Select Committee on Public Administration Minutes of Evidence

Examination of Witnesses (Questions 860 - 879)



  860. It has been talked about for ages.
  (Sir William Wells) However, we were asked and we did give a lot of advice to the policy makers about corporate governance issues on foundation hospitals and they broadly accept the division that we suggested, that the hospitals should have a board to run the hospital and should have a stakeholder council to represent local views and to advise on strategy. How the people on those two organisations are going to arrive is very much in the melting pot. I can only tell you what I read in the press. Certainly, as far as we are concerned, it has not been discussed with us.

  861. That is astonishing, is it not?
  (Sir William Wells) I think it is because it was only, what, 10 days ago that they actually decided what was going to be the broad framework of foundations hospitals and I have absolutely no doubt that it will wend its way through the system and come back to us. I do not know if what I have read in the papers is just conspired by the journalists. But clearly the idea was—and I have no reason to believe that this will be any different in the outcome—that the board runs the hospital, and they will be people chosen very specifically to make sure that the hospital runs as efficiently and effectively as possible, and the stakeholder council will be drawn from a range of local people, in order to give a much greater of feeling of ownership of their hospital through the stakeholder council. That is the philosophy. We can make that work perfectly well in corporate governance fashion, but how those people arrive on each of those boards I think is still a matter of debate.


  862. Does that mean that the non-executive role that you are used to appointing falls away at the board level?
  (Sir William Wells) No. We suggested that the actual board of the hospital should be comprised in the same sort of balance as it is comprised at the moment. What you would do is put in an additional local stakeholder group, which would be drawn from local employers, local authorities, staff—you know, a broad range of people—to be the sort of strategic guide, the organisation which would monitor performance and be responsible for checking complaints and the like.

Mr Heyes

  863. I want to come back to this phrase you used of "weeding out" in relation to single issue people. Your memorandum says, "Chairs and non-executives on NHS boards are expected to have the general ability to challenge the executive team . . ." Is your weeding out approach not in contradiction to that?
  (Sir William Wells) We try to ensure ourselves that everybody whom we appoint as a non-executive will challenge—because that is the key part of their job, to challenge the executive. What tends to be or can be quite disruptive on boards is if a particular director is only prepared and only willing to talk about a particular issue. I am afraid, that can be the case. They are a passenger. For the other 95 per cent of the activities of the board they do not play a part. It is a team.

  864. How would you make the judgment about the unsuitability of that person? It seems to me that the range of skills that you need to apply in your single issue is transferrable to the role of general ability to challenge.
  (Sir William Wells) I agree. If someone demonstrates that they are able to do that at interview, then they get appointed. If somebody makes it very clear that they are only interested in the care of the elderly, for example, and that is what they would contribute and that is all they want to do, then you are starting to create an unfortunate tension in the board. But a lot of people would say, "Yes, we are very interested in the elderly, that is our key, but we understand that we have to play a broad-ranging role on the board," and we certainly would not not consider them.

  865. You say also in your memorandum, "There is no evidence of public cynicism about getting involved in health related bodies." I assume you mean cynicism about the process of getting involved. How did you test that? How do you know that there is no public cynicism?
  (Dr Moore) I think the fact that 32,000 people respond to advertisements is some indication that people think it is worth getting involved and worth applying.

  866. That is the only test?
  (Dr Moore) That is part of the test. I think the other test is drawn from the fact that the principal focus on the health service at the moment is to put the patient at the centre and to encourage patient involvement at all levels, and the trusts, and particularly our primary care trusts, are taking quite major steps to encourage the public to come forward to take part in focus groups, to ask patients to complete questionnaires and the like, and to respond on the direction of travel in terms of treatment strategies and whatever, and the public are coming forward and patients are responding to those requests to play a part.
  (Sir William Wells) We will have, of course, as from next year, patient fora around the country: each patient forum will be able to elect one of their number to become a non-executive director of the relevant trust. So that all the time you are pushing out the ability of people to get involved. Certainly from my experience there is a growing interest in getting involved in health care issues. What we want to do is to try to coral that locally because the whole of Government policy is to decentralise back to the local communities so that they feel it is their health service rather than someone else's who is being paid to run the board.

  867. I press this point because I have picked up some small scale, local, anecdotal evidence of public cynicism amongst individuals who have been through the application process, who in some cases have been interviewed. People who, from my personal knowledge of them, I would have thought would have made potentially quite suitable candidates have found themselves rejected and have talked about—and maybe there is some post-hoc rationalisation working—having been interviewed by people who they know to have very strongly held political affiliations that are not the same as theirs. That is certainly the cause of some cynicism. Perhaps you would like to discuss that.
  (Sir William Wells) Unfortunately, we do have to turn people down. That is a matter of fact. And I think it is very healthy. Previously nobody complained about the system at all because they knew there was absolutely no point in writing a letter to the minister because they never got a reply and therefore they did not. I am afraid that is a matter of fact. That has been going on for years. We do reply and we do actually give them reasons and we do get the involved. I would say that 999 out of 1,000 people sometimes do not like being told why they were not appointed but huge numbers actually accept that we have come to an opinion. They may not agree with that opinion but we have done it in a fair and open way and we have told them what it is.

  868. I was going to ask you to describe your system of feedback. Is it systemised? Is it available on request?
  (Sir William Wells) I reply to every single major complaint personally.

  869. Complaint? Rather than a systematic offering of feedback to anyone who requests it rather than to make a complaint.
  (Sir William Wells) Okay. Yes.

  870. I think you take my point.
  (Sir William Wells) What happens is someone does not get appointed and they are written a letter saying they have not been appointed, thank you very much indeed. They then say they want to know why. They either ring up or write and they will be asked by the relevant person on the staff would they like to see a copy of their interview notes or the sift panel notes. If they say yes, they get sent those. If after that—and I have to say this is a relatively small number—they feel that an injustice has been incurred, then they write to me. If I am unable to satisfy them and they are concerned about the process rather than the quality of the decision, then they write to Dame Rennie Fritchie. That is the process.

  871. Forgive me, that sounds like a complaints process rather than what I understand a feed-back system to be and one that I would hope we would want to advocate. If people have gone to the trouble of making an application or have gone through the interviewing process and then have in some way failed to meet the criteria, then surely those are the people, who have expressed that interest, who are worth sustaining and encouraging and supporting to make further applications.
  (Sir William Wells) I agree.

  872. Either to a health appointment or to some other public sector appointment and an objective, constructive sort of feedback is very different to the complaints system you have described. Are you saying that does not exist? It is an opportunity for that.
  (Sir William Wells) I agree. We were only discussing at the Appointments Commission board last month, now that we have a bit more time, now that we have got through the bulk of the huge amount of appointments we had to make because of the reorganisation in the health service, that we need to be more selective and pro-active about the way in which we tell people that they have not been appointed. In some cases it is only fair and right to tell them that they have not been appointed and not to give them any hope, because there are a significant number of people, frankly—

  873. That can be achieved in a good feedback system.
  (Sir William Wells) In a perfectly and decent and nice way. There are some people who have not quite made it, for a variety of reasons, and we feel somehow or another we need to keep them much more interested than we are at the moment and we are working on that. People who are near-misses we do write to especially and say, you know, "You have been a near-miss. Hang on in there because we think you could stand a very good chance of getting something in a shortish period of time."

  874. Could I just push you a little further. You talk in your memorandum about encouraging people from ethnic minorities and people with disabilities to come forward, and you have established advisory groups from black and ethnic minority non-executives and disabled non-executives to advise on how you should do that. It seems a little bit incestuous to me. Have you made any arrangements for taking external advice? You are taking advice from people who have made it through the existing system.
  (Sir William Wells) In fact some members of those groups are actually not non-executives. They are not involved in the health service. To the two people that we put together to chair these groups we said, "You should draw mainly from the NHS but if there are other people you think could make a really good contribution to that, please use them". There is certainly one, if not two, on the BME group who are not anything to do with the National Health Service.

  875. It is easy to think of voluntary sector organisations and statutory organisations that might have a useful input rather than just trying to do it from internal sources.
  (Sir William Wells) We are making use of standing groups, advisory groups, because they are extremely valuable to us, but we are also encouraging them to bring in people who they feel can help in a particular thing in order to advise them. Although broad statistics of gender and ethnic balance are pretty good, they disguise some areas where we are not at all good, and that is the real challenge for us. There are certain geographical areas where we have very significant ethnic populations where we are not scratching them. We are very good in London but we are less good in some parts of the Midlands and the north. A lot of that is actually getting the right people in those communities, to get them along and find out from them how we can best penetrate those populations and then go out and do some really pro-active spreading of what it is all about to be a non-executive in order to get some representation.

Annette Brooke

  876. In the notes we have it says that part of the selection process is to ensure that non-executives understand legal needs and issues and that through them the community feel a sense of ownership and participation, and you just touched on those same terms in regard to the question of foundation hospitals. In what way is your selection process actually tapping into the community to find out what they want in terms of skills and merits and so on on these bodies? I am particularly concerned about PCTs, which I feel should be very close to the local community but in my experience do not seem to have that feeling of ownership and participation.
  (Sir William Wells) Can I answer the question in a slightly different way, and I will come back to the PCT point which you made. The responsibilities and accountabilities of members of these boards are pre-prescribed, and they are very considerable. This is the thing that many people do not understand. When you come on to the board of a trust or a health authority, you are accountable for the financial well-being of that organisation, personally and corporately, and we are not talking about small organisations; the minimum size is about £100 million, and a lot of them are half a billion pounds. You are also accountable directly to the Secretary of State for delivering his targets, government policies and the like. You are also, obviously, charged with making sure that you improve the health care of the people for whom you are responsible. A lot of people, when they realise that, withdraw their application, because it is not what they thought it was, and we must not live a lie here. This is something I feel very strongly about. I think it would be quite wrong not to level with people as to the responsibilities they are taking on. They are very considerable, and things can go wrong. Those of you who have no-star trusts in your constituencies and see the chairmen and non-executives disappearing very quickly out of the door will know this, because that is what they do if they have failed. This selection severely affects their local standing, and people need to be aware that accountability means accountability, and it is not just a talking shop to reflect what everybody might want to do. As far as PCTs are concerned, they, of course, have got to reflect what people want, but they have the same accountabilities and responsibilities as all of the other trusts. They have to deliver their budget, they have to procure the health care in an efficient and proper way, and they have to deliver the Government's targets. I was only saying at the PCT Conference last week in Harrogate that what we want PCT non-executives to do is to create an infrastructure which will enable patient and public involvement, so that they know what the public want. They should not spend a huge amount of their time doing that themselves. We are going to have patient forums, which will be considerable, attached to every PCT. Every PCT will have up to 20 people on a forum. We want them to be able to set the infrastructure so that they can find out from those organisations what it is that is going on and what it is that their public wants of them.

  877. This just goes deeper and deeper. Anybody who has questioned treatment and what they have been offered one would think might well be weeded out of even that process. It does seem to me you have really quite a problem when you make a claim that the community has got to feel a sense of ownership, yet there is such a huge gulf.
  (Sir William Wells) Dare I say it: I imagine the people who will go on to patient forums will be the people who are on CHCs. They will be drawing from the same pool—voluntary organisations, normal people and the like—but people have to volunteer. They do not get any remuneration for it. It will differ from area to area. I know that we have appointed the Chairman of the over-arching national body recently, Sharon Grant. I was talking to her the other day and I know she has some very firm ideas about ensuring that we get people on to these who do truly represent the communities for which they are responsible, and that is going to be easier, because they do not have the considerable range of responsibilities and accountabilities that a non-executive director sitting on a board has.

Sir Sydney Chapman

  878. Sir William, there is a contradiction between what you submit in your memorandum and what you told us earlier on. You may have cleared this up just now, but I would like to press you. You said you had had in the last year or so, I think since June 2001, 32,000 applications for 2,000 posts.
  (Sir William Wells) Expressions of interest.

  879. That is what I wanted to pick you up on, because in your memorandum you say "generated 32,000 expressions of interest resulting in 14,000 applications," so less than half. Did someone in your office go through those expressions of interest and find some people were under a misapprehension about the sort of job it was?
  (Sir William Wells) No. We send a pack to every single person expressing an interest. This pack sets out the information pretty simply, and we think very clearly. In fact, everybody does say this is very good. It is at that stage that peple say, "Crikey!" Eighteen thousand of them say, "Crikey!" and put it into the waste bin.

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