Scotland's "mutual" National Health Service and the role of direct elections

Scotland has since 1948 had a national health service centrally funded from taxation and free at the point of use. For its first 5 decades the Scottish NHS was similar in its managerial arrangements to that in its neighbor England. However in the decade that followed the restoration of the Scottish Parliament in 1999, the two health services have progressively followed separate paths. Thus whilst in England managed competition and family practitioner commissioning is set to become the norm, Scotland sticks to a more traditional model with 14 geographically defined health boards responsible for both planning and delivering health care to their resident populations. Central to this difference is the Scottish NHS concept of mutuality; a term which encompasses solidarity, collective ownership and responsibility for the NHS as a valued national institution. This talk will explore this concept in relation to the introduction, for the first time, of direct elections to 2 of Scotland's 14 Health boards. In particular it will explore whether this process may further enhance accountability and increase local involvement or whether the factionalism that may result could threaten the very concept of a mutual NHS. The presenter is one of a team of 4 involved in evaluating the impact of direct elections and the methodological challenges involved in addressing these questions will be discussed.