Intended for healthcare professionals


Elections to Scottish NHS boards attract few voters and high costs

BMJ 2011; 342 doi: (Published 11 March 2011) Cite this as: BMJ 2011;342:d1589
  1. Bryan Christie
  1. 1Edinburgh

Fewer than one person in five turned out to vote in the first ever direct elections to NHS boards in Scotland, which have cost over £11 (€13; $18) per voter.

The combination of low turnout and high costs has been criticised by doctors’ leaders who say the £772 986 spent on the election would have been much better invested in direct patient care.

Legislation was passed in Scotland in 2009 to pilot direct elections to NHS boards to see if this would improve public participation and accountability in decision making. Voting took place in June last year in NHS Fife and NHS Dumfries and Galloway to elect 22 new members from a list of 130 candidates.

The process is being evaluated by researchers from the London School of Economics and the University of St Andrews. They have published an interim report showing that voting turnout was 22% in Dumfries and Galloway and 14% in Fife. They also found considerable apathy, with more than 30% of voters saying they did not care at all about the election. This contrasts with only 3% who said they did not care about last year’s UK general election.

Costs are also much higher than were predicted during debates on the legislation when it was estimated that direct elections would cost around 7.5 p per voter. The cost of last year’s election when 66 000 people voted was £11.66 per voter. It is now estimated that the two year pilot programme will cost £1.6m and, if direct elections were eventually to be rolled out across Scotland, the process could cost around £20m.

Direct elections have been opposed by five of Scotland’s 14 NHS boards and also by health professionals including the BMA. Its Scottish chairman Brian Keighley said: “At a time of economic hardship, surely the money spent on a costly election process, with a less than desirable turnout, could have been better spent on frontline services, providing vital care to the local population

“The BMA is in favour of encouraging greater involvement and promoting effective governance but we do not believe that direct elections are the answer. Improved engagement is best done at the most local level by strengthening local structures and supporting NHS boards to improve their own consultation processes and communication with the public. Diverting much needed financial resources away from patient care and into an essentially bureaucratic process seems inappropriate. We are in no doubt that this money would be better spent on clinical services.”

The evaluation will assess if the process has made any difference to decision making within NHS boards and will compare the benefits of direct elections against other methods of increasing public engagement.


Cite this as: BMJ 2011;342:d1589


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