Health Board Elections and Alternative Pilots: Literature Review

2 AIMS, LIMITATIONS AND METHODOLOGY

2.1 In theory, the accountability of health care providers in National Health Service systems is clear: it runs to the minister, who is in turn accountable to the legislature, which is in turn accountable to voters. However this has not always been perceived as successful in practice, and the history of the NHS shows repeated attempts to strengthen the links between local health care providers and members of the public.

2.2 The Health Boards (Membership and Elections) (Scotland) Act 2009 introduced pilots of direct elections to two Scottish Health Boards, and piloted two alternative models of appointing members in an additional two Health Boards. As part of the evaluation of the pilots, this literature review was undertaken to gather evidence on a range of options used internationally to enhance public representation on Health Boards. It presents research evidence on three methods of improving public representation on Health Boards: direct elections, alternative modes of appointment, and advisory committees.

2.3 In Scotland, the pilot elections are the latest in a series of measures which have aimed to increase public involvement and accountability in NHS decision-making. Measures introduced by previous administrations include a statutory duty for Boards to involve the public in decision-making, encouraging Boards to establish Public Partnership Forums, the inclusion of representatives of Local Councils on Boards, and establishing the Scottish Health Council to support engagement with the public. Since 2007, as part of the agenda for a mutual NHS set out in Better Health, Better Care (The Scottish Government, 2007), the Government has introduced the Participation Standard to improve the collection of information on good practice and promote it, and increased opportunities for members of the public to ask questions at their Board's Annual Review event.