Democracy or bureaucracy?
Are there any circumstances in which democracy is a bad idea?
I freely confess that question is posed in a deliberately provocative form to stir you out of your Festive shopping torpor.
Try again. Is it possible, credibly, to argue against the introduction of direct elections to an organisation which spends public money and provides a public service?
Sundry Scottish politicians are about to try. Holyrood's Health Committee has published its report on plans to introduce an element of direct elections to health boards.
The response? A discernibly grudging maybe. For why? How can elected Parliamentary politicians quibble at the extension of democracy to the NHS?
The formal answer is that, while there is a need to improve health board accountability, the evidence gathered does not presently point to direct elections as the solution.
The informal answer from some? That direct elections could provide a further blockage in a service already beset by bureaucracy as Nimbies with zero expertise but a finely honed sense of grievance pursue their own agendas.
(For the avoidance of doubt, that last sentence is also deliberately provocative - summarising the trenchantly held views of others.)
But how to argue against democracy? With delicious irony, the Liberal Democrats - who carry their elective principles in their title - have a shot.
They say broad accountability might better be enhanced by involving local authorities more closely in health boards.
At the very least, say they, let us have full and thorough evaluation of pilots before full implementation.
Such is the conclusion of the committee who urge Ministers to make clear that they will proceed cautiously, if at all.
More generally, we need to determine the purpose of health boards first.
Are they expert bodies challenged by central government to provide health care to a common template but building upon local circumstances?
If they are, then local direct democracy may not be merited. Think of it this way. Would you want decisions about your surgical treatment taken by clinicians - or by single transferable vote?
Then translate that answer into the generality of health provision.
Alternatively, are health boards channels for the practical expression of public opinion into hospitals and NHS services.
In which case, direct elections are entirely valid.
In short, should health boards lead or follow.
As ever, there are arguments to be advanced on both sides.
It strikes me, however, that we are somewhat blurring the core debate by focusing purely or primarily on the method of choosing health board members.
First, Scotland needs to decide what function health boards serve.
I'd welcome your views. Based, I would plead, upon your experience and observation - not your party allegiances.
I'm 
© MMX~RS~q~RS~~RS~z~RS~32~RS~)
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This comment was removed because the moderators found it broke the House Rules.
Brian, nice to see your plea to leave out party allegiances didn't make it past the first posting.
Some people are incapable of taking on any topic without trying to score cheap political points
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i don't want directly elected health boards.
for anyone to say they don't want health boards to be politicised have i got news for you! you are too late.
why should health boards have district councillors or indeed what do all the district councillors already serving on health boards actually do?
how do you get a job at the moment with a health board? oh yes that will be a political appointment.
I want a health board that is filled by health professionals who work on the board FULL TIME .
come on Brian , name me a person on a health board that does the job full time?
I want a health board who have more FRONT LINE staff that THEY employ (not bank staff,) than they have auditors , managers, spin doctors and executives.
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1 Ex Pat.
One can safely assume you approve of an unelected Prime Minister too ?
Wansanshoo.
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Brian
If I buy my nephew a dumper truck and he mashes it, should the taxpayer bail me out?
Should it be some quango or a democratic body that decides?
Now suppose I buy a tummy tuck on a holiday abroad and it goes wrong should the taxpayer bail me out? Would you rely on an "expert" body of those who receive funding to do these "repairs" or a body representative of your ordinary taxpayer who will have to shell out to pay for the same "repairs"?
I cannot see any point in health boards unless they are democratic oversight. I am happy to leave the destination of the "single transferrable kidney" to the experts but the choice between spending limited funds on palliative care for most or a search for a cure for a few is something that the taxpayers representatives must decide.
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It may have been deliberately provocative Brian, but your comment regarding nimbies with zero expertise but a finely honed sense of grievance who pursue their own agendas pretty much sums up the 129 inmates of Holyrood. Why do people believe that ‘more democracy’ is the answer to problems, when the democracy we have is a shambles thanks to grandstanding MSPs and party squabbling and in-fighting. They set a poor example which was spawned by Scottish local government, and will infect the health boards until they cease to function at all. Please – no directly elected boards, it will be the nail in the coffin of the Scottish NHS.
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Democracy seems to have worked well in the BBC Sports Person of the Year Award. Well done to Chris Hoy, and the tens of thousands from outside Scotland who must have voted for him.
I suspect many of our regulars are upset, however. Not by the result as such, but because they can't accuse the BBC of bias, result fixing, phoneline blocking or any of the other widely predicted (not here, in fairness) scams to get Lewis Hamilton into first place.
Maybe I'm too naive? Perhaps it's a truly monumental and devious scam, to relax and reassure us while they plunder our land, or seas, and take our first-born. Be vigilant, people!
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#1 oh! Pinocchio tell us another lie.
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6. How do we have an "unelected Prime Minister"? Are lessons on the UK constitution and the concept of 'parliamentary democracy' needed here?
As to the topic at hand....let's continue the evolution from public sector-style management to private sector-style management where hospital trusts compete with each other for custom.
Let the patient make their own choice of hospital and where their money is spent - as in the private sector.
Let the hospitals choose their own form of management - as in the private sector.
And, as again in the private sector, watch as the efficient hospitals succeed and grow, taking up the slack left in the market by the inefficient hospitals.
No more social experiments and no more ideological untried theories being forced into practice. Let the market sort it all out with minimal government interference.
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Greenockboy, you missed out #6 from your complaints to the mods.
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Accountability of Health Boards doesn't need that much to improve it. I'm certainly not convinced about elections given the performance of some so-called elected reps I've seen. And we don't need additional bureaucratic stasis around normal operating decisions.
Have the annual reviews of each Board in front of the Health CommitteeThe HB Chair HB Chief Exec and Medical and Nursing Directors ONLY (no camp followers) arrive for a half day full "grilling" in the Committee chambers. The local patient/public involvement reps, the Scottish Government Health Delivery head and the Cabinet Secretary should also attend. Written questions from the public gallery to the HB reps may be allowed in the session on the day.
You can then ditch the current charade of months of scripting and PR visits to newly -painted health centres etc, that currently gets labelled an accountability review.
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This issue is about ACCOUNTABILITY and REPRESENTATION.
Who do the health boards represent and who are they accountable to?
Health boards are currently populated by the so called 'great and good' of society, where by over 50% of board members have very close connections with the Labour party. Health boards have already been politicaly skewed to certain party viewpoint over a whole range of controversial matters.
So it is no surprise that over the recent recent years that health board decisions and actions have been severely criticised by doctor groups, patient groups and by independent health, financial and legal reviews. As a consequence Health boards are not enjoying the best of health at the moment.
So maybe a good dose of REAL DEMOCRACY will do it more good rather than political patronage where the views of Labour party place men and woman have held sway for many a year.
Lets trial the direct elections of health boards to discover what benefits that process brings rather than persist with the current politically tainted system.
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Brian, I think your premise is wrong. We already have democracy in the system. Our MSPs are responsible for the NHS is Scotland. It's part of their remit. It's part of what we elect them to do.
However, I think all parties can be guilty of attempting to shirk their responsibilities.
In this case, the deception of directly elected Health Boards would simply be a way of taking the heat off the people who ultimately are responsible for the NHS - our elected politicians. Health Boards have to take hard decisions based on the limitations placed on them by their political masters. Putting another layer of politicians in the mix will simply confuse people as to who holds the power.
Labour and the conservatives have been getting away with this for years. Privatisation (overt & covert) has been more about taking responsibility for public services away from our elected politicians than about efficiency or the free market.
High heating costs? It wiznae me...
Buses not running to time? It wiznae me...
New schools not fit for purpose? It wiznae me...
Crumbling roads? It wiznae me...
Prisoners escaping? It wiznae me...
Do we want to add another. No hospital beds? It wiznae me...
Health Boards should simply be a layer of management in the NHS, nothing more or less. Getting the right people to manage the NHS is not a matter of democracy, it's a matter of qualification and ability.
If the SNP don't think the correct people are in place (and they may well be right), they should spend the time and energy to create a new structure that will encourage people to apply who can perform the role effectively.
Some poor decisions have undoubtedly been made by Health Boards in recent years. But, would self-serving politicos (do they already exist in Health Boards?) make the NHS in Scotland any more joined-up?
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Brian
"Based, I would plead, upon your experience and observation - not your party allegiances."
Well RE in #1 ignored that pretty fast!
Actually it's difficult to see why the two most expensive (and extensive) public services - Health and Education should be handled differently, other than for historical reasons.
The NHS was originated at a time when "central planning" was seen as the best delivery approach, and developed from a situation where all the hospitals had been placed under government control during WWII.
Education (like pre NHS Health) had also traditionally been provided at the local level - in the late 19th century via elected School Boards - in 1929 incorporated into local government.
Instead of piece-meal tinkering, it would seem to make sense to debate the structures of the NHS and Local Government simultaneously.
We might develop something like Regional Councils with a remit purely to manage centrally funded areas like NHS and Education, while real local councils raised their own funds to run locally determined functions.
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We all know the Lib Dems are anti-democratic really, that is why they oppose a referendum on independence,
"Independence by the back door" and all that garbage. It should be no surprise that this anti-democratic party is staying true to form.
As for this simplistic idea of resorting to the market - what a time to bring up a completely untried, theoretical ideal and force it into practice in one of the most important PUBLIC SERVICES around!
If you want to make healthcare into just another service industry; where you have no right to be treated for even the most basic injuries and disease then, by all means, go ahead - but don't pretend you can maintain the PUBLIC SERVICE element while doing so.
What happens to those "inefficient hospitals" in remote areas like the Highland or the South-West which "fail"? What happens to the population served by them, do we try to redirect them to Stirling or Ayr or similar! Or does this mean that those remote hospitals need not compete in this notional 'marketplace'?
This sort of Blair-Brownite nonsense has completely failed in England, which is why they are reversing many of the marketizing reforms as we speak; the last thing we need to do is copy costly IDEOLOGY-DRIVEN mistakes made elsewhere.
Direct-elections to healthboards have possibilities, the key is making sure that a designated number of particular services remain in each area.
Otherwise we might as well all join Expat in these market-based delusions.
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RE -11. you have surpassed yourself today. what a load of nonsense !!
so what would i or countless others do ?
none of the kind insurance company's will touch me with a barge poll for life insurance never mind health insurance , as it stands, which would be the end result if we were to follow your plan.
very interesting you think it is OK to spout forth on this subject whilst not in the country and therefore not affected by your very silly comments.
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17. Patsymkirkwood, market forces are an "untried and theoretical ideal"??
LOL
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Of course we should have a significant proportion of elected members on Health Boards.
What we have had till now is a huge proportion of faithful party servants on an expenses gravy train who have been totally compaint and unlikely or unwilling to rock any boats in case they get removed from their comfortable positions.
The management certainly don't want any prying elected members interupting their complacent organisations either. Would the tradgedy at the Vale of Leven have been concealed had there been an elected health Board? I don't think so.
The opposition to elections to Health Boards is, like everything else, under attack because it is an SNP initiative.
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Instinctively a directly elected health board is right but bearing in mind the civil service dislike of the elected element in government - just look at their disdain for local government - the likelihood of effective real power being devolved is limited. A median position would be to use councillors; they are elected; joined up thinking between health and local government is crucial; they are used to working with central government and are able to operate effectively. In the longer run why should the two organisations be separate? Does Scotland need 2 parallel organisations to deliver services locally?
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They're coming out of the woodwork now, aren't they!
18. Where to begin?
1. I never said anything about private health insurance, did I. Read up on how continental health services are managed. Start with the newly reformed Dutch system.
2. Just because my long-standing username suggests I live overseas doesn't mean I am now. Am I allowed to comment now?
Oh, and Patsy at #17; poor hospital management obviously doesn't mean the hospital would close, does it. It would be taken over by the management of a successful hospital - as in the private sector. You should read up on oversea's health services too.
(Wow!)
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Elected health boards, whatever next ? They would end up like councillors , paid to do what the bureacrats tell them. At the moment as far as I"m aware all they get is expences and the odd taxpayer funded junket. How long before they become another useless tier of local government with wages and golden handshakes, nodding their heads when they are told to do soby the people they are supposed to be overseeing. These boards, whether elected or not, are toothless quangoes populated by self styled pillars of the community, most of whom are more concerned with what they are seen to be doing rather than what they actually do.
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Brian
I think the issue should not be how we elect people to health boards, but do we need health boards in the first place.
In a country as small as Scotland would our NHS not be better served as a national service. Safeguards would have to be put in place to ensure it did not turn into an Edinburgh and Glasgow health service, but that should not be beyond the scope of competent management.
Question, are each health board responsible for buying all their medicines, goods and services on a regional basis? If they are, would central buying nationally not be more cost effective?
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17. Another correction needed for your post:
"This sort of Blair-Brownite nonsense has completely failed in England, which is why they are reversing many of the marketizing reforms as we speak"
Wrong. These "marketizing" reforms worked down south and are actually being extended.
Apart from that, you're absolutely spot on with this sentence. You clearly never fabricated anything and instead based it on thorough research of real facts.
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The actual (as opposed to purported) function of Health Boards is to serve as a buffer and firewall between Government and NHS. The apparent autonomy of Boards is in fact extremely limited as the Government has the power of veto, so much of the so-called planning role of the boards is actually an exercise in guessing what the Department is thinking.
This is a great system for the Government (of whatever complexion) as it means that Ministers can take credit for popular initiatives (e.g. be photographed at the opening of new facilities) but hide behind the Boards when unpopular decisions have to be taken. " The decision to close X Hospital is purely one for Y Health Board and not a matter for central government. The Health Board is allocated Z million pounds a year for the health needs of their population; how they choose to spend it is a matter for local decision."
The fundamental dishonesty of this system means that anyone who sits on a Health Board expecting to influence what happens locally becomes disenchanted and cynical - only the speed varies, depending on how quickly they realise how things actually work.
It follows from all of this that direct elections to Health Boards would not actually increase local influence and accountability, but would be merely an expensive sham.
So it will probably go ahead ....
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RE- 22
you did not need to say anything about private health insurance anyone with an ounce of common sense could see that it would be the final stage of your idea.
at no point did i say you should not be allowed to comment.
my name is not Brown !!!
kaybraes - 23 almost correct! the majority of members of health board's are political appointments who were placed their to do the bidding of the Labour party.so for numerous health boards to come out and say they didn't want to become politicised is an absolute joke.
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21 - hurah- most councillors cannot cope with the limited powers they have at present ,so giving them more powers especially the health service is a recipe for disaster, health boards are in a bad enough state as it is without local councilors getting their grubby little paws on it.why do we need councillors on health boards?
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What should the Boards be for? 1. To develop a clear strategic direction. 2. To provide governance oversight. 3. To review and consider performance in the light of the above and national priorities.
My own preference would be for two types of elections: First, one third elected by the public, second, one third as professional members elected by staff. I would keep one third selected via the public appointments process.
In a dream world, it would be good if those standing for the public election did so on a non- party political basis. They could be members of a political party if they wished, but party names and colours would be absent from voting forms, and parties discouraged from campaigning.
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The Health Board should be above party politics and that is exactly what elections would be trying to do.
Do we need democracy everywhere? The Civil Service are apparent in our democracy for a reason.
As for the Health Boards, well no, they should be accountable to government but separate from full stop.
To be fair on Health Boards they do take their work very seriously, least the one who's paperwork and other fun I get to deal with does. And yes there is a lot of paper work but then there is a hell of a lot there to be done, it no easy job and again in my experience, it isn't taken lightly..
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20. I wonder how many people on here would be so supportive of elected health boards if this wasn't an SNP policy?
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27. sidthesceptic: "you did not need to say anything about private health insurance anyone with an ounce of common sense could see that it would be the final stage of your idea. "
Well, you were wrong then. Read up on continental health services as I have suggested.
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#2 Expat
You would hope that this would be the case and morally it should be but there is a real danger that, in times of recession, when the 'parent' hospital, decides to retrench and cut costs and, as in the private sector, close its less profitable operations (if you'll pardon the pun).
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#2 Expat
You would hope that this would be the case and morally it should be but there is a real danger that, in times of recession, when the 'parent' hospital, decides to retrench and cut costs and, as in the private sector, close its less profitable operations (if you'll pardon the pun).
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#31 Expat
So long as the people running our health service have a basic modicum of competence, I don't really care how they are appointed or what their political background is. What is important is whether or not they deliver the goods.
I suppose, one advantage of electing them is that, if they fail, we can always unellect them again. The current system of appointing people makes weeding out the incompetants just a little bit harder.
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Brian
How come your topic only contains one measly "not". You must take a leaf out of the book of how to blog exemplified by your poster #1; he is a master of the double negative, possibly all things negative even.
I promise to pay attention to any postings that are free of negatives, from whoever they originate.
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#28 sidthesceptic: Correct. Why do we need councillors in the Scottish Parliament either? Not good enough for Westminster?
I travelled to Torquay expecting to take my aunt, aged 92, home from hospital after a hip replacement. She broke it in a fall a week earlier.
She had been left lying for a week, sustained on morphine, with nothing done because the health board's political priorities were targets in other specialities. I had to do the 1000-mile round trip again a week later when she was finally discharged. By the way, the operation was done the day I arrived after I threatened to throttle the consultant in charge, and expose his manipulation of a helpless old lady with no relatives within 500 miles.
I would be a good health board appointee, but I'd be thrown off after a week for telling it like it is to the media.
Unfortunately, the type of people on health boards, whether elected or appointed, are quickly indoctrinated into the cover-up culture because they like their name and picture on the big board in reception. And the possibility of an OBE.
You find the same crowd in the poverty industry, the gender industry, anywhere there's cash or kudos for warming a seat and looking righteous.
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#34 & 36
My ability to spell (and type) seems to have abandoned me today...
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#35 Fit_Like
"So long as the people running our health service have a basic modicum of competence, I don't really care how they are appointed or what their political background is. What is important is whether or not they deliver the goods."
Would you apply the same principles to the delivery of our education service?
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#29 Clamjamfrie
Seems perfectly sensible and, for that reason sadly, most unlikely.
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#37 brigadierjohn
"Unfortunately, the type of people on health boards, whether elected or appointed, are quickly indoctrinated into the cover-up culture"
Not to disagree with you on that, but would you agree that the same is true of the boards of directors of the financial sector?
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#29 Clamjamfrie,
Some good thoughts there. Here in North Carolina we have directly-elected school boards working alongside the county commission (ie, council). The commission approves the school board budget and the board implements it more or less as they see fit. The elections are non-partisan but this has recently caused a problem. In my county, a supposedly ad hoc group formed to get candidates elected, ostensibly to change the board's policy of annually re-assigning students between schools to relieve overcrowding. They actually had a more sinister purpose. They want to remove any mention of Charles Darwin in science classes and replace it with creationism.
So if there must be direct elections I think partisan elections have their place. At least you know the sort of line the candidates are likely to take. As I see it, health boards need to be made up of three groups. Firstly, medical professionals. Principally doctors and nurses (senior nurses have a perspective that doctors don't have) but perhaps other fields as well. Secondly, bureaucrats. You do need accountants and facilities managers with a full say. Finally, you need patient advocates. The problem is in deciding how they should be chosen to sit on the board. As the first two groups are going to be appointed, ex officio or elected by small groups, perhaps there is an argument for direct elections for patient advocates. An informative campaign would be invaluable. For that reason, I would argue for the involvement of political parties.
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We need health professionals running the hospitals, not accountants.
You do need financial controls in place, but the person in charge of a hospital should be a senior consultant and a matron.
My local hospital was rebuilt under PFI. They failed a random cleanliness inspection and the Chief Executive gave the reason as "we were not expecting the inspection!".
it is attitudes like these we need to change. The NHS is not a commercial business (yet, look at Labour's love of USA private health companies to run some English GP practices!).
Why don't these people understand that it is cost-effective to spend a lot of money on keeping hospitals clean? It reduces the chance of infection after surgery - always there even in the cleanest of hospitals - which in turns reduces the cost of treating an infection.
Party politics should play no part in the NHS, except for parties to work closely together instead of cheap point scoring.
There should be no voting at all.
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#43 Neil_Small147
"We need health professionals running the hospitals, not accountants."
True, and also true for other professional services such as Social Work and Education.
However, the professionals cannot be given an open-ended budget, nor can they be unaccountable.
The question is who should oversee the performance of these services on our behalf, and how should they be chosen.
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Neil @43- excellent post , don't always agree with you but you have hit the nail on the head this time round.
we need health professionals with front line experience at the top of NHS Scotland full stop.
whilst the NHS in Scotland must come in on budget year by year health boards continually cutting front line services to come in within budget is not acceptable.
we need more and more front line staff who actually see patients and we need less and less auditors, managers,spin doctors and executives.
Sid
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Re 11 expat
Let the market decide? Just like the good ol US of A?
No thanks. What about universal access toall based on need? Surely that must be the test of any healthcare system.
So please no more free market in healthcare.
Re 14
When the SNP appoint they will be different?
I feel health boards do need some degree of local accountability, they need to serve the people of the area. However elections are unlikely to work as this would get little interest from the public.
I think appointments should be used as boards should have people that can add to the NHS knowledge. However I feel this should be done in a non partisan way, perhaps by a local appointments body? there must be a way of achieving this, I think the sentiment behind this is good, don't think the vehicle is right.
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I agree absolutely. And I'd go further: our "them and us" culture permeates all walks of life from football clubs to political parties. Once people are ensconced in nice little sinecures they feel nobody "outside" needs to know what they're up to.
It's one of the reasons why I was uneasy about dumping hereditary peers. These guys didn't need money or patronage and could act without fear. Labour have replaced them with a kind of Supreme Soviet.
Sure, some were inbred imbeciles, but many had good experience and a positive attitude to doing what was "right for the country." How many politicians today could claim that?
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#39 oldnat
''
Absolutely!
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Interesting article - and provocative, concede yourself a grin of satisfaction.
The choice you offer depends very much on how you define democracy.
Appointments to any public position feed the cynic in me. There have been so many cases where merit has appeared to trail way behind cronyism and political expediency - almost as far as Dundee United behind the old firm :)
My only experience of elected officialdim -typo but seems apt, I'll not change it - are our MPs and MSPs, not the best of references. While they are elected to represent the views of their constituents, in practice they represent the views of their party leader; the two do not necessarily coincide. Once elected, they must be tolerated for up to five years however they perform - that' s five years of power without accountability.
So I lean towards direct election but would be very wary of the conditions of such elections - ideally the constituents should have a mechanism for firing as well as hiring. Applying that to parliamentarians would leave a few spaces in Holyrood and probably empty Westminster :)
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#48 Fit_Like
I thought you would want to apply the same principle to education - so would I.
So to go back to the issue I raised in my #16
"it's difficult to see why the two most expensive (and extensive) public services - Health and Education should be handled differently".
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#47 Apologies. This was of course a reponse to oldnat's #41
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Brian
When can we have public committee to investigate the go slow moderation on this blog?
I don't see the problem with local people making decisions on local needs rather than so called experts who will have natural bias one way or tother. While their at it remove these ludicrous league tables as they do nothing for patient care and the same goes for education.
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Look forward to No 50 onwards tomorrow sometime.
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I agree with post 24. There requires only to be one Scottish National Health Board which could quite easily be managed from Clydebank for instance. The amount of costly duplication built in to our present system for a population less than Yorkshire's is unacceptable. Insofar as there are a plethora of Health Boards at the moment however they should have publicly elected members on them to blow up the comfortable compliance to instruction from above which has rendered our present system of boards packed with political appointments a waste of time and money.
RE's suggestions are a recipe for chaos, duplication, waste, cherry-picking and a two tier Health Service. What we require is a efficient health service properly funded and properly managed - probably by persons with a clinical background. If all the money being poured in private Health Insurance was poured instead into the NHS there would be no need for private health insurance. Thatcher broke the committment to a universal Health Service and we see the dire results today. The central tenet of parity of treatment across the nation was knocked down by the fragmentation of the Health Service she engineered. Her cockeyed attempts to save money in the provision of a health service had exactly the opposite effect and we now pay more for less clinical activity to accommodate an army of management and duplication of effort from one Health Board to the next.
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The Herald's version of the Health Board story
Compare the opening sentence -
"Plans for health boards to be directly elected received a mauling today by MSPs."-
with the rest of the story.
The story is reasonable, but doesn't justify the lead in.
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Democracy every time.
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#51 brigadierjohn
You may feel discriminated against because the mods are delaying your post.
However, some posters on NR's blog have been unmoderated for over 8 hours!
The Beeb needs to post an explanation as to why there are these ludicrous delays on some days.
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#54 sneckedagain wrote
"If all the money being poured in private Health Insurance was poured instead into the NHS there would be no need for private health insurance."
Is that really true? It seems daft to me that we think nothing of having building and contents insurance, even car insurance - we don't think twice about it.
Surely health insurance is far more of a priority? So I'd find nothing strange about making provision for (as I do for the others) BEFORE the others. Obviously there may have to be built in to the system some help for those whose costs would be a lot compared to their earnings, but in most case this should not be so?
Based on my view of its past history, I am unconvinced that the NHS is not just a black hole for taxpayers money. One day will we not have to admit we can't just keep pouring money into it without end?
It doesn't have to be turned into a ruthless business model of course, but on the other hand right now it feels like a staggering misuse of money. This cannot merely be excused because it's for altruistic reasons. Surely there's a better way?
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the labour party did indeed pour in an unprecedented amounts of money into the NHS but failed to ensure the money was used correctly.
the number of auditors, managers,spin doctors, executives have risen substantially as each small part of nhs Scotland gets it's own management system from chief executive all the way down to the manager of the manager of the manager of the manager eventually down to the nurse that has to do all the work. an average of 5 people to manage the 1 person who actually deals with a patient .that's where all the money has gone .
add to this the reducing number of staff actually employed by health boards and the explosion of use of bank staff who work for private company's who charge the health boards vast amounts of money for the use of their workforce.
these are just 2 examples of how the nhs in Scotland has wasted the money with the health boards right up there at the front leading the way.
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I always laugh at those who slight private health care and private schooling.
At the end of the day I pay for the NHS through NI.
Then I pay again, to free up my space for someone who pays less, so I can go to another hospital which I pay for just so I can get a satisfactory level of treatment (and hopefully the other person doesn't have to wait as long!)
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Brian
I'm against "directly elected" health boards as these elections will be dominated by the local press and their agenda.
If the press have their way whatever sells newspapers will be the agenda for local heath board elections. Some might argue that at present the NHS is already heavily skewed towards pensioners and children. Stories about children and pensioners sell newspapers. Stories about middle aged people who can't get Doctors' appointments and end up dying do not sell newspapers.
Apart from that don't we already have enough MPs, MSPs and Councillors to keep Health Boards going?
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61-uk_abz_scot-
yes we have more than enough mp's msp's and councillors. if you have a good look around you can see how pathetic most of them are at their day job without letting them loose on our health service.
our health boards and indeed nhs Scotland should be run and controlled by health professionals who actually understand how it should work.
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Leaving aside all debate about whether there should be health board elections, could I ask. "Who will vote?"
If the recent elections in Ayrshire are a guide, the the answer is 27.04% will turn out to vote.
Assuming that number remains fairly constant, what is the point in holding another set of elections? If it is to 'to improve public participation and involvement', then doesn't look like it will.
The voter has to walk or get on the bus, get a lift or drive to the polling station (or else arrange a postal vote). Beforehand s/he has to be interested enough to gather some knowledge to be able to form a decision as to which way to vote. I can't see it.
So even if the proposed elections are a good idea in principle (pass - see above), are they a good idea in practice?
PS #60. BrianSH - Snap. :-)
(Plus your tax system post of a few blogs ago was super.)
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#50 oldnat
Again, no arquments from me there. I think, given that both are treated differently at present, in an ideal world, both methods would be revisited, the best of both agreed upon and then use this new and improved basis for both.
Again, probably unlikely ever to happen though as there are far too many people witha vested interest in preserving the the status quo in both systems.
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(63 add on)
Or could it be only health services employees who vote?!
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#63 aye_write
The proposal is for postal voting.
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BrianSH
I understand the point that you are making. However the main shortcoming with private health insurance is that it is limited in scope.
It can only work as an add on to the NHS and will never replace it.
If you are, heaven forbid, involved in a car accident today, waving your BUPA card would do you no good, when an NHS ambulance took you to an NHS Accident and Emergency unit.
So no one can claim that they do not need the NHS and should not pay for it (I know you have not said this) but many people with BUPA etc do.
I do think though that the NHS and BUPA type organizations can work more closely together to reduce respective costs, and provide a better service.
Perhaps this could be part of the remit of health boards.
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Some bloggs moderated, I wonder why? But I'm getting a distinct whiff of something here! Yeah perhaps the Glorified Regional Council aka Scottish Parliament should be doing more to make sure Health Boards / Management etc etc are held to account thru sackings / demotions and a ban of ever holding any other public service post!
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#67 Quite correct, healthcare should be free at the point of delivery. Most especially during an accident
But I'm not terribly impressed by those who claim that paying private health care is in some way wrong or immoral.
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Brian
Your posters seem to have little faith in the "quality" of the members of these Boards either appointed, self-selected or elected. Could we not charge the, appointed, chairmen with the same responsibility as company chairmen to see that their Board is balanced and competent and if not to ask (aka insist) on resignation and to advertise the qualities necessary to re-balance the board for the subsequent appointment, selection or election?
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Its quite simple really the boards should be composed of a mixture of management, businessmen, doctors + nurses and msps. They should do this for a nominal sum as it is not a requirement that they meet 8 hours a day, 365 days a year.
The councils (and ultimately the government) in which they operate should have responsibility for ensuring due diligence and their appointment.
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BrianSH
Neither am I with people against private health insurance. I think there is a need for a mixture of the two.
A perfect example is the use of the scanner that the Royal Bank sited at Edinburgh Infirmary. Though I believe some people were against the NHS using it
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Redrobb
Nothing like running Scotland down. How does the "glorified regional council" differ from that larger body at Westminster?
Maybe it is because in Scotland we are, too wee, too poor or maybe too stupid to run our own affairs, and we should be grateful that we get our pocket money, mind you we better watch we spend it on things Westminster likes or the pocket money will be cut.
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71. Change MSPs to councillors and that's pretty much the structure as things stand.
It's the same as the board structures of the vast majority of public agencies, which in turn has emulated corporate board structures: 'Executive directors' of managers and senior staff and 'non-executive directors' of business experts and shareholder (ie. the electorate) representatives.
I still see no practical reason why directly-elected bods would be any better. Wouldn't the candidates be the same business experts and councillors but who would now have to pander to media/politically-hyped hysteria?
I'm still curious as to why Sturgeon claimed this idea of elected members was "massively popular" last week....but then couldn't/wouldn't demonstrate this to the committee this week?
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#66. oldnat
Thank you. I'm glad you know! (Information doesn't filter down much to the plebs.)
My initial reaction to that: Oh, dear, sounds unnecessarily costly - and antiquated (sigh) = makes whole scheme sound like another waste of money that won't impress the ill-informed masses who don't care exactly how it works. Finished now :-)
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71
Every category you list has a vested interest, mostly in not rocking their master's boat.
Fail.
Do you believe that the steady rundown of Vale of Leven Hospital to a demoralised and underfunded shell, which is the ultimate reason for its present crisis could have happened if alert and determined members of the public were on the Board instead of the political placemen on it who tugged the forelock to a Labour MP, a Labour MSP and a Labour Executive in Holyrood as their hospital was stripped?
We need elected people on the Health Boards
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#22 - more remarkable ignorance on display!
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First, Scotland needs to decide what function health boards serve.
(I think that Scotland needs to have functionally health boards)
~Dennis Junior~
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