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Value of elected health posts unclear, says report

THEY were supposed to make the NHS more democratic and give ordinary people a greater say in the way the Scottish health service is run.

But a pilot of health board elections found most people did not vote and some candidates who won seats became frustrated at how little they could achieve.

An official evaluation of the experiment, quietly released by the Scottish Government, reveals there was tension between newly elected health board members and long-serving appointees. The latter "expressed concern that elected members became too involved in operational matters" and some felt they asked "daft laddie" questions which took up too much time.

In the end the report finds the more disruptive newcomers were tamed. It says long-serving health board recruits "perceived the new cohort as developing what one executive director referred to as a 'social norm of non-executiveness' – a set of informal expectations about how it was acceptable (and unacceptable) for themselves and other non-executives to behave".

The evaluation goes on to say those elected still asked critical questions at board meetings but the report has raised questions about what spending at least £11m to roll out health board elections across Scotland would achieve. Pilots were held in Fife and Dumfries and Galloway.

Dr Charles Saunders, deputy chairman of the British Medical Association in Scotland, said: "Elected members tell us they feel their role is to effectively rubber stamp decisions made by executive members of the board, rather than pro-actively involve themselves in decision-making. It is doubtful that, as a result of these elections, the average person in Fife or Dumfries and Galloway feels there is greater transparency about decisions made regarding healthcare services in their local communities."

In Dumfries and Galloway, following the elections in May 2010, a row blew-up about whether the newly elected members could hold surgeries where residents could talk to them individually and raise concerns. The board decided this was not allowed.

Alis Ballance, a Green Party candidate elected in Dumfries and Galloway, held surgeries anyway and was criticised by the chief executive in the press. Ms Ballance, who stood down from the board in 2011, said the atmosphere for those members who did not toe the line was unpleasant. She said: "What they expected us to do was rubber stamp what was put in front of us and everyone did except me and that got me a lot of hassle.

"They should be rolling out health board elections, but they ought to be doing it very, very differently."

Tommy Sloan, who also won a seat in Dumfries and Galloway, said patients were frustrated they could not come and talk to him about issues. He added: "I believe 100% in elected health boards, but I think we should be more accountable, by making ourselves available to the public."

He did not feel NHS Dumfries and Galloway made any different decisions as a result of the health board elections, although more objections to decisions were noted.

Other elected members feel they have made an impact. In Fife, campaigner John Winton believes plans to centralise end-of-life care services were reconsidered because elected members spotted them in a finance paper and questioned the money-saving scheme. He said: "Officials and executives are wary about a lot of us and learning they have to get along with us."

Arthur Morris, a retired surgeon who won a Fife seat, also believed elections were valuable. "I have been heartened by the talents people have and the things they have brought to meetings," he said.

Professor Peter Donnelly, principal investigator of the evaluation commissioned by the Scottish Government, attributed some problems experienced due to health boards being accountable to the population and the Government. He praised the Scottish Parliament for the way it looked into the idea.

A Scottish Government spokesman said: "We are considering the evaluation of direct elections to health boards and will outline next steps in due course."

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