BBC BLOGS - Blether with Brian
« Previous | Main | Next »

Democracy or bureaucracy?

Brian Taylor | 11:24 UK time, Monday, 15 December 2008

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.


or register to comment.

BBC © 2014 The BBC is not responsible for the content of external sites. Read more.

This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.