Let the people decide over NHS – and our police service, too

CAN you name any members of your local health board? No? Nor can I. Shameful, no doubt, but there it is.

They're probably all worthy people, appointed for the best of reasons, if also, in some cases, because they are loyal supporters of the party or parties in power. They make decisions about how certain funds should be allocated, and they also make what are called long-term strategic decisions about transferring certain services from small hospitals to large ones, and also about hospital closures. These may be challenged, but experience suggests that they usually go through.

Now Nicola Sturgeon, the health secretary in the SNP minority administration, has cautiously proposed change. Her aim is to have at least half the board members directly elected by us, the public, rather than appointed by ministerial say-so.

A proposal to this effect was in the SNP election manifesto, but, recognising that, as a minority administration, they can't force through measures but must seek consensus, she has sensibly launched a consultation document. It doesn't put forward proposals, but – again sensibly – poses a number of questions: who should be eligible for election? Should political parties be permitted to field candidates? Should elected members be in the majority? What role should be played by local councillors? Should board areas be divided into electoral wards? Which method of election should be used? Should board members be paid, and, if so, how much?

Clearly, Ms Sturgeon is not going to get a coherent or compelling set of answers. There will be a range of opinions. Nevertheless, some sort of majority view may emerge. In any case, it's the right way to go about it, even if the implication – "let's trust the people" – is unusual here in Scotland. So I think Ms Sturgeon should be congratulated.

Some think we have already too many elections: for Westminster, for Holyrood, for the European Parliament flitting between Brussels and Strasbourg, for local authorities and for community councils. In certain moods you may agree. That said, we have far fewer directly elected representatives than you find in other countries, such as the United States, France and Germany. Given the importance attached to health questions and the manner in which the health service is organised and run, it's hard to argue that we ordinary citizens shouldn't be allowed to choose representatives on health boards – people who would be accountable to us, the public, and whom we could dismiss if we disapproved of their performance.

There will be a certain amount of condescending criticism of the proposal from the professionals and probably a degree of disgruntlement. The electorate, we will be told, won't be in a position to see "the big picture" or comprehend "strategic necessities".

Would elected representatives ever be likely to agree to what the professionals regard as necessary cost-cutting measures? Would they ever agree to the closure of small local hospitals in order that expensive and better facilities might be provided in large district hospitals? Would they ever approve the transfer of accident and emergency or maternity wards from one hospital to another? Wouldn't elected members always fight their own narrow corner? And so on.

These questions are fair enough, and quite often the answer might well be disappointing, or even mistaken. But that's in the nature of democracy: "The people have spoken, damn them."

However , there is never only one invariably correct measure of efficiency. In one sense, it may certainly be more efficient to close down small maternity units and centralise maternity services in a large hospital where facilities are absolutely up to date. But from the point of view of expectant mothers and their families, such a move may be irksome and less efficient, given that a majority of births are relatively uncomplicated and require no more than the services of a competent midwife. And something similar may be said of most cases presented to an A&E unit.

Again, some may object that quite unsuitable people may be elected. This is undeniable: look at some of those we elect to parliament. But this, too, is in the nature of democracy, which is not all about efficiency but about satisfying the desires and aspirations of the electorate. We, the electorate, are entitled to make bad decisions, or decisions that turn out badly. At least when we do so, we can correct them next time round. In any case, few would assert that appointed members of health boards today always get everything right.

It may be that at the end of the consultation period – set at three months – Ms Sturgeon may find there is no great appetite for change. That would be disappointing for her and for those who believe that the health service might function more satisfactorily if health boards were more responsive to public opinion and their members indeed directly responsible to an electorate.

But I suspect it won't turn out like that. If health and the condition of the NHS are really as important to people as answers to opinion polls suggest, then I reckon Ms Sturgeon will be proved right and that she will consequently be able to assemble a majority in the parliament in favour of change.

Let us hope so. Then, perhaps, an even bolder initiative will follow: elections for police boards, which, fortified by a democratic mandate, would be able to instruct chief constables to provide the sort of policing people want, rather than what chief constables decide they should get.

Indeed, should elected health boards prove a success, it would be very hard to resist a demand to hold popular elections for members of police boards. To have officials directly accountable to the people they are supposed to serve would be no bad thing. To deny the public the power to elect such officials is to display contempt for Mr and Mrs Average Citizen.