Where we are and where we will be

Where we are and where we will be
The idea of Edinburgh is a combination of place, soul and symbolic leadership of a nation

Monday, 15 December 2008

When democracy needs to prove itself worthy of the task

Brian Taylors excellent post about health board elections is provocative and captures the issue. Democracy is not an end in itself. It is a tool to an end and its application in any given circumstances must to tested against the outcomes hoped to be achieved.

In the case of health boards that must be; accountability, scrutiny, transparency and good governance. There is nothing about direct elections that will inherently deliver these things any better than other systems that avoids the dangers of single issue campaigners or decisions about serious clinical issues being taken by people with no clinical training or expertise. This is case where democracy in the form being suggested must prove itself rather than been seen as a ethical good in no need scrutiny. Link


Stuart Winton said...

Good stuff, but to that extent would you advocate the removal of some powers currently exercised by local councillors, for example with regard to education?

Ewan said...

Stuart, thanks or this. The answer to your question is no because we are not making direct decisions about the delivery of the curriculum in the same way that health boards are involved in clinical decision-making, because our primary task is to appoint heads and to lay out broad policy parameters and because its done in context that means our decisions are both transparent and accountable.

Education sits as a service that is integrated into the wider council services and so part of the accountability is in that context.

One of the strengths of local councils is that they are accountable not just for specific decisions but for how those decisions sit within the wider delivery of services. I would devolve more power to councils, not remove power from them.

Stuart Winton said...

To be honest I don't know much about the workings of either education committees or health boards, but surely your contrast between the two is slightly overdone.

Surely a bit of expertise is necessary to evaluate a head teacher, for example, or the "broad policy parameters"?

On the other hand, your claim that health boards are involved in clinical decision-making - and to that extent unsuitable for lay people - is osverdoing the extent to which board members are 'at the coalface'?

Stuart Winton said...

Just had a look at the profiles of some of the Tayside Health Board members, and some of them seem to demonstrate no kind of clinical expertise at all, so how are they any more qualified than people directly elected would be?

Ewan said...


thanks for these. Health boards at present already have democratic accountability through the health minister and the appointment of a councillor from each of the local authority areas that they cover. What is that will be achieved by direct elections in terms of democratic accountability that is not already being achieved? If the assumption is that a locally elected board would never shut a hospital or change the place or way a service is delivered or make any of the other difficult decisions that have to be made then that does the health service no favours. If the assumption is that they would better reflect the views of he people then they would do so with an eye on the election and so their decisions will always be short term where as of all public services, health prevention programmes which bring about systemic change, which is the best way of improving the health service, are long term programmes that show little return in 4 year cycles.

Stuart Winton said...

Thanks for the responses, and I'm inclined to agree with you about the lack of need for another tier of elected representatives, but that does slighly divert things away from the 'expertise' argument ;0)

Ewan said...


good point. The question remains how do we find the right expertise and how do we make their decisions transpert and accountable and I think we are some way from an answer

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