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In recent hospital trust elections turnout was less than 2%. Is this true democracy? ...
In recent hospital trust elections turnout was less than 2%. Is this true democracy?

We have written earlier about the problems posed by creating elected special-purpose authorities - like those for foundation hospitals - are being considered by ministers, civil servants, opposition parties and think-tanks for services like education and police authorities, and even parks committees (LGC, 14 March and 12 September 2003). Since separate elections will intensify the separateness of such public bodies, there will be greater difficulties in seeking joined-up governance.

Advocates of such proposals contend, however, that providing an electoral base for local public bodies will strengthen local democracy. But they ignore the electoral base that already exists for multi-purpose local government - or rather they despise it because of what they term its low turnouts. They hope voting on a specific subject like health will interest the public more and encourage a higher turnout.

We can test this argument as the new foundation hospitals hold elections for their boards of governors. We will examine the March 2004 elections for the University Hospital Birmingham Foundation Trust, in which John Stewart took part as a member of the public. The source for the results is a declaration by the returning officer to the trust, audited by the Electoral Reform Society.

To be a voter one has to become a member of the trust by applying either as a resident in Birmingham or as a recent patient at the hospital. This trust has been the most successful of all in registering members: 70,000. At the time of the election only 49,000 were eligible to vote because of the closing date for the right to take part. The figure of 49,000 - or even 70,000 - is only a small percentage of those who could have joined and voted. One calculation puts it at no more than 10%, well below the turnout in local elections.

Of this small number of members, only 19% voted, which means only 2% of those who could have taken part did so. Eve n after quibbles over the calculations the conclusion is clear: only a small fraction of those who could have, actually joined or voted.

The 19% is surprising since the elections were held by post, which would normally increase turnouts in local elections to 50% or more. Even more surprising, one might have thought those who chose to become members would be particularly interested in health issues and would therefore vote. But the reverse is true. Significantly fewer voted than in local elections for the city council.

There were three sets of constituencies. One involved staff, divided into four constituencies - medical; nursing; clinical scientist and allied health professionals; ancillary, administrative and other staff - with one representative for each constituency, except the nursing staff, with two. There was one constituency for patients with six representatives, and another for the public. This last group is the focus of our exploration.

This public group was divided into nine area constituencies, seven of which correspond to parliamentary constituencies. Each of the other two combines two parliamentary constituencies, since they are assumed to make less use of the hospital. Five of the constituencies have one representative each; and the other four have two each.

In one constituency, Perry Barr, no candidate stood; in the others there were between two and six. The constituency of Selly Oak, including one of the trust hospitals, had the highest vote: 290. Its two successful candidates received 112 and 111 votes, less than 1% of the votes gained by successful candidates in local council elections.

The friends in local government of Sir Richard Knowles, former leader of Birmingham City Council, will be pleased to learn he was elected for Edgbaston but with just 95 votes, a minuscule number compared with those who voted for him in the past in local elections. His vote was high compared with other constituencies. In Ladywood the successful candidate was elected by attracting 12 votes, compared with her opponents who received 7 and 2 respectively.

These results would be considered disgraceful in local government elections. Representatives are being elected by tiny numbers. And this derisory performance has taken place for a trust that put greater effort than other trusts into recruiting members. In some trusts turnout from members was higher but membership was much lower.

One wonders what those who argue that there is a case for democratic renewal because of low turnouts in local and in national elections, think about these results. Certainly before more proposals are made for new special-purpose elected bodies, the lessons of these results should be learned.

It is important for councils to study these results. Perhaps a new value will be seen in local government elections, which provide a firmer basis for local democracy than these piddling ballots.

George Jones, emeritus professor of government, London School of Economics and Political Science, and John Stewart, emeritus professor, Birmingham University

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