Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 100-119)



Dr Naysmith

  100.—perhaps we can talk a little bit about training which you say is a very vital role that is going to be performed in the future. Is there a danger that as training becomes much more of a requirement, as people get to know about this and it becomes more important, do you think these demands might deter able people from applying to come and serve on the board of a Trust?
  (Sir William Wells) A very good question.

  101. It begins to seem like an imposition, a burden, for people?
  (Sir William Wells) A very good question. We have got to make sure that we do not over-burden these people who are giving a relatively short amount of time so that they spend all their time being trained and none of their time being non-executives. On the other hand, we believe that there is a need and a demand for training. What we have done is that we sent out a questionnaire to all non-executives and chairs asking them what they would want from training, how much time they are prepared to spend on training and how they would like training to be delivered. We will be getting that back and it will be coming to the Commission's Board in July, and this will then enable us to publish and to develop a programme which reflects the demands of the non-executives. All the training will be very local because we are very conscious that to make people travel long distances is not only expensive and terribly time-consuming, but if people can give up an hour or two in an evening somewhere which is reasonably accessible we think that that will be the way to do it.

  102. Do you think it will be using National Health Service facilities to deliver this?
  (Sir William Wells) No.

  103. But it will be moving around?
  (Sir William Wells) Yes. One of the great advantages of training get-togethers is that we can get non-executives from different trusts to meet with each other. People actually find it very lonely and rather isolationist if you are on a PCT. You never meet the people from the acute trust. What we want to do is to get some interplay between the two so that they understand what their respective roles are and that should help to improve the system.

  104. The other side of the same coin is that if they are meant to act as a critical friend, which it says somewhere in the memorandum is part of the role, not to be too much involved in the process but to look at things from outside, if you train them too rigidly will they end up just as National Health Service managers who are not able to make a suitable contribution? I realise it is a balance.
  (Sir William Wells) I have to say I think that has happened already and we are quite concerned about it. We are looking at a lot of these aspects. There has been a great move over the last few years to say, "A non-executive should head that up", and so you find them heading up what are quasi-executive groups, and I do not think this is what non-executives should be doing. I think non-executives should remain detached but knowledgeable so that they can give objective advice and assistance. We are going to be issuing some directions on what we recommend non-executives should be used to do.

  105. Can I return the compliment and say that is a very interesting answer because most of the trusts I know think that it is good practice to try and get non-executives involved in taking a particular role, some of them, as you say, traditional NHS roles. You are saying that may not be best practice?
  (Sir William Wells) They get sucked in and they cannot—all they know is about care for the elderly or complaints or whatever because that is what they are spending their time doing, so they cannot make a sensible contribution sitting round a board table. What we want is non-executives to be representative of the people and therefore they should be able to get out and understand what it is that their community are worried and concerned about, whereas at the same time also being able to contribute to the general business of the trust or health authority, not a specific aspect of it. The last thing we want is a group of five people only interested in their little segment of the situation.

  106. I know one trust which would have real difficulty functioning its appeals procedure if it did not have somebody who spent most of their time doing it.
  (Sir William Wells) This is again something that we are going to have to look at. It is becoming increasingly time-consuming.

Dr Taylor

  107. I would welcome training very much. It really does make non-executives into independent contributors and arguers with the executives because at the moment so many non-executives appear to me to be just silent stooges.
  (Sir William Wells) I agree. I think your analysis is right and I think it is all wrong. If we are going to have non-executives and the nation is going to pay the amount that it costs for non-executives, we have to make sure that they can properly contribute.

Julia Drown

  108. So at the moment are we getting value for money from our non-executives?
  (Sir William Wells) I do not think you are getting as good a value as you should be.

  109. Picking up on the point that Doug Naysmith made there, if you do get them too detached and you are likely to get people who just come over for the board meetings and nod through the things that the chief executives say, are you not underestimating their skills? Surely somebody could be very involved in care of the elderly work within their trust but also be able to take a step back at board level?
  (Sir William Wells) It is going to be horses for courses but certainly the complaint that I am getting from non-executives—and I went round last summer, and I am going round again this summer, and met all the non-executives in the country—is that they are finding themselves being pushed on to these things where they do not feel that they are making the best contribution that they can. A lot of those roles can be filled by executives who are paid to do it with the non-executives contributing if they have got specific knowledge of specific issues rather than having to do all the work. It is a question of balance at the end of the day, but clearly we hope that people who will have specific interests and involvements will be able to contribute on those but they also have to have an ability to contribute on all of the work of the Commission.

  110. What proportion of non-executives do you think are not giving value for money at the moment?
  (Sir William Wells) That is impossible to answer. I think they would agree with me, because I do not think we have facilitated them to do so in the past, that there has been very little training, very little attention to non-executives. We want to make a quantum leap forward over the next two or three years.

  111. I do not expect you to answer this now, but would you be able to provide the Committee with the overall costs of non-executives, taking the whole costs of your outfit as well and do that in addition to the salaries that they get and indeed put in the training costs so that we get the overall costs of non-executives? That would be helpful.
  (Dr Moore) Yes, we could do that.

  112. Do you think trusts and primary care trusts should be able to have some more flexibility about how many non-executives they have so that, for example, they can decide that half the number of non-executives can have a different type of management structure if they want to?
  (Dr Moore) I understand the regulations for primary care trusts now give them considerable flexibility around their structure provided that they maintain a lay majority on the board.

  113. What about hospital trusts?
  (Dr Moore) Hospital trusts have less flexibility but they can still go up to, I think, seven non-executives.

  114. What is the minimum they can have?
  (Dr Moore) The minimum I think is five.

  115. Do you think they should be able to have less?
  (Dr Moore) I do not think it is for me to say.
  (Sir William Wells) A number of trusts do not fill all their vacancies.

  116. But they are obliged to, are they not?
  (Dr Moore) They are obliged to have the minimum number.

  117. In your view would the management of trusts deteriorate—
  (Sir William Wells) I think the reason is a very good reason, that if you are going to have non-executives there is no point in just having two because they are then totally overwhelmed by the executives, so it loses the point.

  118. So you are satisfied with the current arrangements?
  (Sir William Wells) I am pleased that we have got this increased flexibility as from yesterday on PCTs because this was becoming a problem. Certainly where acute trusts have put up a strong case to increase their numbers we will normally get it through. We have never had a request to decrease their numbers. It is much more the reverse because of the volume of work which is now required from non-executives.

  John Austin: You have described some of the roles of the non-executive members, including having a broad overall view of general interest, being in touch with the community and its needs. Do you think therefore it was a mistake for Kenneth Clark to do what Jim Dowd referred to?

  Jim Dowd: I have recovered from it now.

John Austin

  119. To remove local authority representatives from health authorities?
  (Sir William Wells) We appoint local authority representatives. We have no barrier against councillors at all. In fact, we have appointed a lot of councillors. I am not going to comment on what Kenneth Clark did in the past. It would be extremely unwise.

  Mr Burns: That is over ten years ago. Life has moved on.


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