Memorandum submitted by Jane Hanna (PCT
48)
I am writing to ask whether the Health Select
Committee will receive further evidence concerning the issue of
the democracy and the role of the Non-Executive Director? I noted
the concern raised in the Health Select Committee on Thursday
10 November regarding the potential democratic deficit arising
as a result of a significant reduction in the number of Non-Executive
Directors. It concerns me greatly that accountability for the
acceleration of outsourcing of NHS services including possible
contracting out of Commissioning is to rest with Primary Care
Trusts as I believe there is an existing serious democratic deficit
which is likely to worsen with the proposed merger of PCTs.
My interest in this matter is as a former Non-Executive
Director of South-West Oxfordshire Primary Care Trust (2001-04)
and Non-Executive Director of the Oxford Radcliffe Infirmary NHS
Trust (1993-97); as a Tutor in Constitutional and Administrative
law at Keble College, Oxford and as a District Councillor for
the Vale of the White Horse. I became committed to public and
patient involvement in the NHS following the sudden unexpected
death of my partner in 1990, which also led to my founding a health
charity, Epilepsy Bereaved and working as a member of the Joint
Epilepsy Council.
I believe that South-West Oxfordshire PCT was
the only PCT in England where the Non-Executive Directors and
the Board voted in 2004 against the contracting out of cataract
operations to Netcare. Our experience described in summary below
represents a test case of the effectiveness of Non-Executive Directors
in ensuring accountable and locally responsive decision making
particularly in the context of the outsourcing of public services.
As Non-Executives we were categorically told
by managers from TVSHA that if we did not vote in favour of the
Netcare contract we would be liable to a personal surcharge. Subsequent
to our decision not to contract with Netcare, we were criticised
by TVSHA in the Oxfordshire press and substantial inappropriate
pressure was brought to bear on Board members leading to a reversal
of out Board decision in an emergency meeting held within a week
of our original decision (four Non-Executives did not alter their
original position). Local Oxfordshire MPs including David Cameron,
Evan Harris and Tony Baldry were kept fully briefed of the facts
of this affair at the time and gave what support they could at
the time to the Non-Executives.
Our Chair, Martin Avis was the only Chair in
Oxford not to have his position renewd by the NHS Appointments
Commission and he told us that the reason given to him was the
vote on the Netcare contract. The Chair of the Strategic Health
Authority subsequently resigned and went public about her concerns
about the lack of independent and accountable decision making.
File on Four reported serious allegations of
political interference with the PCT, but no independent or internal
inquiry was ever held despite the request of our Chair. An Independent
Review of eye services in Thames Valley commission by TVSHA found
that the Netcare contract posed risks to Thames Valley eye services
in Oxfordshire where extra capacity was not needed. There has
been no accountability for the Netcare contract decision, not
for the interference with the South-West Oxfordshire Board. In
subsequent outsourcing decisions such as contract with Capio we
were told repeatedly in no uncertain terms that not only did the
non-executives have no option but to agree to all outsouring proposals
but also that we must present these decisions as local decisions.
I resigned as a Non-Executive Director in June
2004 because of a number of issues including my experience on
the Netcare contract decision. I considered that it would not
be possible for me to fulfil my statutory governanace responsibilities.
These were described by Lord Warner in evidence to your committee
las week:
"Non-executive directors in the new PCTs
will be in exactly the same position in discharging their non-executive
functions as the non-executive directors in the current PCTs.
They will be in the majority, they will discharge the same functions,
they will hold the chief executive and other members of the executive
board to account. I though this was rather elegantly explained
by Mr McIvor to you last week."
I am enclosing a set of some of the supporting
papers relating to this matter including the following:[59]
Letter from Non-Executives to John Reid, Secretary
of State for Health (requested by our Chair, on the day following
our Board decision, on the instruction of TVSHA but never sent
by TVSHA).
Statement of Reasons by South-West Oxfordshire
PCT Non-Executive Directors.
Notes of an emergency meeting of South-West
Oxfordshire PCT Non-Executive Directors.
Although these events happened in 2004 I am
aware of one Non-Executive Director in Oxfordshire who allegedly
has received ongoing threats of discipline which he believes are
due to the fact that he continues to challenge decisions and another
Non-Executive in Oxfordshire who has recently resigned in order
to speak to the media about his public interest concerns.
I appreciate there are serious allegations contained
in this letter and have contemporaneous records available to produce
a more detailed memorandum should the Committee consider this
helpful.
Jane Hanna
12 November 2005
59 Not printed. Back
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