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Introduction
1. The Government's policy is that healthcare services should be delivered as locally as possible, so that they are convenient and responsive to patients' needs. NHS Boards are responsible for delivering this policy. Some recent decisions to change the way NHS services in Scotland are delivered have raised strong feeling in local communities and many people believe that some NHS Boards have not taken sufficient account of the views of local people. Difficult decisions about NHS services have to be made but local people must always be at the heart of the change process. Where change is necessary the process should be rigorous, evidence-based, and open to scrutiny.
2. The Government believe that elections to NHS Boards can help ensure that the voice of local people and communities is heard when major decisions are being made.
3. Encouraging greater public and community involvement lies within the broader context of promoting effective governance across the public services, including the NHS. Key features of good governance in the NHS should ensure:
- a focus on quality services for patients;
- effective service delivery supported by clearly defined roles and responsibilities;
- promotion of the recognised values of the NHS in Scotland as a public service;
- that Boards make decisions in an informed and transparent manner;
- development of Boards so they are efficient and effective bodies; and
- that Boards engage with stakeholders and are properly accountable to Ministers and the Scottish Parliament.
4. It is important that in taking steps towards encouraging public/community involvement and proposing some form of direct elections to Health Boards, the good governance features set out above are reinforced and not undermined.
5. Good governance also encompasses effective scrutiny of the NHS. At present NHS Quality Improvement Scotland (" NHSQIS") largely fulfils this role. For the future, Professor Lorne Crerar has recently published his Independent Review of Regulation, Audit, Inspection and Complaints Handing of Public Services in Scotland. The broad principles and vision of this Review have been welcomed by the Scottish Government and are under consideration. Clearly, there is a relationship between any arrangements for external scrutiny and the additional internal scrutiny that may be achieved by introducing direct elections to NHS Boards. These approaches must contribute to good governance and not conflict or overlap.
6. The need to address concerns about the role patients and the public play in decisions about how local health services are designed and delivered was central to the consultation. Views were sought on how this might best be achieved.
Consultation
7. The consultation document was split into 2 separate, but not mutually exclusive, sections. Section 1 asked questions about strengthening existing policies to ensure that the needs of local communities are heard more effectively, within the current framework of appointed NHS Boards. Section 2 asked for views on introducing new legislation to require elections to be held to NHS Boards to place locally elected members on Boards.
8. The consultation was launched on 8 January 2008 at the Pearce Institute in Glasgow. The launch was attended by the media and the Cabinet secretary for Health and Wellbeing took the opportunity to discuss the contents of the consultation with the representatives of some key stakeholder groups including the Scottish Health Council, Fair For All, Help the Aged and the Scottish Consumer Council. Almost 2000 copies of the consultation were sent out to a wide range of interested groups and it was also made available through the Scottish Government's website and was offered in a number of formats. During the consultation period, officials were also invited to a number of meetings across the country to discuss the contents of the consultation and help facilitate discussions before those concerned submitted their written responses.
Analysis
9. The consultation received 142 responses. The Bill Team were also invited to attend a number of meetings with groups to discuss the consultation in detail. These groups included NHS Boards, Tenant Organisations, a Citizens Panel, Public Partnership Forums, Voluntary Organisations and the Scottish Partnership Forum.
10. While the consultation was split into 2 sections and contained 33 questions, most respondents sought to discuss the issues in general terms. The 2 sections were not mutually exclusive and there were a number of areas where a degree of crossover occurred. With this in mind, it was decided that for the analysis of the report that a question by question tabulated analysis would not prove effective in capturing the broad issues covered. Instead, a summary of the key issues raised under each section would be best placed to draw out the various points made. Additionally, each question is discussed in broad terms so as to reflect the views of those consulted.
11. It should be noted that the findings contained in this report are specific to this consultation exercise and do not necessarily reflect the weight or range of views within the population as a whole.
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