Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 40-59)



  40. What is the youngest person that you have appointed?
  (Dr Roger Moore) Completely off the cuff, I think it is 24 or 25.

  41. How many 20-year-olds have you appointed?
  (Dr Roger Moore) A relatively small number.

  42. Are you trying to address that?
  (Dr Roger Moore) Yes, we are making efforts. We have got a considerable number of people in their seventies, and we think we should counterbalance this with people from the younger age group.
  (Sir William Wells) There are some trusts where, having 70-year-olds is a very good thing, in a place like Worthing, dare I say, and Eastbourne. A huge number of people for whom they are responsible are that sort of age. We do not have, genuinely, a policy of age. We did have an 86-year-old, but sadly he has just died. The point I would make to you is that we are constantly striving to reduce the age.

  43. I notice that sometimes you use the term "chair" and sometimes "chairman"; and when you were speaking you were assuming that chief executives were men. Do you think the language adopted should be non-gender specific?
  (Dr Roger Moore) The Commission tries to use the word "chair" rather than "chairman". There may be some slips occasionally.
  (Sir William Wells) That is our policy, to use the word "chair".

Dr Naysmith

  44. Sir William, you said you were striving to reduce the age. Quite seriously, it depends where you start, whether 40, 50 or 60. A hugely high proportion of those who use the National Health Service are in their elderly years rather than their younger years. Would it not be more sensible to try and include more elderly people in making decisions about service that to a very large extent involves services for elderly people?
  (Sir William Wells) Everything is a matter of balance. What we do not want is to have boards that are predominantly 55-plus because inevitably they bring a particular perspective on it, which is human nature. There are, for example, lots of children who are cared for in the National Health Service, and therefore it is very important to have young mothers, because they bring a different perspective. I have to say that if we were to analyse the applicants, you would find a huge percentage of them are white 55-plus males.

  45. Would it not be sensible to try and ensure that on each board there were at least one or two who are post retirement?
  (Sir William Wells) I do not think there is a danger of that. I do not think there is a single board that has not got a post retirement person on it.


  46. I have had one or two letters from people I have known over the years, and there is a feeling that when they did not succeed in being appointed, they were treated in a way that left a lot to be desired. Being charitable to the Commission, it may be that due to all the pressures you have been under, it has been overlooked, but the final paragraph in a letter from a person who has been involved professionally in relation to the positions of various trusts over many years since 1962 reads: "My career in the NHS is now finally over. No letters of thanks, no acknowledgment of years of service. I believe strongly in the NHS and its values. It is a shame the beliefs and values are not reciprocated." I felt that she made a fair point. Do you feel that that is an area that you could work on?
  (Sir William Wells) Very strongly. I personally signed a letter of thanks to every single non-executive director and chairman who left the NHS as at March of this year because I feel very strongly about it. We did have a false start, in that there was an administrative error and an appalling, badly presented letter was sent. It was still a letter of thanks, but it was badly presented. As soon as Dr Moore and I saw it, although we could not withdraw it, I did write another one. There have been a number of people who have been disappointed. We have to remember that one in nine people is appointed, so for every person who applies, eight will be disappointed. The leverage effect on the disappointed is very high. We are very conscious of this because people have gone to a lot of effort to make the application, and sometimes go through an interview. We feel they should be dealt with just as well as the people who have been successful. We have not been as good at that as we should have been. I will be quite frank about that. It is very high up our agenda to deal with the disappointed just as well as we deal with the appointed.

Mr Burns

  47. The Chairman raises an extremely important point, if only out of good manners and courtesy. You now say you place a great deal of emphasis and importance on these letters of thanks, and rightly so; but was there a gap when people were not getting thanked, because, presumably, as the only person round this table who has made these appointments—we made a point that everybody who finished their term and were not re-appointed got a letter of thanks at a ministerial level for the tremendous work they had done within the Health Service. Are you saying that from 1997 for a period that procedure stopped, or there was just a hiatus in the system, which you then picked up when you took over, and reinstated it?
  (Dr Roger Moore) I do not think there was a deliberate gap. It has always been the policy, both when ministers were making appointments and when the Appointments Commission took over, to thank people when their term of office came to an end. That is not to say that on occasions there have not been administrative oversights.

  Jim Dowd: Let the record show that in 1990, when I was booted off the North Southwark and Lewisham Health Authority by the then Secretary of State, I did not even get a postcard.

Dr Taylor

  48. I cannot resist coming in on that. I was a health authority member in the old days and then I was a three-times unsuccessful non-exec applicant. I went through sifting interviews twice and a Nolanisation interview twice, and then I discovered that in the West Midlands there were people who had gone through the sifting panels, and the only way they had a chance of getting one of the jobs was that their names were picked by the then regional chairman. As I was a fairly well known agitator by then, I obviously did not have any chance! Going back to the script, I want to explore the role of non-executive directors, because an NHS board is mainly management, and in the old days non-execs were not allowed to say they were representing various people. Lord Hunt put it very specifically; he said they were allowed to reflect the interests of the people in the area they lived. How do you see the role of management and representation of non-execs particularly?
  (Sir William Wells) The board of directors, whether they are non-executives or executives, are responsible for delivering the policies and objectives of the government of the time being, as reflected in that particular trust or strategic health authority. I am very clear about that. They are accountable ultimately to the Secretary of State, to Parliament, for delivering those objectives. Clearly, in being able to do that job they have to be knowledgeable of the local population for whom they are responsible. I much prefer to express it by saying that non-executive directors are representative of the local community, and not representatives for the local community. That, in a way, means they have to have knowledge and go round to talk to people about what they want, so that they get the views of the local community reflected in the work of the board. It is government policy that it is not just implementing national policy; but they also have to reflect local views. It is getting that balance right, Dr Taylor.

Dr Naysmith

  49. You said at the start of this procedure that one of the aims of the new procedure was to ensure uniformity, so that things were similar, if not the same, in one part of the country to another. Yet local chairs of National Health Service boards may well have different needs to meet in their areas. Obviously, Surrey and Essex are very different from some of the industrial areas in the North. How do you ensure these different needs are met in the selection process? How do you ensure you are not so uniform that people are imposing completely different standards from those required?
  (Sir William Wells) It is a very good point and I perhaps did not make myself as clear as I should have done. The process has to be consistent across the country, in other words the methods by which we seek, search and decide upon non-executives; otherwise, quite clearly, it would be unfair on various groups of people. The job of the individual selection committees, interview committees, is to make sure they are putting forward people on merit for the job that is on offer. One of the big changes that has taken place since the Commission came in is that we do not generically advertise and generically interview for non-executive positions. We advertise specific positions, and we will say in those advertisements that, for example, there is a shortage of somebody with legal skills, so we give indications of the particular areas, rather than just saying that we want a non-executive. The effect of the previous system was that a huge number of people were being very disappointed because they thought that they were just the right person with all the skills, and in fact the board were looking for a specific range of skills.

  50. What about knowledge of geographic area?
  (Sir William Wells) Indeed, I come back to my answer to Dr Taylor. If you are representative of the local community, you have got to know the local community.

  51. You are enforcing rigidly the geographical situation and address qualifications.
  (Sir William Wells) Yes.

  52. So that people live where they are going to e a board member for.
  (Sir William Wells) This is much more important on primary care trusts than it is necessarily on strategic health authorities and acute trusts, because their patient span is so huge. Certainly on primary care trusts, it is critically important that geography is taken into account.

  53. Where do you find the independent assessors from, who you say are very, very important?
  (Sir William Wells) We inherited a pretty ad hoc system of independent assessors that was less than satisfactory. They had been drawn from a relatively small cadre of people.

  54. Why were they unsatisfactory?
  (Sir William Wells) We have been to OCPA and OCPA have carried out a big exercise on the way independent assessors were appointed. We are drawing now independent assessors from their recommendation, and we are now training them and putting them through a process of accreditation. It is very important, if you are going to have an independent assessor, that these are people of authority and knowledge who are able to say to people within the service "you cannot have that person for the following reasons".

  55. Are they independent in a personnel sense?
  (Sir William Wells) They are not involved in the National Health Service.

  56. So they know nothing about the particular needs of the NHS.
  (Sir William Wells) they normally have a background in personnel and HR. They are actually advising on the qualities of the person against the brief that has been given—because every single job comes back as a specific brief.

  57. There is a specification.
  (Sir William Wells) Yes.

  58. What main criteria are used? What mechanism is in place to ensure that they are impartial? I am talking about appointing the assessors.
  (Sir William Wells) OCPA have done a lot of work on this and so we were very much relying upon them to produce a pool of people from which we could draw. Then we have our own internal audit process where we attend interview committees from time to time, and see independent assessors. We have feedback from chairs as to whether the independent assessors are doing a good job and vice versa; we have asked the independent assessors to advise us whether the chairs are doing similarly.

  59. You have not specified any particular criteria other than that these be carried out by people experienced in personnel management.
  (Sir William Wells) We then told them what it is that we want them to do. That is part of the training. They cannot carry on doing this unless they become accredited, which means that they have got to be able to demonstrate to us that they understand what it is they are meant to be doing, and the part that they have to play in these interview panels.


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