Reform of the the House of Lords has been rumbling along for many years. Started by Tony Blair’s Labour Government, it was in the manifesto of all three main parties during the last general election, and it formed a lynchpin of the coalition arrangement between the Conservative and Liberal Democrat parties. Nick Clegg is personally championing the current plans for reform, submitted as a draft bill in May 2011.

A key proposal of the coalition’s draft bill is to introduce elected members for the first time. Currently there are 789 members, all appointed, but the average daily attendance in the 2009–10 session was only 388 members. The proposal is to reduce this number to only 300 members, but fully salaried and pensioned, as full time parliamentarians. Importantly 80% of the new members will be elected for terms of 15 years, with only 60 appointed members. The joint committee on the draft house of lords reform bill published its report on 23 April and its recommendations broadly supported the draft bill with some distinct deviations; including increasing the membership from the government’s planned 300 to 450 members. Although the committee was split on the final vote, the majority also proposed that the decision to elect members of the House of Lords should be submitted to a referendum, an issue that may also divide the two parties of the coalition.

Whilst elections of members would appear to be a central tenet of a 21st century democracy it is worth stepping back and considering what our wholly appointed House of Lords currently achieves. Despite being very fractious, the Health and Social Care Bill, now the Health and Social Care Act, highlighted the fundamental importance of the expertise contained in the current upper house. When the House of Lords received the Health and Social Care Bill from the House of Commons on 8 September 2011 there were still major concerns, such as no mention of training or research in the bill and a risk of competition on price and privatisation, with negative consequences. The Lords tabled 374 amendments that went back to the Commons on 14 March; all of which were accepted. In total 34 of these amendments were not tabled by the government, but nonetheless accepted.

So why did the government suddenly change the bill in so many ways during its passage through the Lords? The government tabled 340 of the 374 amendments—reflecting the sheer number of changes that they thought were needed after debates in the chamber and committee rooms. Many of these amendments were prompted by amendments drafted by cross-bench peers, among the most vocal being members of the medical profession. Who were these doctors who felt the need to table so many draft amendments? Lords Ribeiro, Walton, and Patel, and Baronesses Finlay and Murphy; a surgeon, neurologist, obstetrician, palliative care physician, and psychiatrist. All five were very active during the seven reporting stages, and their constructive debates led to the government agreeing with them on many points. Of interest the amendments that were not tabled by the government they were brought by a TV producer, historian, mental health commissioner, engineer, civil servant, teacher, two lawyers, and five members of the healthcare professions. Only two were tabled by career politicians.

So a bill that was voted through the elected lower house is fundamentally improved in the non-elected upper house. Although many health professionals and royal colleges were still not happy about the Health and Social Care Act when it passed, they all have to accept that it was a better act than the one that came out of the House of Commons. There seems to be something fundamentally unbiased about having a chamber where almost a quarter of members do not have a political affiliation, and many come from non-political or civil servant backgrounds. It is impossible to quantify the exact impact of having practising doctors, lawyers, engineers, historians, and teachers examining our laws but, with this bill at least, they seem to have done some good.

How many of these experts would have chosen to stand for elections? To go through a political campaign, affiliate with a party, raise funds, speak at hustings? How many would have chosen to give up their career and become full-time politicians? In the new house all of the members will be expected to work full-time on a salary commensurate with a Member of Parliament (currently £65 738) and 80% will need to seek election.

Although democracy and free elections are a worthy pursuit, what are the safeguards to ensure that people from a broad range of backgrounds can scrutinise and debate our bills? The Health and Social Care Bill acts as a case in point. Where would we have been without the due diligence paid to it through fifteen sittings of a committee and seven sittings of a house made up of the best professionals in the UK? Hopefully over the coming months this and many concerns surrounding Lords reform will be examined, freely debated in both houses and ample opportunities for consultation from the public. Democracy has an important role here. Maybe it can be democratically decided that elections are not necessary for the majority of members; just a transparent, open, apolitical policy of appointment of the very best brains that the UK has to offer.

Grant Hill-Cawthorne is a medical virology registrar at the Norfolk and Norwich University Hospital Trust. He is also a PhD student in pathogen genomics at the King Abdullah University of Science and Technology in Saudi Arabia.