Select Committee on Public Administration Appendices to the Minutes of Evidence

Memorandum by Observers to the Board of the NHS Appointments Commission (PAP 68)

  David Bower and Wendy Mason were appointed as Observers to the Board of the NHS Appointments Commission in May 2002. David Bower had previously contributed, as a member of the scrutiny team, to the OCPA Report on the NHS Appointments process conducted in 2000 and was therefore familiar with the operation of the previous, decentralised NHS recruitment organisation. Both Wendy and David, who were previously Human Resources Directors of large organisations, have had substantial experience of the operation of centralised and decentralised recruitment processes and the issues associated with the management of change in organisations.

  The role of Observer to the Board of the NHS Appointments Commission was created in discussion with OCPA and in line with the commitment of the NHS Appointments Commission, to improve the NHS Appointments process and public confidence in it.

  The role is required in order to fulfil the OCPA guidelines of independent scrutiny throughout the whole public appointments process, as Ministers have delegated their responsibility for making appointments to the NHS Appointments Commission Board.

  The Committee has already received a submission from Sir William Wells, Chairman of the Board of the NHS Appointments Commission.


  Our comments are based on attendance at Board meetings in the last 12 months.


  The new Commission was established following the OCPA report in 2000, which included 28 recommendations for improvement.

  Of the 28 recommendations contained in the OCPA report, some, notably those concerned with the role of the regional offices in the appointments process, were overtaken by the Health reorganisation. All the others have either been implemented or are in the process of being implemented as part of establishing the Commission itself.

  Initially the work of the Board was hampered by:

    —  the significant increase in workload associated with the establishment of the new NHS structures viz; Primary Care Trusts, Strategic Health Authorities and the like;

    —  the simultaneous introduction of new processes and procedures;

    —  lack of familiarity with those processes and procedures;

    —  under resourcing in both the Leeds and London offices;

    —  the lack of a suitable, fit for purpose IT system early in the establishment of the Commission;

    —  on-going development of appropriate templates for Board submission papers listing the critical factors on which decisions would be based;

    —  inconsistent documentation of submissions from the two offices;

    —  lack of familiarity and understanding of the new roles and accountabilities of the Commission, the NHS the DoH and responsible Ministers.

  In spite of the above, and due to the commitment of the Board and all the staff in the Commission, high volumes of appointments have been managed and progress made in improving the efficiency of the Commission's services.


  Our view is that the Commission has been open to suggestions for improvement in all aspects of its operation. Meetings have been conducted in an open and supportive manor encouraging contributions from the Regional Commissioners and the Observers present.

    —  the standard of documentation of submissions has improved significantly, enabling the Board to focus on matters of substance rather than detail, and hence deal with an increasing volume of appointments;

    —  the IT system introduction is close to completion, which will enable more efficient working and improved data reporting;

    —  there is now an, almost, full complement of staff, which enables the Board to focus on, more strategic as well as operational issues;

    —  flexibility to deal with urgent issues, such as the authorisation of key appointments is demonstrated by the selective use of quorate conference call Board meetings.


  We would note that any issues of perceived or actual underperformance in the new Commission were addressed promptly when raised, in no small measure due to the openness with which the Board handled them as they occurred.

  We would also note that many if not all of the issues associated with the introduction of the new Commission could have been minimised if it had been possible at the time to:

    —  develop and implement a change management transition plan which covered not just the new roles expected within the Commission itself but also the new roles and responsibilities of the other stakeholders in the appointments system viz; the new NHS, the Strategic Health Authorities the DoH;

    —  to include contingency plans to cover unplanned increases in high volume campaigns ie: those associated with the introduction of the new NHS structures;

    —  make available earlier a fit for purpose IT/data recording system;

    —  issue earlier clarification of consistent standards of and accountability for performance and governance.

  Significant change affecting, in this case, the people, the processes and the organisation structure accountable for, over 1,600 appointments were made in the first year of operation, has been effected despite the lack of some key requirements to achieve those changes efficiently and effectively.

  Those responsible for further changes, particularly if on the same or greater scale have the opportunity to learn from the experiences of the NHS Appointments Commission.

David Bower and Wendy Mason

February 2003

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