Select Committee on Public Administration Minutes of Evidence

Memorandum by the NHS Appointments Commission (PAP 61)


  The NHS Appointments Commission welcomes this opportunity to present evidence to the Select Committee. This memorandum outlines the responsibilities of the Commission, describes how they have been carried out and addresses some of the issues about this method of public appointment which have been raised by the Committee.


  The NHS Appointments Commission was established on 1 April 2001 as a Special Health Authority under the NHS Act 1977. Following an open competition including public advertisement, the first Chair, Sir William Wells was appointed from April 2001 and eight Commissioners (listed in Annex 1) from 1 July 2001. Dr Roger Moore was appointed as Chief Executive from December 2001. The Commission has an establishment of 45 staff, plus the Commissioners, and is based in offices in Leeds and London. The annual budget of the Commission is around £3.5 million.

  The Commission has the duty of improving the effectiveness of approximately 4000 chairs and non-executives on the 630 boards of NHS trusts, Primary Care Trusts and health authorities. An important part of this task is to make their appointments. Historically, these appointments were made by the Secretary of State for Health but since July 2001, Ministers have no longer played any part in the recruitment and appointment process. The full remit of the Commission is at Annex 2.


  The Commission is accountable to the Department of Health for the delivery of its budget. However, it acts completely independently from Ministers and the Department when making appointment decisions. It is held to account by the Commissioner for Public Appointments for the integrity of its appointment process. Her auditors will carry out annual inspections of the process and the Commission is required to provide her with annual statistical returns. The Commission for Public Appointments does not become involved in the merits of individual appointments, although candidates for posts have recourse to the OCPA if they have concerns about the quality of the process.

  The Commission is also accountable to Parliament through the Select Committee system and directly to the public at its annual public meeting.

Outline of the NHS Recruitment and Appointment Process

  The process followed by the Commission is simple and straight forward. In summary, recruitment is through public advertisement in local or national newspapers, including the ethnic minority press setting out the particular skills/background required for the vacancy.

  Candidates complete an application form. The candidates who best demonstrate the qualities needed for the post are identified through a standard short-listing and interview procedure.

  The short-listing and interview panels for chairs consist of another NHS chair, an independent assessor and are chaired by one of the Regional Commissioners. For non-executive posts, the panels consist of two NHS chairs, one of whom is the chair of the body with a vacancy (who will not chair the panel) and an independent assessor.

  The final appointment is made by the Appointments Commissioners sitting as a board, following a recommendation from the Regional Commissioner on the basis of the views of the panel.


  Although the procedures are straight forward, the scale of our operation ranks us with the larger senior recruitment agencies. A high level of professionalism and administrative competence is required. Since June 2001, we have run 490 recruitment campaigns. They have generated 32,000 expressions of interest, resulting in 14,000 applications from which we have appointed around 2000 people.

  We believe that this demonstrates not only that our recruitment activities are widely seen but that a large number of people are prepared to take up public office and play a significant role in their local community. There is no evidence of public cynicism about getting involved in health related bodies.

Citizen Involvement on Public Bodies

  The role of the individual on public bodies varies widely. Some are appointed because they are expert in a particular field; some represent other interests or stakeholder groups; some have specialist skills; some are there to represent their fellow citizens. Recruitment techniques may vary according to the role. However, the selection procedures of application form, short-listing and interview is part of any transparent and fair process to ensure that those appointed have the skills needed.

  Chairs and non-executives on NHS boards are expected to have the general ability to challenge the executive team and take part in corporate decision making. However, part of the selection process is to ensure that non-executives understand local needs and issues and that through them, the community feels a sense of ownership and participation.

Diversity Issues

  We have identified five factors through which to ensure that as well as their general competencies, the non-executives on a NHS board are collectively representative of the communities they serve. They are: gender, ethnicity, disability, geographical spread and life experience.

  Gender: our recruitment procedures are tailored and targeted to achieve balanced boards. At present, the proportion of female non-executives hovers around 50 per cent and although only 40 per cent of chairs are women, we expect this to change as more women come forward for chair posts from the ranks of non-executives.

  Ethnicity: the proportion of non-executives from the black and ethnic minorities is around 11 per cent although this disguises areas and communities where we have particular recruitment difficulties. We have established an Advisory Group of black and ethnic minority non-executives to advise us how best to address these difficulties.

  Disability: less than 3 per cent of non-executives have declared that they are disabled. This is disappointing and we will be working with our Disability Advisory Group of disabled non-executives to seek ways of attracting more disabled people to become non-executives.

  Geography: we try to ensure that non-executives are representative of the whole area served by an NHS body and we are able to advertise specifically for people from a particular are which may be under-represented.

  Life Experience: NHS non-executives are at present drawn predominantly from the ranks of professional people, the self-employed, the retired and people with working partners to support them. This is self evidently not fully representative of the community. We plan to redress the balance in a number of ways. First, we intend to review the non-executive role to enable it to be less time consuming and compatible with other employment. Second, we intend to pursue with the Department of Health, a change in the job selection criteria from that of previous work experience to competencies and ability. Third, we believe the level of remuneration of £5,294 for the current five days per month discriminates against those on lower salaries, an issue we will continue to pursue with the Department of Health.

Future Role

  The Secretary of State of Health has already directed the NHS Appointments Commission to make appointments to a number of other public bodies. The Commission for Healthcare, Audit and Inspection, the Commission for the Regulation of Healthcare Professions, the Commission for Patient and Public Involvement in Health are recent examples. We expect that the Department will increasingly take advantage of the independence, expertise and competence of the Appointments Commission in delegating further appointment responsibilities to it.


Appointment versus other methods of selection

  We believe that filling these NHS posts by appointment is the best way to ensure that the particular skills needed by the board are met. In our view, an election process with a large constituency of voters is only satisfactory for large bodies such as Parliament and local authorities where a wide balance of skills is needed.

  On the other hand, an election process, with a small constituency of voters can be useful to identify a small number of people when the candidates are well known to the voters, such as in a sports club etc.

  Attempting to ask a large number of voters to identify a small group of people with particular skills, as would be the case for NHS boards, will not produce a representative board with the required skills

  The experience of the Mutual Building Societies and large organisations such as the National Trust where a very large number of members are invited to vote for a small number of board directors, is not encouraging. These boards are hardly representative of members and generally reflect the usual "great and good" or commercially successful people who stand for election and are proposed by the board.

Advantages of the independent Appointments Commission model

  An independent organisation such as the NHS Appointments Commission, running an open and transparent appointment process has considerable advantages in encouraging citizen involvement in public life. In our view the main advantages are:

    —  The Appointments Commission is perceived as an independent body which can make appointments based on merit without the involvement of Ministers or political influence.

    —  The procedures we use are open and transparent. Because the process of advertisement, short-listing and interview is standard and familiar to people, they have confidence in its inherent fairness. They can understand that appointments are made on merit by testing the skills of applicants against those needed for the post.

    —  There are economies of scale in giving the NHS Appointments Commission the responsibility for such a large number of NHS appointments.

    —  Compared with Government Departments, the Appointments Commission is able to specialise in appointments work and will become increasingly professional, competent and consistent.

    —  The Appointments Commission, working with other agencies, can use its expertise to increase citizen involvement and ensure that NHS boards have access to a full range of community perspectives.

  The model of the NHS Appointments Commission has proved successful for the NHS and the Department of Health because there are a large number of public appointments. It might not be so practicable for Departments with less public appointments. However, it is not inconceivable that Departments could delegate the task to the Appointments Commission or a body established on similar lines.

October 2002

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Prepared 26 November 2002