A huge number of ideas have been put forward for changing the way elections are run. In November, for instance, MPs on the House of Commons political and constitutional reform committee set out proposals aimed at increasing participation, including lowering the voting age, allowing people to vote online, and making voting compulsory.

Significant changes such as these are unlikely before the next general election in May. But another low turnout – 85% of voters participated at the 1950 general election, compared with 65% in 2010 – could further undermine the perceived legitimacy of the political system and give the government a strong incentive for reform.

The NHS rarely features in this debate. In the political and constitutional reform committee’s 115-page report, the health service gets not a single mention. This is surprising, given the fact that the NHS has been experimenting with new democratic processes for over a decade. A rich source of evidence that could inform any reform programme has largely gone untapped.

When the foundation trust model was established in 2004, the Labour government heralded it as the dawn of a new age of democracy in the NHS. Trusts would be held to account by local communities, staff and patients, who would elect a council of governors to oversee the running of the trust. A decade later, it is clear that the range of innovative practices used at foundation trust elections means they are highly relevant to the debate on political reform.

Most obvious is the use of the single transferable vote (STV) electoral system by many trusts, uniquely among public elections in England. The public rejected the opportunity to introduce the alternative vote (AV) electoral system when the government staged a referendum on this issue in 2011, but STV would represent a more radical change as it distributes seats proportionally among parties depending on their support in a constituency, which AV does not. If our existing first past the post (FPTP) system for House of Commons elections continues to fail to produce working majorities for governing parties, STV may seem the best option for delivering stable and predictable coalition government.

One key finding from my study of 135 NHS elections in 2013-14 is that women do better under STV than under FPTP. Where STV was used by the trust, 43% of female candidates were elected, compared with 40% under FPTP. For men, the position was reversed: 34% of male candidates were elected under STV, compared with 39% under FPTP.

Another overlooked NHS innovation is the lowering of the voting age. Scotland was thought to be breaking new ground in the UK when it allowed 16- and 17-year-olds to vote at September’s independence referendum, but foundation trusts had been doing this for years. Most trusts allow over-16s to become members, and thereafter to vote in governor elections or stand as candidates. Unfortunately no data is available on how young people participate in NHS elections. With the leaders of most major parties now backing votes at 16 for all UK elections, research into the NHS experience would provide valuable insights, particularly as foundation trust elections more closely resemble regular elections than does the one-off independence referendum.

Finally, the NHS has led the way in the introduction of online voting. The political and constitutional reform committee recommended the government begin a new round of pilots to assess whether allowing people to vote online could increase turnout. Foundation trusts are already introducing this reform. Encouraging results were achieved by the first trust to do so, Lancashire teaching hospitals NHS foundation trust, where turnout was high among those people choosing to vote online, who were also disproportionately younger voters.

Foundation trusts’ democratic processes have not been an unqualified success, as participation levels in governor elections vary considerably between trusts. Last autumn’s election at Tees, Esk and Wear Valleys NHS foundation trust saw nine candidates fighting for a single governor post, for instance, while in many other cases candidates are elected unopposed or posts are left vacant. Yet it would certainly be worth the government looking a little closer at the health service’s great experiment with democracy.

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