19 December 2008

Politicising Health Boards?

It seems that the main point of contention regarding the Government's plan to hold formal elections to Health Boards is that you might end up with a politicised NHS.

Of course, that elides the fact that responsibility for the NHS lies generally with Nicola Sturgeon, but let's leave the fact that health policy is (like most things, actually) by its very nature political to one side.

Regardless of whether or not health policy is political, what about health boards?

Board Members are appointed by the Minister in charge. A look at the Scottish Government website will see appointments being confirmed by Susan Deacon, Malcolm Chisholm, Andy Kerr and Nicola Sturgeon. So politicians - elected politicians - are appointing the Borad members. Let's consider: the people elect the MSPs (some of them are even responsible for getting the Minister/Cabinet Secretary in question into Parliament). The MSPs elect a First Minister, who proposes Ministers to Parliament. MSPs then vote on those Ministers being appointed, and the FM (elected to and by Parliament) then assigns to the Ministers (elected to Parliament, proposed as Ministers by the elected FM and confirmed by Parliament) various portfolios. These elected Ministers then appoint the Board Members. So as we're electing the people who appoint the Board, why not elect the Board?

And Councils have individual representatives on the Boards. Guess who they are? Councillors. Guess what's special about Councillors? They're... politicians, and elected ones at that. So Members are either elected to a local Council which then appoints them, or their appointed by people who have been elected to Parliament. So the process by which Board Members take thir positions is political. Why is holding an election for those posts more political than having them appointed by politicians?

Then there are individual Board Members. Now, before I start this section, let me preface it by stating that I am not for one moment suggesting that they have less of a right to be involved, or that they are less qualified. That is not the case. What I am arguing is that they are political, and that if they can be on a health board, why would electing them politicise that board? Isn't it already politicised to an extent?

Take NHS Ayrshire & Arran. Its Vice-Chair is Rita Miller. Rita Miller was a South Ayrshire Councillor. And the Labour candidate in the 2000 Ayr By-Election. And the Labour candidate for Ayr in the 2003 Scottish Election. She currently works for Sandra Osborne MP. She's political.

How about NHS Greater Glasgow & Clyde? One of its members is Rani Dhir. She is also a member of the Calman Commission. Granted, she's an apartisan member, but can she really be apolitical if she's on the Calman Commission? How exactly would that possible? And one of its former members is Maire Whitehead. The SNP candidate for Hamilton in the 1983 Westminster Election, and for Glasgow Cathcart in 1997, 1999 and the 2005 By-Election. Political? Hell yes. On the Health Board? Not now, but she was.

Then there's NHS Highland. Its chair, Garry Coutts, was the Highland Council representative, but resigned his Council Membership in 2004 (he was Councillor for Beauly & Strathglass, if you're wondering) precisely to take up the post. Then there's Dr. David Alston, who is not the Highland Council representative, but is on the Board as the Chair of the North Highland Community Health Partnership. He's the LibDem Councillor for the Black Isle, and the Budget Leader on Highland Council. And there's also Gillian McCreath, who it seems stood down as a Highland Councillor in 2007, having previously been the SNP representative for Westhill & Smithton. I'd say those three are going to be somewhat political. Coutts may have been an Independent, so may be apartisan, but that doesn't mean that he was apolitical.

One of the NHS Lothian Board Members is Cllr Iain Whyte. He's not the City of Edinburgh Council's actual represenative, but still the Tory Councillor for Inverleith on there. He was the Tory candidate for Edinburgh North & Leith in 2007, having been the Westminster candidate there in 2005. He stood in Edinburgh South in 1999, and Edinburgh West in 2001. Yup, he's political.

Finally, despite NHS Shetland having its own Council representative, its Chair is Betty Fullerton. Mrs Fullerton is also a member of the Council, for Shetland Central. Again, apartisan, but not necessarily apolitical.

As I said, none of this should take away from the work or ability of Miller, Dhir, Whitehead, Coutts, Alston, McCreath, Whyte or Fullerton. All I'm saying is this, why is it OK to have them appointed to their posts by Ministers, but not to have them elected by the people? Why is it that it's OK to have them involved, but that the election to a Health Board of someone like former GP and MSP Jean Turner, or health campaigner Julie McAnulty would be some sort of disaster for NHS management?

The answer is that it wouldn't be a disaster. They have much to add, just like the politicians who are already on the Boards.

And would the fact that they are 'single-issue' campaigners be a problem? Well, health is considered a 'single issue' (with many sub-issues contained under the heading, but still a single issue). And it was important enough to get Jean Turner a term in the Scottish Parliament. So single-issue candidates are nothing new and aren't necessarily a bad thing (unless their single issue was the restoration of the death penalty, in which case why would they stand for a health board?).

So the opposition has a flawed case. It's based on the fear of creeping politicisation of bodies whose members are appointed by politicians, and can be politicians themselves. It's also based on the proposed threat of single-issue candidates when the Board itself is a single issue entity. So criticisms of the proposal are criticisms of the status quo, the appointments process and the purpose fo the institutions in question.

By contrast, the proposition is simple: here is an issue that affects everyone. Here is a body that controls has a major play in that issue in a given area. Here is a method of ensuring that its members are accountable to the people who have the most to lose from them screwing up, and the most to gain from them doing well. So we have a problem: health boards aren't acocuntable. A reason why that's a problem: the performance of the NHS can affect us all at some point in our lives, and yet we have no way of ensuring that they work in our perceived interest (how, for example, is closing an A&E ward in anyone's interest). A solution: elected health boards. A reason why it could be a solution: it makes Members directly accountable to us.

For me the one bone of contention is this: we need to know just what an elected Health Board would actually do. Basically, where do the Health Boards begin, and central policy decision-making structures end?

Answer that, and the Government has a proposal that I'm 100% on board with, while the Opposition needs to re-think just what they opposing and how they're opposing it: you can't worry about politicising the already political, and you can't say that single-issue candidates have no place on a single-issue body.


Advanced Media Watch said...

Hi J. Arthur MacNumpty, enjoyed reading your "Politicising Health Boards"

I think and hope over time Nicola sturgeon will make Health boards more accountable to the Scottish people than to politicians, however on saying that parliament must have some leverage over the NHS because of the huge sums of our money that the NHS spends.

Also i would like to see more spent on resources helping the sick than going to hospital managers.

The SNP are on the right track but by my reckoning it will take at least a decade to put right the 10 years of Labour/Lib mismanagement of the NHS on Scotland.

Coatsie's mate said...

It's just the usual trite from a bourgeoise nationalist party.

Will said...

AMW, thanks for that, and you're right that Parliament does have a massive oversight role to play in the NHS. What it's now down to the Government to do is spell out where lines will be drawn between what the board does and what the centre does.

Coatsie's mate, firstly, is 'party' a feminine noun in English? Does English even have feminine nouns?

Secondly, right now the health boards are populated by the Establishment, and its members are formally selected by Government Ministers. Who are pretty Establishment-ey, whatever party they're from, let's be honest. These plans open them up to the people, all the people, whatever their background. So the working classes will have more of a say in who is watching over their local NHS than they currently do. And that is anything but bourgeois.

If you want to maintain the status quo, then you have to accept that the Establishment has the health boards in a headlock. Is that what you want?

Julie McAnulty said...

Hi will,

Sorry I missed this post; I've been off doing other things. Of course I agree with you; we in Lanarkshire have spent three years fighting off one of the most blatantly political decisions about Monklands hospital. There are also commercial interests at play in the boardroom; when SERCO tried to take over Harthill Health centre, it came out that two members of the health board had connections with SERCO. Having direct elections would mix things up a bit and break the hegemony of the party hacks that are on the health boards just now.
Btw, just done a post on Jamie Hepburn and PFI if you fancy a squint..