A prelude to Imbyism. That is the main objection of those who oppose holding open elections to appoint health board members. The argument goes that elections would result in local activists opposed to the closure of hospitals and medical services being elected to boards on an in-my-backyard ticket. Objectors maintain that this would result in stasis in the NHS, leading to a situation where plans to provide better services more efficiently would be continuously blocked against the best interests of patients. The Labour-led Scottish Executive's opposition to directly-elected health boards is based on these reservations.

Labour has produced a compromise which it hopes will marginalise the issue until May's Scottish Parliamentary elections have passed. It says it would test directly-elected health boards in some areas over the four years of the next Holyrood term to establish their effectiveness. But hopes that the compromise would kick the controversy into the long grass were undermined yesterday when Bill Butler, the Labour MSP behind a bill to introduce elections for health boards, won the support of Scottish Parliament's health committee. Scenting victory in the wake of this endorsement, Mr Butler expressed confidence that the bill would become law before May's elections.

There is a long way to go before then. The intervening period should be seized as an opportunity for a full and informed debate on what is an important and potentially significant member's bill. This could begin with an examination of the executive's position. Realpolitik (heading off a potentially embarrassing rebellion producing legislation ministers do not want) can be seen all over the executive's compromise. But it is a principle that is at stake. Direct elections for health board members are either to be endorsed or rejected. Testing them in certain areas would produce an uneven playing field that could make some parts of Scotland more vulnerable to hospital closures than others.

The Herald supports the principle of electing health board members. There are possible pitfalls that helped shape the executive's opposition. Change is a constant in the NHS, as in other walks of life. Health boards have to make decisions that will not please all of the people all of the time. When justified, they must be made. There is a risk that boards hijacked by single-issue pressure groups would not serve the interests of the NHS or the patient.

This would be avoided by having a mix of directly-elected and appointed members in a model that guaranteed clinical expertise and other NHS interests fair representation, as well as giving communities a substantive say. The detail can be worked out. But recent experience of hospital closure and centralisation programmes has given substance to the criticism that health boards have failed to take proper account of community concerns. Boards need to be made more accountable, more transparent and more democratic. An elected element that gave communities a direct say in the decision-making process and had safeguards built in to ensure that its influence was not disproportionate, would serve both ends. Boards should have nothing to fear from such a system. Nor should ministers.