Put local councils in control of Scotland's health, says think tank

It's a radical rung in its Holyrood manifesto which demands a new commitment to place more power locally.

The non-party think tank says the proposal could "easily" be piloted in areas such as Fife, Dumfries and Galloway and the Highlands and Islands, where councils and health boards have identical boundaries.

They say: “Councils should take over their responsibilities and be able decide how best to meet the healthcare needs of their local population.

“It would also help ensure better cohesion between social care and health care."

The 16-point strategy published on Thursday also says local authorities should have full control of council tax and business rates to local authorities, without any Scottish Government interference.

It also suggests a bonfire of quangos, with their functions either taken on by government departments, independent bodies or councils.

They say the government-funded network of executive and advisory non-departmental public bodies are "not sufficiently accountable" to the Scottish Parliament or the Scottish people.

In 2013, the Scottish government abandoned the idea of directly elected health boards, an idea introduced by ministers to improve public confidence in the NHS. But a pilot of the move resulted in a low turnout.

A Reform Scotland spokesman said: "The issue for Reform Scotland is that there is no accountability in health boards. Our issue is the board of trustees is not responsible to anyone.

"If you consider that local authorities have responsibility for social care already, and we are talking about a closer working with social care and health. There is no real reason why it couldn't work.

"The advantage is that it would create a situation whereby they are accountable to an electorate for their performance, whereas at the moment the only accountability there is is through the health secretary."

The Scottish Government has plans in place to integrate health and social care.

Local authorities and health boards are joining forces to deliver more care in the community from 1 April to ease the pressures on Scottish hospitals struggling to cope with a growing elderly population.

But Audit Scotland has warned the new joint boards could put patient care at risk due to staff confusion over strategy and difficulties agreeing budgets.

And Reform Scotland suggests that the governance and strategic planning of the boards should be taken on by local authorities, who would have control over spending, with NHS budgets ringfenced.

"The argument is about being more responsive to local needs and creating a more responsive health service," the think tank spokesman.

It forms part of a plan which it believes can be delivered in the next Scottish parliamentary term which aims to suggests devolving more power within Scotland as Holyrood gains greater powers including further control of taxation.

In the 2007 election, the SNP pledged to introduce elected health boards, citing concern that health authorities had not always properly listened to local views when considering changes to services.

Pilot elections were held in Fife and Dumfries and Galloway in 2010, in which 16 and 17-year-olds were allowed to vote for the first time.

But turnout was low, with fewer than one in five voting in Dumfries and Galloway, and one in 10 in Fife.

A Scottish Government spokesman said: “We do not agree with Reform Scotland's suggestion or assessment. We are taking forward the integration of health and social care, funded by an additional £250 million, so that local authorities and NHS boards work together more closely.

“Our plans for council tax reform were set out in full earlier this month. Under these plans, the rates paid by those in the four highest council tax bands (E, F, G and H) will be adjusted in a move that will generate £100 million a year.  The additional revenue will be invested in schools through future local government settlements.”