Plans for health boards to be directly elected received a mauling today by MSPs.

Plans for health boards to be directly elected received a mauling today by MSPs.

MSPs on Holyrood's health committee gave their support to pilot health board elections in two areas But the go-ahead was heavily qualified - they said the results of the pilot schemes should be studied before any decision was taken to go further.

While there was a need to improve public accountability, no "overwhelming" case for direct elections had been made, nor was there "widespread enthusiasm" for the idea, the committee said.

And in giving the green light to the pilots, the committee said the results of these should be compared with other schemes to improve public involvement.

The SNP made health board elections a manifesto pledge, and the draft legislation backed today by the health committee will set up pilots in to yet-to-be-chosen areas.

The idea of direct elections has the backing of unions but has found little support from health boards themselves.

Under the Scottish Government scheme, boards will have three types of member - a chair and other members appointed by ministers, local councillors appointed by ministers, and members directly elected by postal ballot for a four-year term.

Sixteen-year-olds will be able to vote in the elections, the councillors and directly elected members will together form a majority, and the pilots will run for up to seven years before being extended nationwide.

But the committee voiced concerns over security aspects of the postal ballot, and said the Scottish Government may have to reconsider an all-postal ballot if the cost and logistical implications of addressing these concerns are to great.

The proposal for letting 16 and 17-year-olds vote has been opposed by the Electoral Commission and today's committee report voiced "serious concerns" at the proposal - in particular because this may require records to kept of 15-year-olds.

The committee also called for a tougher Parliamentary approval process if the pilots are to be rolled out.

And health secretary Nicola Sturgeon should also change the name of the Bill.

"Given its title and drafting, the passing of this Bill by the Parliament could be interpreted as support for the principle of direct elections to health boards, rather than simply for the introduction of pilots to test that principle," said the report.

"The committee believes that this is regrettable, as the purpose of pilots is to gather evidence on whether the policy will work.

"The committee asks the cabinet secretary to consider whether changing the title of the Bill would be appropriate."

Health committee convener Christine Grahame said: "While we agree direct elections to health boards have the potential to improve public participation and involvement, we have not seen and heard enough evidence or enthusiasm to convince us that direct elections are necessarily the most effective way to achieve this goal."

"The results of the pilots for direct elections should be compared with the outcome of these additional pilots and developments in boards where no initiative takes place and the results published.

"That way we can make a fair assessment."

Liberal Democrat health spokesman Ross Finnie said: "I am pleased that this report makes it clear that Parliament should not be asked to agree to the principle of direct elections to health boards before pilots have been tested and evaluated.

"Liberal Democrats believe that direct elections are not the best way of improving health board accountability.

"That is why we have called for alternatives like getting local councils more involved in running local health services."

Ms Sturgeon said: "I am pleased that the committee has agreed with me that pilots of direct elections to health boards should go ahead and I have always emphasised that this must be done and analysed before wider roll-out.

"We are committed to addressing the specific suggestions raised by the committee."

Many people felt there was a "democratic deficit" in health board decisions and the Bill will put the public "at the heart of the decision making process", she said.

"I believe wholeheartedly that this will empower communities and individuals whose taxes, after all, pay for our health service."

Dave Watson, Scottish organiser for the Unison union, said: "Although the committee's support is conditional, their backing for the pilot projects proposed in the Bill is positive.

"Since it was created in 1948, the NHS has not been directly accountable to or engaged with the public."

Tory health spokeswoman Mary Scanlon said: "Barely a quarter of those who responded to the consultation were in favour of these elections, and only four of Scotland's 32 councils back the plans.

"A case has not been made for direct elections to health boards.

"Scottish Conservatives have supported pilots but only on the condition that a thorough, independent evaluation is carried out on completion and that the issue is fully debated in the Scottish Parliament before any roll-out is contemplated."