Examination of Witnesses (Questions 900
- 919)
THURSDAY 24 OCTOBER 2002
SIR WILLIAM
WELLS AND
DR ROGER
MOORE
900. You then go on to say, "providing
monitoring of chairs, undertaking regular appraisals of chairs"—how
do you do that? Do you have a written report of non-executives
or what?
901. We have introduced for the first time in
the National Health Service appraisals. This is an annual appraisal
of the chairman and non-executive directors, as well as for the
first time that the chief executive and the executive directors
have objectives set.
902. Targets?
(Sir William Wells) No, objectives.
Chairman
903. Would you explain the difference between
an objective and a target?
(Sir William Wells) Some of them can be quite soft,
and you cannot have a soft target, because a target is normally
a number or a quite clearly expressed situation, whereas some
of the objectives are softer things like improving the standing
of the hospital with the general public.
904. So it is soft and hard.
905. Yes. Of course, the objectives will be
a mixture of government targets and softer objectives, but we
call them all objectives.
Mr Liddell-Grainger
906. So can you have in an appraisal both a
target and an objective?
(Sir William Wells) We call them objectives, but of
course, a lot of them are targets, because they are things which
are imposed upon the trust from above and therefore we have to,
quite properly, reflect those through the performance of the board.
907. So does an appraisal have a line of boxes
called targets and a line of boxes which says something else?
How do you do it?
(Sir William Wells) Effectively an appraisal sets
out the pre-agreed objectives, so there is a session at the beginning
of the year between the two, the appraiser and the appraisee,
and they agree the objectives. At the end of the year you have
another session, and you sit down and decide between you whether
the objectives have been achieved, and the appraisal is the document
which is agreed between appraiser and appraisee and signed off.
908. So you have done the year, and you have
not quite achieved all the things you thought you were going to
do. Is that a public document?
(Sir William Wells) What will be public is whether
the trust has met its targets, but the appraisal is a document
which is between the appraiser and the appraisee and the Appointments
Commission.
909. But what we do not know is whether the
chairman of that committee or whatever is the one that is not
performing, or whether or not it is the targets are too onerous
to be achieved by that board.
(Sir William Wells) The Regional Commissioner and/or
the strategic health authority chairman is responsible for appraising
the chairman. That person will have the appraisals of the other
people on the Board so that they will have a knowledge of the
outcome of those appraisals when they do the appraisal of the
chairman. It is going to be at least 100 if not a 200 per cent
improvement on what we have at the moment, which is nothing, and
therefore you go on hearsay and hope.
910. Yes, I accept that, but what I am getting
at is that you are responsible for these people. You have to assess,
at the end of each year, whether they are doing the job they are
meant to be doing. You need an appraisal which is an objective
round-up of that person. Are you going to be able to get that
to make decisions on situations which may arise where things have
not been achieved, so that you can say, "That's all right;
leave him" or "That's not all right, out"?
(Sir William Wells) Yes.
911. Do you get three strikes and you are out?
(Sir William Wells) The system is that everybody is
appointed for four years, and ideally we would like to re-appoint
people for three or four years after that. They will get re-appointment
without competition if they have four appraisals which demonstrate
that their performance has been consistently good over those four
years. If they have one year when it is not deemed that their
appraisal is good, that will be taken into account and they will
not be automatically re-appointed. I suggest if they have two,
steps will be taken to make sure that they go.
912. Do they sign their appraisals to say acceptance?
(Sir William Wells) Yes. Then, as I said, they are
looked at by the strategic health authority chairman.
913. Are they signed by them and accepted as
a true representation of what they think has gone on in that year
in that trust?
(Sir William Wells) Yes, and the other person has
to sign to say they also agree that it is an accurate reflection,
and it may well be that they do not agree. If they do not agree,
it goes up to the grandfather.
914. That was my next question. Who is the grandfather?
(Sir William Wells) The strategic health authority
chairman or the commissioner.
915. Depending on who it is or what level it
is?
(Sir William Wells) The commissioner is the person
who is responsible, but there is often a mismatch. We were introduced
as a body before the government decided upon strategic health
authorities. They subsequently decided on the introduction of
strategic health authorities and they said they were responsible
for the performance management of the trusts. Therefore, we said
pragmatically, "Look, if you are responsible for the performance
management of trusts, you should actually be responsible for the
performance of the individuals on the board, and accountable to
us for it." This is done in different ways across the country.
In some cases strategic health authority chairmen ask the regional
commissioners to do some of these appraisals, and in some cases
they do it themselves, but whatever the outcome is, the team of
the strategic health authority chairman and the regional commissioner
will decide on whether action is needed or not, and if it is,
they will make a recommendation to the board.
Chairman
916. Can you have an excellent chairman of a
no-star trust?
(Sir William Wells) You can indeed, provided that
the chairman has not presided over the no stars. We have come
to a fairly pragmatic decision, which is not a rule, but if a
chairman has been with a no-star trust for longer than 18 months,
in most cases we would suggest that that person is responsible
for the no stars and therefore should go. What we are endeavouring
to do—and we are working very closely with directors of
health and social care in this—is to anticipate this, because
I think it is bad news when suddenly somebody decides that a trust
has no stars and everybody says, "My goodness! This is a
terrible surprise. We need to sack the Chairman and the Chief
Executive" when we actually should know a lot further in
advance than that, and that is the reason for the appraisal system.
If we see a trust is descending down through the stars and the
appraisal looks a bit iffy, then that is the time to take action,
before they become a no-star trust.
Mr Prentice
917. Do you ever organise "away days"
to train boards to work together?
(Sir William Wells) We have a very comprehensive training
programme. It did not exist before. It was very patchy. London
was quite good. The rest of the country was pretty poor. What
we have done first and foremost—and the last line of questions
was interesting—is we are setting in train some very high-quality
appraisal training to take place over the course of the winter.
Chief executives are going to be involved in that, so that we
have the executive taking the same approach as the-non-executive
side. It is the first time it has ever happened. It is very important.
When we have got through that, so that we can hopefully have some
really proactive appraisal processes in the spring, we are going
to be introducing whole-board training—again, this has never
happened before—where executives and non-executives, alongside
each other, are actually trained in how to operate as a board
and get a much better understanding—and this is one of the
big problems, that executives do not understand what non-executives
are about, and non-executives are pretty unclear as to what executives
are about. A lot of boards are far less efficient than they should
be as a result of that, from one small but very fundamental misunderstanding.
We will be starting quite simply, taking boards away, getting
them to understand what each other's roles are, how they can best
work together and the like, and that will be the bulk of the training
for 2003. We think we will get a step change in performance as
a result of that. I think we will be able to see that not only
internally but externally, coming back to your point about how
they interface with the community. I think there is a lot of confusion
about how they should do that, which means it is getting lost.
918. I take it that all those appointed actually
use the NHS?
(Sir William Wells) They are not required to say that
they are, but it would be pretty odd if they did not, frankly.
919. Why not just ask them?
(Sir William Wells) We actually ask it. There are
many questions on the application form, such as "Are you
a patient, a carer, a user? What are your views about the ideals
of the NHS?" There are zillions of questions. You can soon
suss out whether somebody is just standing on the sidelines.
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