Scotland's health boards have warned they will need to cut almost £14m from patient care and frontline services if they're made to go ahead with elections that would give the public a direct say in the running of local health services.

Holyrood's finance committee will this week hear that the cost of holding elections nationally - now estimated at £16.65m - would divert money away from vital patient care.

In written evidence to the committee, seven NHS boards, half of all those who could be obliged to hold elections, raise serious questions about the financial downside of the change. The medical establishment has already warned elected boards could be too nervous to make tough choices on budgets and service changes, resulting in paralysis. MSPs will now question the government's lead officials on the policy on Tuesday.

The SNP made direct elections to NHS boards a manifesto pledge last year after public outcries over the closure of accident and emergency units in Ayr and Monklands. A common complaint was that local communities felt ignored by unelected NHS managers.

Holyrood's health and sport committee, which is leading on the Bill, does not begin taking evidence until November 5. However, in a taste of things to come, this week the Finance Committee will hear evidence on the financial implications, and already the resistance from boards is clear.

"In order to deliver direct elections, it is likely that funding that would have gone to frontline services will require to be diverted," NHS Grampian said.

NHS Highland was equally adamant. "The cost of direct elections would apparently be a cost to the NHS, and government and patients have to recognise that if implemented it will impact on patient care."

The board estimated remuneration for its elected members would run to £150,000 a year, plus another £85,000 in travel and subsistence costs.

NHS Ayrshire and Arran estimated its costs would be at least £800,000 every four years. "This is a significant sum of money within the context of NHS Ayrshire and Arran being required to achieve £11m per annum of cash releasing efficiency savings which could otherwise be spent on patient services and to improve the health of our population."

NHS Lanarkshire said finding the £1.4m it estimated it needed to run the elections "would present the board with a significant challenge".

NHS Shetland said it had "no uncommitted resources, so any costs falling locally would have to be met by making savings in the frontline service."

NHS Lothian said it was "unlikely" that existing budgets could absorb the new costs. Fife is the seventh health board affected.

Last month, Nicola Sturgeon, the health secretary, admitted the cost of rolling out elections nationally had risen 28% since the Bill was published in June, from £13.05m to £16.65m.

"The intention is that the costs will be met from existing budgets," she said.

Dave Watson, Scottish organiser of the public service union Unison, which has long campaigned for direct elections, said NHS boards were exaggerating the impact of the costs as they didn't want public scrutiny.

"Health boards have always been opposed to the introduction of democracy in the NHS but it's the right thing to do. It's a cultural thing - they just don't get it." "

Cathy Jamieson, the shadow health minister, said it was irresponsible not to provide the funding for key policies. "Scottish Labour believes there is a good case for direct elections to health boards," she said, "but not if the money to fund them is taken from frontline services.

"I want Nicola Sturgeon to provide an absolute guarantee that if she intends to press ahead with directly-elected health boards, she will provide additional funding and services will not be cut to pay for them."

Mary Scanlon, health spokeswoman for the Scottish Conservatives, claimed there was growing opposition to elected health boards. She said: "I don't see any great appetite for more elections and I don't think that there's any evidence that better decisions will be made just because people are elected. We have some very competent unelected people serving on health boards at the present time.

"The government consultation really has been an eye-opener. It certainly does not stack up in favour of SNP policy. And against the backdrop of cuts and efficiency savings, if there are more cuts in frontline services that will make the policy even more unpopular."

A Scottish government spokeswoman said the current intention was for only the £2.9m pilot costs to be met by central government, with roll-out costs coming come from existing budgets.

"It is only after there is an independent evaluation of the pilot in mid-2012 that firm decisions will be made about whether to roll out elections and in what form. We can't speculate on who's going to pay for them until we know what the costs will be."