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NHS elections to pass crunch vote Health elections pass crunch vote
(about 17 hours later)
Plans to trial health board elections in Scotland are likely to pass their first parliamentary hurdle, despite strong opposition from health boards. Controversial plans for directly elected health boards in Scotland have passed their first hurdle.
Health Secretary Nicola Sturgeon said they were needed to improve public confidence in the health service. MSPs voted in principle for legislation to introduce trial schemes in two health board areas.
But five of Scotland's NHS authorities have opposed the plans, with a further five expressing strong concern. Five of Scotland's NHS authorities have opposed the plans, while a further five have expressed strong concern.
Rival parties are expected to back pilots in principle, with the proviso of another vote to roll out the scheme. Doctors' group the BMA is also opposed, but Health Secretary Nicola Sturgeon said the public often felt "shut out" of decision-making in the NHS.
Ms Sturgeon said she was determined to end a "democratic deficit" and ensure the views of communities were properly considered when health boards were making decisions about services.
"Accountability, transparency and responsiveness must be at the very heart of public sector decision-making and direct elections to health boards are an obvious and logical way of achieving this," she said.
Further vote
Five of Scotland's 14 health authorities - Highland, Tayside, Ayrshire and Arran, Lothian and Grampian - have opposed direct health board elections outright.
A further five - Shetland, Forth Valley, Lanarkshire, Greater Glasgow and Orkney - have expressed doubts about the plans.
They include concerns about the "politicisation" of boards and being flooded with single-issue candidates with no interest in overall policy.
Critics also pointed out that councillors already sat on health boards, which were accountable to ministers and parliament.
The government hopes to pilot health board elections for at least two years before a decision to roll them out Scotland-wide is taken.
Opposition parties are likely to support that position, but say there must be a further vote at Holyrood before that could go ahead.
One of the earliest acts of the SNP in government was to reverse decisions by the previous administration to close accident and emergency units at Ayr hospital and Monklands in Lanarkshire, which had caused a local outcry.One of the earliest acts of the SNP in government was to reverse decisions by the previous administration to close accident and emergency units at Ayr hospital and Monklands in Lanarkshire, which had caused a local outcry.
Health board elections would cost nearly £3m to pilot - and nearly £17m if they were implemented nationally. Boards 'unresponsive'
"Many people - in all parts of Scotland - believe that there is a real democratic deficit in the operation of our health boards," Ms Sturgeon told MSPs.
"Too often the public feel shut out of the big decisions - big decisions accounting for significant sums of public money - that are taken by boards on a daily basis.
"And sometimes that exclusion from the decision-making process leads to a deep-seated alienation from the decisions that are reached."
Ministers also agreed to a Liberal Democrat plea to pilot alternatives to elections.
The party's health spokesman, Ross Finnie, said Holyrood's health committee had found "considerable disquiet" in the way health boards were discharging their functions.
"There certainly were views that they were not responsive, there were views that they were not clear about how they engaged or what they were to do about engagement," he said.Heath board elections would be held every four years under PR
Labour's Cathy Jamieson said allowing the public voice to be heard must be at the heart of the decision-making process - but stressed the sentiment must count for all issues, not just controversial ones.
And she said elections must be properly funded, without hitting frontline services.
Tory health spokeswoman Mary Scanlon said objections to the idea of health board elections could not be ignored, but agreed there was more support for piloting them.
The two pilot elections would be paid for by central government at a cost of £2.86m and independently evaluated before any decision on further roll-out was taken.
If introduced Scotland-wide, elections would be held every four years through proportional representation, using the Single Transferable Vote system.
A single ward would cover the whole health board area and the voting age would be lowered to 16.
The pilot legislation will now move forward to the next stage of parliamentary scrutiny after being unanimously backed by parliament.