Memorandum by Professor Alasdair Breckenridge,
Department of Pharmacology and Therapeutics, Liverpool University
Question 1. Justification for filling public offices
by appointment rather than election.
There are two distinct type of appointments
to public office. First, there are those which require technical
scientific expertise in very precise areas. Second, there are
those where broad experience but not in a specific area is required.
While the second type should normally be filled by election, it
is more difficult to justify this for the first type. What is
often done for the first type is to draw up a list of candidates
with the appropriate background from which a panel will select
one. While this is not strictly speaking an election, it has a
greater semblance of democracy than merely choosing one person.
It must be said, however, that on occasion the number of appropriate
candidates might be very small.
Question 2. Consequences of election rather than
For the first type of appointment described
above, open election would mean that many applicants will not
have the necessary scientific expertise to allow the relevant
committee to function. For example, the Committee on Safety of
Medicines (CSM) requires expertise at high level in a number of
precise areas to allow it to come to its recommendations. Open
election would not be an appropriate method to fill these appointments.
In contrast, CSM also has lay members and it is entirely appropriate
that these appointments are made by election.
Question 3. Civic Duty.
Question 4. Priorities for improvement of the
The first priority is to make the system more
open and comprehensible by the public. The second is to rid the
system of overt political influence.
Question 5. Role of Government Departments.
The system as described has evolved over recent
years especially as regards the involvement of outside assessors.
I consider that it is in general satisfactory. It has the great
merit that it works.
Question 6. Inconsistencies of Government's approach.
Dame Rennie Fritchie's most recent report is
not entirely clear as to the extent of political influence on
Question 7. Political influence.
There has been, and in some quarters still is,
considerable evidence relating to appointments to Health Authorities
and NHS Trust Boards that the government party of the day held
undue influence over these appointments. One would hope that changes
in the appointment process including the appointment of the Commissioner
(Dame Rennie Fritchie) would have tempered these excesses.
Question 8. Role of politicians.
Members of Parliament should have the same rights
as any member of the public to put forward names for public appointment
and there their role should finish. They should not have the right
of veto of an appointment as has happened in the past in the NHS.
Question 9. Evidence of political bias.
I have not seen the latest data on declarations
of political affiliation to NHS appointments. At various times
over the past 10 years, such lists showed evidence of political
Question 10. Acceptability of political bias.
One should work in a system where once political
bias is abolished, it should not be allowed to return. I hope
and believe that we are approaching this situation in the UK.
Question 11. Role of Parliament.
The system of public appointments should be
the responsibility of Parliament as should any modification of
Question 12. Independent Appointments Commission.
For all the reasons given above (eg the need
for specific expertise in particular areas) I am content that
such appointments remain the responsibility of Government Departments,
provided the necessary safeguards discussed above are put in place
and are seen to work.
Questions 13 and 14. No comments.
Question 15. Remuneration.
I suspect the answer to this question is yes.
There are marked discrepancies in remuneration for different public
bodies whose reasons are not obvious. On one hand it is attractive
to suggest that no member of a public body should receive remuneration
but that is unrealistic in this age. Abolishing remuneration would
decrease the diversity of membership, and a realistic comparative
appraisal of the scale of remuneration and its publication would
be helpful and appropriate.
Question 16. Understanding of the process by the
Clearly the public do not understand the process.
Many appointees to the system do not understand it either. The
clarity of the process has moved forward but there is still a
long way to go.
Question 17. Improvements.
This must be a slow process. Articles in newspapers
and programmes on TV help to make the process more understandable.
I do not know if the government issues a booklet on the appointment
process which is written in easy to understand language; if not,
it might be an idea.
Question 18. Role of the Commissioner.
I have read what Dame Rennie's remit is, and
I have given evidence to her on specific issues. At the time that
we met, her main preoccupation was with the extent of political
influence on appointments within the NHS, but her remit is broader
Questions 19 to 23. No comment.
Question 24. New NHS system.
I approve of this strongly. It was badly needed.
Question 25. Application forms and interviews.
I can see no reason why such people should not
complete application forms and be interviewed. It should be clearly
seen that the public appointment system is open and fair at all