NHS needs a healthy dose of democracy

Published: 02 February, 2007
John O'Groat Journal and Caithness Courier

WHAT'S the good of the buzz words "community planning" without community decision-making to carry out the priorities people decide?

This week various organisations have made their submissions to HITRANS, the regional transport partnership, about the neglect of Caithness in the outline Highland transport plan. Meanwhile in Parliament, the first stage of a Member's Bill has been debated to ensure that health boards are partly elected to reflect local needs. But would they? And will we ever reduce the numbers of quangos that rule over us?

Firstly, on roads, ferries and trains, the Caithness Transport Forum sensibly called for better, quicker links in, to and from the county. Of course, money doesn't grow on trees, but we need to declare our ambitions boldly. I had a glance at the submissions from south-west Scotland, the Galloway and Dumfries area; they include major projects like the reopening a direct rail route from Carlisle to Stranraer that suffered the Beeching axe in the 1960s. Other rail upgrades are also sought there. Yet up north, HITRANS has ignored the growing clamour for a Dornoch rail link alongside road improvements as key needs for Caithness.

Some £350 million has been spent in the last 30 years on modernising roads and bridging the firths for the A9 north of Inverness. Realistically it would cost a fraction of that road budget to modernise and shorten journey times on a carbon-friendly railway. As I've already said, if we aren't bold we'll be ignored. The gain per minute per pound of investment on the railways will surely speed up and modernise the passenger and freight times compared with unlimited spending on road improvements. Of course, road improvements are needed to make certain sections safer, but road journey times are much harder to shorten whatever the amount of cash invested.

Secondly, concerning a public say in running health boards, the Member's Bill proposed by Glasgow MSP Bill Butler has provoked a big debate in Holyrood about how democratic our modern NHS really is or should be.

During the Caithness maternity crisis, the lack of any appointed members from the county impeded our ability to put the case for Far North health needs. However, due to the concentration of population in the Inverness area, any election to the board of NHS Highland (and Argyll) would need a proportional system that recognises geographical spread. I'll be keeping a close eye on this one.

Sad to say, the BMA, the doctors' union, and the RCN, the main nursing union, are opposed to democratic representation of the "customers". However, the present system allows the executive managers to be members of the very health boards that decide their ultimate policy. The need for non-executives to have the majority input is compelling.

I have always believed that health should be treated as part of local government, but now NHS Highland covers two local council areas. I also believe that the elected element is essential to open up decision-taking to public scrutiny.

But perhaps the community health partnerships, the CHPs, ought to be looked at as well. In our case, North Highland CHP should have more than an elected lay convener. So this debate about democracy in local health delivery offers a chance to challenge the health quangos to meet local expectations. Since patients' organisations have been centralised, I think it is time the public had a greater say in the way the most expensive part of Scottish government services is run.

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SHOWCASE Scotland was part of the Celtic Connections festival in Glasgow last weekend. I was asked to host the seminar and reception that was promoting the Shetland Folk Festival, a venerable 27 years young, Stornoway's 10-year-old Hebridean Celtic Festival, and Blas, the Highland 2007-backed folk event running for nine days in early September that is now in its third year.

It was great to see old friends from the North at the event and to meet festival organisers from Norway, Quebec, Belgium, Germany and Ireland.

The festival's DVD presented pictures and sounds of fine players like Gordon Gunn from Wick. After the event and a top-notch concert by Orkney's Kris Drever I did an impromptu interview with Robbie Mackay of the folk programme on Caithness FM.

We have a big local audience for the Northern Nashville Caithness Country Music Festival held in Halkirk in early April. I'm sure they would enjoy the crossover music of American and Scottish influences that Celtic Connections displayed so well.

In its closing weekend one star attraction is Rosanne Cash, who sings to a sell-out crowd in Glasgow's Royal Concert Hall on Friday 2nd.

The Cash forebears came from near Falkland in Fife and the breadth of folk music's appeal is captured by her music. As Vanity Fair magazine put it, "Cash's dark muse led her from Nashville to New York City, where she has lived since 1990, and her latest gem, Black Cadillac – about the deaths of her father [Johnny Cash], mother, and stepmother over a two-year period – shows her at her introspective best."

Yes indeed, love and death feature in the folk music of every age. I do hope the Caithness country music audience can dip a toe into the next offering of the Blas festival later this year, as the roots of country music stem from songs and tunes carried by people from every part of Scotland to the New World.