Memorandum by the NHS Appointments Commission
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
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
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
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.
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.
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
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
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
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.