate Legislation Committee members, who will scrutinise the draft regulations.
I direct a supplementary question to Councillor McColl, but others witnesses might wish to respond as well.
I think that you are speaking about two different avenues. The directly elected person has a direct mandate from the electorate to be on the health board, but a councillor also has a direct mandate as an elected person, although not necessarily in relation the health board. However, such a councillor certainly has responsibility for many health issues, as we have just heard. More and more often, matters are being dealt with jointly by health boards and councils, with more joint accountability, involving more projects—around, for example, "The Road to Recovery, "The same as you?" and "Equally well"—and legislation. For many such initiatives the money comes via health boards, not councils, although councils and elected members are responsible to their communities for helping to deliver the policies. I suppose that we have a mandate to be on a health board because—
I am not questioning that mandate, and I agree whole-heartedly with your proposition. My question is whether it helps the governance of a health board if councillors—whose legitimacy you have just explained very eloquently—are confronted by persons who might make a different claim because they have an explicit mandate. Does that not create a tension?
I do not think that it creates any tension. We have come across the same situation with national park authorities, to which councillors are appointed and other members are directly elected. Having been a member of one of those authorities for four years, I saw no such tension whatsoever. The idea is that everyone is there to work for the good of their community, regardless of the avenue through which they have been elected. That is the overriding consideration, and I do not think that there is a tension.
There might be a slight confusion in the eyes of the public, who will not recognise that there are two different types of councillor on boards. They will think that all councillors are there on the same ticket. They will not discern between councillors who have been directly elected to a board and those who have been appointed to it. I am not challenging your view that all councillors will represent the people, but the public's perception will be that they all have the same mandate. They will not notice that different electoral methods have been used.
Yes, but I do not think that that is a problem. At Holyrood, there are directly elected members and list members. The public do not think any less of a list member than they do of someone who was elected in a first-past-the-post system.
Come, come. List members are elected at the same election, on the same day and for the same purpose as constituency members. There is no connection between the situation that we are talking about and the situation at Holyrood. Such an analogy could be drawn if list members were elected in a different place, in a different vote and on a different mandate from constituency members. If list members were elected at a different time and for a different purpose, the Parliament would be very different.
Possibly. Okay.
I make the observation that the scenario that we are considering would not be a new one. In the past, single-issue candidates have been elected to the Parliament and to our council—
That is not the point. There will be two groups of people on health boards with the label of councillor. Councillor A will have been appointed to the board and councillor B will have been directly elected to it by the public for that specific purpose. Ross Finnie is quite correct. There will be two types of councillor on boards for different reasons and with different mandates. The public will perceive that they are all councillors; in that regard, there will be public confusion, which will not be good for councillors.
The point that I was about to make was that when people phone up a local elected member, they will not think about whether that person was elected on a single-issue ticket; they will simply pass on to them the issue that they are concerned about.
We will leave the discussion there.
Again, COSLA did not take a position on that, but my view is that we should try to engage 16-year-olds. As has been said, a 16-year-old can go off and fight a war for us, so I think that they should be able to vote in health board elections.
What about the date of the elections?
It would help with the issue of perception that you mentioned if they were held on the same day as council elections.
I agree that holding the elections on the same day as council elections would ensure the maximum voter turnout and would avoid apathy. That would make a lot of sense. We have not taken a view on the extension of the age range.
We did not take a view on the age range. We think that health board elections should be held every four years, in line with local authority elections, but obviously there is a lesson to be learned from what happened in 2007, when elections to the Scottish Parliament coincided with local authority elections, which created confusion. We support elections being held every four years, but we do not have a specific position on 16 and 17-year-olds being able to vote.
Will extending the franchise to 16 and 17-year-olds and holding health board elections on the same day as local authority elections not cause confusion, as the franchise will be granted at a different age for health board elections?
Perhaps by that time 16-year-olds will be able to vote in local authority elections.
Oh, I see—you have a hidden plot.
A point about administration was made in, I think, South Lanarkshire Council's submission. When a register of voters is established, a mark is made on it to indicate whether someone is 16. Do you want to comment further on that?
Very briefly, please, Mr Stevenson.
That is a technical issue to do with the running of elections, which would need to be arranged properly.
I thank all the witnesses for their evidence.
Good morning, everyone—or should I say good afternoon.
There is a contradiction at the heart of the bill between what the public think it is about and what it is really about. When the public see the phrase direct elections in the title of legislation, they think that it is about local accountability and the capacity to change policy.
Will you comment first on the New Zealand example? I accept some of your points about the national aspect of the health service. However, in New Zealand, people have been able to accommodate such issues in an agreement.
With regard to Unison's evidence, my question is where we draw the line between local and national issues. You and I might agree that hospital car park charges are a local issue; however, the Cabinet Secretary for Health and Wellbeing made it into a national issue. John Swinney cannot do that in relation to local government. As you have already pointed out, ministers can sack health board members; John Swinney cannot do the same in local government.
Liz, that was thrown at you.
I have to admit that I do not know about the national-local relationship in New Zealand. We support the view that the BMA expressed in its evidence. The evidence from New Zealand suggests that elections have not significantly contributed to the democratisation of the health service. There are concerns about falling voter numbers and that the same people end up being elected to health boards. We note that evidence, but I am afraid that I am not aware of the agreement that you mentioned.
I am really struggling with the issue. When the Health Committee in the previous session considered the matter, we heard evidence that an agreement between the Government and the health boards would set the parameters and clarify how things would work. Could an agreement between central Government and local government not be set up in the bill? There will always be a degree of tension, but professionals can work out ways to address the issues.
The issue is the extent to which the public wants variations in health standards. That relates to your point about local factors. What factors would you want to be different in, say, Argyll and Clyde or Highland? I do not know the answer, but I think that it would be difficult to have such differences. People want the same standard of treatment from the national health service regardless of where they are located.
They want the fundamental standards to be the same, but allowances must be made for local factors. For example, the health boards in Highland and Argyll and Clyde cover massive areas. Given our earlier discussion, it cannot be beyond the wit of professionals in the Government and elsewhere to sit down and set up agreements between the health boards and the Government.
With respect, that could be done within the existing system. Elections are not required to bring that about. There could be an agreement between the health minister and the health boards as to the division between decisions that health boards can take and decisions that are appropriate for the minister to take. That does not require legislative change.
Before we move on, I ask you to consider making a distinction between national standards—we accept that there should not be a postcode lottery—and the method of delivery. Local people tend to raise issues about how things are delivered in their area. That includes issues to do with remote and rural areas. In my view, the concern is about delivery. Do you agree—you probably do not—that democratising the boards is about the delivery of services?
I do not disagree that the concern is about delivery. However, the issue is not democracy but something that Mr Finnie mentioned—the perceived effectiveness of the boards. Changing the status of members and making them elected rather than appointed will not change the deficiencies. That is the issue.
Mr Scott can comment on that in a moment. Before he does that, I welcome to the public gallery a contingent of Vietnamese politicians. I hope that this meeting does not put them off having committees. We are on our best behaviour. I welcome our visitors to the Scottish Parliament and to the Health and Sport Committee.
We strongly support the principle of direct elections because we think that they bring a good method of scrutiny and accountability to the governance of health boards. Democracy is the best method that we have come up with so far. The public must be able to decide whether the services are being delivered locally in the way in which they want them to be delivered. Services such as maternity and accident and emergency services are crucial to local people, and we think that local people should have some input into the decision-making process.
I have a short supplementary question. I do not think that the approaches that have been mentioned are necessarily mutually exclusive. I am interested to get more detail, because I care about independent inspection in the health service for other reasons. Which vehicle do the witnesses think would be appropriate to ensure that health boards are truly independent of ministers? Which would restore public confidence?
In his statement on scrutiny, John Swinney proposed that NHS QIS, parts of the Scottish Commission for the Regulation of Care and parts of the Mental Welfare Commission for Scotland should join to become an independent body. The bit that is missing is accountability review by ministers, which is the bit that needs to be independent. That function needs to be built into an independent scrutiny body that is accountable to Parliament and scrutinises the performance of health boards, not only on clinical issues but on the same issues that are scrutinised in local government. Under the best-value regime in local government, councils are asked whether they are continually improving and whether they are fit for purpose. The same question should be asked—independently—of health boards. That could be done by Audit Scotland reporting to a scrutiny body.
That is interesting. I would like to clarify one point. My understanding of NHS QIS and the proposed new body is that they would still be accountable to ministers.
, NHS QIS is actually accountable to Kevin Woods.
So it is not even accountable to ministers.
That is not transparent.
The key issue for you is accountability to Parliament rather than to ministers.
Absolutely.
Thank you. That is helpful.
I am interested in other panel members' views on what we have heard so far. I want to explore the interesting concept of independent advice to non-executive board members and ask Consumer Focus Scotland what it thinks the right balance of non-executive members on the board would be.
No. There are two issues. First, there is the argument for external independent scrutiny, which is good practice in any public service. Secondly, there is the need to enhance the role of the non-executive members so they can challenge the executive members—I agree that it is difficult for them to challenge professional opinion. Our submission suggests that, on major issues, the non-executive members should be able to access independent advice. A fund of money in each health board should be ring fenced for the non-executive members to draw on if they feel that, although they have listened to the advice of the board's experts, they want to take independent advice. That would help them to develop the confidence and the skills to undertake effective scrutiny of the executive members, which is not happening in the way that it should.
Is there not a risk that the dominant role of the executive members has already been established? Non-executive members might not seek such advice because they are already immersed in the administrative culture.
There is a case for reviewing the governance of the health boards to consider the balance and the number of executive members on the board. I have given the reasons why such a review needs to be conducted. I am not arguing that there should be no executive directors on the health board, because it is a national health service and the accountable officer has specific responsibilities, but there is a debate about whether we need to have the current number of executive members on the health board or whether we could use different models. We could perhaps use models taken from local government, such as the proper officer model, in which the officer has the right to be heard, but not to vote. That model is capable of some degree of transfer to the health service.
Of course, the local government model has elected members, which you are arguing against. I would be interested to hear the views of other panel members.
It comes back to the point that we are not comparing apples with apples. Local government is a separate tier of government that is accountable to its local electorate and people; the national health service is, as it says, a national service that is accountable through ministers to Parliament. The bill will not change that accountability. The difficulty is that the public will think that, as a result of these direct elections, accountability will change. It will not, the public will find that confusing and I am worried that it will lead to even greater disillusionment with the health service.
Before I let Ross Finnie in, I wonder whether the other witnesses will defend direct elections in the face of Mr Sinclair's robust rejection. We have heard from Mr Scott; does Mr McAndrew or Mr McGuigan have anything to say?
Voluntary Health Scotland supports the general principle of direct elections as a means of increasing the public's democratic involvement in health delivery. Direct elections will provide patients with a stronger voice on health service delivery decisions and open up a channel for hard-to-reach or excluded equalities groups such as young people not in work or training, homeless people and isolated older people.
How do you refute the evidence that suggests that those are exactly the people who do not put themselves forward for such roles and that the positions are filled instead by the usual middle-class professionals and people who have connections to the NHS?
Perhaps we are not approaching those people in the correct way.
Direct elections are important, because the general public should be involved more. In the past, too many decisions have been taken without any consultation with the general public, and this move will give people more involvement.
I listened with great interest to the suggestion that there is greater concern for equalities in an appointments-based system than there would be in a system of direct elections. Elections at least create the opportunity for people from all backgrounds to become involved.
You might not have this information, but might we have a breakdown of the percentage of disabled people on boards, and on health boards in particular?
I tried to get a breakdown of the numbers of disabled people on health boards, but was unable to get it from the Office of the Commissioner for Public Appointments in Scotland.
We might see whether we can source it because it would be interesting to committee members.
Those last two pieces of evidence illustrate graphically the difficulty of where we are. Mr Scott argues cogently for a different form of representation, but I am not entirely clear that any of us—I include myself—are clear about where we are going in relation to the question that we are being asked.
Our position is quite clear: electing rather than appointing people will not, per se, remove the deficiencies of governance that you have mentioned.
Opening the system up to democracy will fundamentally change it. Of course, that will not happen overnight—it will take some time—but the public's perception of health boards and their views on what they want from them will change over time. It is no bad thing to let the light of democracy into the decision-making process. After all, although doing so will fundamentally alter things, we will still want national standards. There is no problem in that respect.
But can we not have both approaches? As I said, they are not mutually exclusive.
I do not think that they are.
I certainly agree with the approach that Ross Finnie has taken in his question; he analysed the difficulties quite well.
So the first question is about the three pilots and the second is about expenses for carers. If we can start with—
My question was about basing pilots on the RCN model.
As the lady from the RCN pointed out, the bill has been presented very much as a response to the question of how the widest possible range of patients and local communities can be involved more in the health service and whether direct elections can contribute in that respect. The first question is the more important and certainly provides a very good argument for testing different models. Rather than putting considerable sums of money into piloting elections, it could be used to develop public and patient involvement in other board areas in different ways. We would definitely support that.
We have had quite a long meeting, but I do not want to put words in your mouth, Mr McAndrew. Can I take it that you would not agree with that view?
I agree with the RCN's pilot proposal. It is a very good idea to have controls, instead of just doing the two pilots as proposed in the bill.
I have not been able to consult my membership on that, but my personal view is that I do not see why the other things could and should not be done to increase public participation.
I want to move on to the funding issue.
There is a particular issue about public appointments and the fees that are paid to those who serve on public bodies. Most disabled people cannot benefit from those fees because they are clawed back by the benefits system. Most disabled people put themselves forward in the knowledge that they will be sitting alongside people who are being paid quite generously for giving their time to the public body, but that they themselves will not end up any better off for having served on the board. Disabled people have to live with that at the moment.
I take it that that is your position too, Mr McGuigan.
Yes.
Mary Scanlon, do you have a final point? Time is running on.
I have a point that should be raised. It is from Consumer Focus Scotland. There is a danger that having elections
It is fair to say that elections are not cost neutral. The money has to be found from somewhere. That is self-evident.
Yes, but my point was about health boards being less willing to consult and involve local communities because the assumption would be that elections—
All our public service organisations have to create a culture of engagement with the public. They should be doing proper consultation and they should be proper customer-led organisations, whether they are in local government or the health service.
Are you saying that the elections might be seen as a substitute for proper involvement?
That is a possibility.
Okay. My second question is for Phil McAndrew.
I certainly hope so. The comment to which you refer was not about the expenses and so on that board members would receive, but about the total cost of running the elections. The concern is that it should be beneficial in the medium to long term.
We did not remove it.
We are a bit confused about that just now.
That is a difficult question to answer. I hope that excluded groups will be able to find some funding—obviously not from the health boards—or backing so that people can stand for election.
For the record, convener, the Subordinate Legislation Committee did not remove the provision on expenses. It recommended that the Health and Sport Committee's attention should be drawn to the issue.
I do not know the correct position. We will try to clarify it, but I know that it will not have been the Subordinate Legislation Committee. We will find out what the position is on remuneration.
The minister made a proposal to the Subordinate Legislation Committee that we said we would draw to the attention of the lead committee. It is a policy matter for this committee.
I do not want to get into a debate about it just now because there are conflicting views. We can find out; it is not rocket science. We will get that sorted out for our next meeting.
Meeting continued in private until 12:43.