Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 1-19)




  1. I welcome our two witnesses. We are very grateful for you coming along today. Thank you for your written submission, which has been of interest to the Committee. Can I ask you to briefly introduce yourselves and say a bit about your background prior to becoming involved with the Commission?

  (SIR WILLIAM WELLS) I am Chairman of the NHS Appointments Commission, and I was appointed just a fraction over a year ago. Before that, I was a regional chairman of a variety of regions as they changed, with bewildering speed, in the south of England. Prior to that, I was Chairman of the Royal Free Hospital Trust in Hampstead. Prior to that, I was Chairman of the Hampstead Health Authority, and then we go back into the mists of time. I have been involved in the NHS for a long time.

  (Dr Roger Moore) I have been Chief Executive of the Appointments Commission since December. Before that I was responsible for the appointments process as it was run by the Department of Health, because I have been a career civil servant up until now for the previous twenty years, working in diverse fields. I started off with orthopaedic implants and moved from there through to this. Before that, I was in academia.

  2. You have been in post since April last year. As a starting question, what have been your broad impressions of the development of the Commission and the work you have done over that period of time, and how it is developing, the positive and negative aspects and the issues you feel concerned about?
  (Sir William Wells) First, Chairman, we have really only been in existence for nine months because albeit I was appointed on 1 April, I was the sole member of the Commission until 1 July, when the Secretary of State appointed the eight regional commissioners. As you have heard, we did not have a Chief Executive until December. For our first twelve months we had no specific budget and we had to borrow and steal from existing regional offices and the like. We had no permanent staff. Therefore, our biggest achievement in the first nine months was to make 1600 appointments on the basis that we did not have a permanent staff. How have we found it? First and foremost, we have found a great relief amongst the non-executive cadre that we now have a single system for appointing people across the country, so there is a much greater degree of consistency than there was previously, when there were eight different systems. Albeit we have not got it, by any means, entirely right, we have been much quicker and more efficient in notifying people as to whether they are appointed or not appointed. That has had some difficulties towards the end because of the huge volume of PCT and strategic Health Authority appointments we had to deal with. One final point is something that we are now putting much higher up our agenda: we found the lack of training and development for non-executives to be appalling, frankly, and in fact there was not any. The only exception perhaps would be London, where they did have a programme, but nowhere else were there any meaningful programmes. We put this high on the agenda because if we are going to achieve the objective of appointing people that can make a difference—and there is no point having non-executives unless they can make a difference—then we have to be able to train them.

  3. How do you feel the work of the Commission is perceived by Members of Parliament? I get letters from aggrieved MPs, as somebody who very strongly supports the move to political appointments. The direction in which we have gone is, in my view, an improvement. However, I do get lots of letters from colleagues who are very uneasy about the way in which the Commission is operating and the way in which they do not feel able to obtain any explanations as to why certain people are appointed and certain people are not appointed. Do you get a lot of representation by MPs? Can you quantify the level? What, broadly, are the concerns that they express to you?
  (Sir William Wells) The answer is that we do of course get representations from MPs. In terms of the total number of MPS, it is relatively small as a percentage. Mainly, people are concerned that they do not believe that geographical representation has been properly looked at in terms of the boards. We obviously get representations but as a percentage of the overall number of appointments we make, it is very small.

  4. You are saying one of the key issues is the geographical issue.
  (Sir William Wells) Certainly. That, I have to say, is quite a difficult tension for us because we have to make sure that we have a proper balance on the board between skills and geography. You cannot sometimes satisfy them both. We appoint on merit; that is our sole criterion. Sometimes you get greater merit in terms of the skills, and I understand that and am very sympathetic to it. I have had discussions with several MPs about this. We very much take on board where there appear to be big geographical gaps we will certainly look to address those if we can find people of the correct merit.

  5. What is fascinating in my area is that before the boundaries changed all the magistrates and all the people serving in positions of power appeared to live in one particular ward. One of the concerns of the new commission, as proposed, on patients, is how to develop skills and capacity among those communities where normally you would not get that kind of representation. Is that something that you are involved in as well?
  (Sir William Wells) Very much so. I think this is one of our single biggest challenges. We see a very high priority as improving the diversity of boards. On the other hand, you cannot achieve that overnight because it is not fair to put people on boards who do not have the skills or knowledge in order to be a member and hold their heads up, because everybody suffers—the board suffers and the individual suffers. Therefore, we are looking at ways in which we can widen the range of training and our ability to get people into the scope of the appointment process so that we can, over a period of years, significantly increase the range of people who will serve on them.


  6. Sir William, did you read the debate that took place on public appointments in Westminster Hall, just after we came back?
  (Sir William Wells) Yes.

  7. What did you think of the criticisms made, particularly of the meeting with you, by the Labour MP for Durham about one of the NHS trust appointments?
  (Sir William Wells) The MP stated his views, and he is perfectly entitled to state his views. What he did not say was that the reason why we had a slight disagreement at the start of the meeting was because I was not prepared to discuss hearsay and criticism of one of the commissioners involved. I was quite happy to discuss the case, which we subsequently went on to discuss. At the end of the meeting he said that he was satisfied with the meeting, and therefore I read what he said with interest.

  8. I happened to be at that debate and listened very carefully to what he was saying, and he certainly did not convey to that debate the impression that he was satisfied. In fact, having listened very carefully to what he said, he certainly gave the impression that he was remarkably dissatisfied with not only the meeting but also the way, as he perceived it, that the appointment system had taken place.
  (Sir William Wells) I do not disagree with that latter point. Quite clearly, he is dissatisfied with the decision that was reached by the Appointments Commission, and he made that very public. I have explained to him in the best way that I can, as indeed did the Commission, the reasons why the decision was reached.

  9. Would it be possible for you to briefly tell us now the reason why that decision was reached?
  (Sir William Wells) I am very reluctant, Chairman. I do not know that the particular member of public is willing for this case to be discussed in public. As the Commission, we are very, very clear: we do not discuss publicly individual cases; we only discuss with the individual or their representatives in private the situation surrounding the appointment or non-appointment.

  Mr Burns: Chairman, can I seek your guidance? We are talking about a public appointment to a public body. Obviously, I would not expect Sir William to discuss personal aspects of any applicant's merits or demerits of appointment, but I would seek your guidance as to whether, given the strength of feeling in certain quarters about the process involved in that individual appointment, it is justified for this Committee, which is holding hearings today on public appointments to NHS bodies, to press Sir William as to why it was felt that that individual was appointed and not the other one.

  Chairman: My personal view would be that we are here to look at the principles rather than the detailed cases. I suspect that if we started exploring this particular case, a number of other colleagues would ask why we have not explored their concerns as well. It is important to look at the principles. I know the selection process will be a key issue to address later, and John and Julie want to come to that. Perhaps we could deal with the principles, and without dealing with that case look at some of the wider issues because there is a concern about how the processes can be transparent, and there is a tension that I appreciate we need to explore. I would rather do it as a principle than going into the individuals involved.

  Mr Burns: I will certainly abide by your ruling, Chairman, but I would like to add one statement: listening to the gentleman who took part in the debate, to my mind, if I understood his speech properly, he raised a number of principles involved in the appointment of a person to a body, which were the problems being highlighted in this appointment process. As I say, I certainly accept your ruling and would not challenge it.

Jim Dowd

  10. I want to go back to your rather uncertain start. You were appointed, but you had no body to head. There was no ratification of budgets, and you went hand-to-mouth with the DoH. How did that come about in those circumstances, and are you now reasonably sure, in as much as anybody can be in the public sector, that it is adequately funded and supported for the task given to it?
  (Sir William Wells) I do not know how it came about. All I know is that I was appointed on 30 March and the Commission came into being formally, when the order was laid, on 1 April. Therefore, for whatever reason, there were not staff and budgets waiting for me to check. I do not want to make too much of this because we managed to utilise the existing facilities from the old appointments section. It was not ideal, but nevertheless we managed to get through a significant number of appointments. In many ways, that was no bad thing, because it did give us an opportunity of being able to assess much more accurately what we were going to need in order to be able to have an efficient and effective Appointments Commission. We are satisfied. We have a budget, which has been approved, and that is sufficient to be able to cope with our current needs. We are virtually now fully staffed at the Commission, and we are really open for business for the October round of appointments and re-appointments.

  11. You say in your submission that your staffing level has reached 45. When did you start recruiting?
  (Dr Roger Moore) We began recruiting in November and December, and we expect to be up to full complement within four or five weeks.

  12. Is your budget adequate for your work in those 12 months?
  (Dr Roger Moore) We believe so.

  13. Turning to the regional commissioners, without going into individual cases—and I know the London commissioner fairly well—can you describe their role and the level of knowledge they would have about individuals who are likely to come before them?
  (Sir William Wells) There are eight regional commissioners. They are responsible for a geographical area that more or less represents the old health regions. London is the only place where there has been no change, because London is London. Their job is to make recommendations to the Commission about the appointment of all of the non-executives or the re-appointment of non-executives in their area. It is also their responsibility to make recommendations about people who are not cutting the mustard and who need to go. It is also up to them to be responsible for ensuring that every single chair and non-executive as from this year is appraised on an annual basis. It is their responsibility to see that there is proper training and development for non-executives in their part of the country.

  14. The second point was about how they would develop awareness or working knowledge.
  (Sir William Wells) There are of course about 4,000 applicants per old region—about 30,000 applicants. Clearly, they cannot have knowledge of that number. Starting in the hierarchy, the regional commissioner is responsible for chairing the interview committee for all chairs, who are either being appointed or re-appointed. He or she works with the three or four strategic health authority chairs who are responsible for the performance management of the trusts in their particular strategic health authority area. There is a very close relationship between those three or four people and the regional commissioner. There is also a very close relationship between the regional commissioner and the director of health and social care for the region. I would expect them to know well all of the chairmen. Clearly, it is not possible logistically for them to know all the non-executives, and they must rely upon the individual chairs of the various organisations, which, after all, have to form boards which have to work properly, for knowledge of the non-executives, but we do expect the regional commissioners to attend board meetings, particularly of those which they hear are not operating as well as they might.

  15. You have made some 1600 appointments so far. Is that essentially an initial flush, and how many would you imagine making on average now that it has settled down?
  (Sir William Wells) I hope we never have to make 1600 appointments in such a short time again, frankly. It was a very significant task. We make about 1000-1200 appointments every year, but of those up to 50 per cent are re-appointments, and therefore we are looking for about 500 new people every year across the country. This year, we will be looking for more because the numbers of non-executives on the PCTs will be increased, and that could mean another 300 or so non-executives that need to be sought. As you know, non-executives have to have a majority of now increased executive on PCTs. This year we will have more. It should settle down at about 500 to 600 new people every year.

Mr Amess

  16. Is it solely the Secretary of State who is responsible for drawing up the members of the Commission?
  (Sir William Wells) The Secretary of State appoints the members of the Commission.

  17. Did you yourself have any input into who your colleagues would be?
  (Sir William Wells) Yes, indeed I did.

  18. From my point of view, because the previous system absolutely stunk, the two members who entirely affect appointments in my area, are part of the old regime. Far from this being a new set-up with a new reason for existence, I find, when I look down the list, that the two people who will actually be dealing with all the appointments that are pushed through, are part of the whole set-up. I want to put this to you: what confidence can someone like me have in this new system, with all the hype it has been given—"we are going to turn over a new leaf and everything will be different"—if the two people who affect decisions in my area have been on the scene for a very, very long time and are part of the old regime?
  (Sir William Wells) All I can say to you is that they were selected on merit as a result of an open competition.

  19. For goodness sake! Whose merit?
  (Sir William Wells) There was an open competition.


previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 17 July 2002