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Baroness Jay of Paddington: I thank the Minister for her very detailed reply. It put much more flesh on the bones which before had been rather bare. She mentioned the need for chairmen to achieve links with the universities, which were being encouraged by the Secretary of State. That is precisely the kind of informal arrangement, which depends on individual personalities and the good will of different people in different parts of the country, about which the CVCP has felt uneasy. But I fear that, though the Minister has put much more flesh on the bones, the clear and unambiguous formal

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mechanism that is asked for is far from being in place. I also suspect that the arrangements for consultation that she has described will not quite meet the requirements of the CVCP. However, as the noble Lord, Lord Walton—the original author of these amendments—is not present, on the understanding that he may wish to bring the matter back at Report, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Jay of Paddington moved Amendment No. 19:

Page 19, line 41, leave out ("appointed by the Secretary of State") and insert ("elected by members of the authority.").

The noble Baroness said: In moving Amendment No. 19, I should also like to speak to Amendments Nos. 21 and 22. All three are exploratory amendments designed to look at ways to improve the selection of health authority members and suggest alternatives to those that are proposed by the Government. They try to address some of the public anxiety that surrounds the question of appointments to health authorities. They are also designed to root health authorities in their local communities and correct the so-called democratic deficit. If authorities and trusts are to retain and improve public confidence, a rigorous process of selection, appointment and reappointment of their boards is necessary. At the moment, the practice varies between the different territories and, within England, between the various regions. We know that the regions in their present form will cease to exist, and there is little evidence of awareness of a need for some universal standards to be applied.

I remind the Committee that the Committee on Standards in Public Life of the noble and learned Lord, Lord Nolan, has received more representations on the question of membership of health authorities than on any other subject. The evidence given to that committee by the National Association of Health Authorities and Trusts was that, in order to improve the present situation, more people needed to be attracted to putting their names forward for consideration for appointment. Greater balance needed to be shown in the people appointed in order to embrace different skills, experience, attitudes and background, and the process of appointing and reappointing chairmen and non-executives needed to be transparent and more rigorous.

Amendment No. 19 addresses the question of how the chair of a local health authority will be selected. The Committee will know that the Bill proposes that this should continue to be done directly by the Secretary of State for Health. The amendment proposes that, although this may continue to be someone appointed under a selection system, which I shall describe as one alternative in a later amendment, once one has agreed a group of local people (all, it is to be hoped, with local interests and local responsibilities) and who must know each other better, one assumes, than the Secretary of State, they should themselves elect their own chair. After all, that is done at every level in every organisation, whether it is a voluntary body, a political party, any form of charity or any other informal organisation.

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The amendment would correct some of the feeling that all chairmen are simply there as place people of the Secretary of State. I shall forbear this afternoon getting into the argument about whether they need to be political place people. If a simple system were adopted whereby on a more free basis members were appointed to authorities, there should be little to stand in the way of the local members, with their local appreciation of each other and their understanding of the qualifications of their colleagues, electing their own chairman.

Amendment No. 21 refers to a method which was originally suggested by Mrs. Winifred Tumim. She has written about this proposal in the Health Director magazine this year and has also canvassed the idea very widely. She is a non-executive member of a London trust and has enormous experience in the voluntary sector. Drawing on that experience she has suggested—I am in agreement with her about this possibility being considered—that community health councils could act as a form of electoral college and that perhaps two or three board members could be elected by that local community health council. Candidates would have to agree to give a minimum monthly time commitment and a commitment to undertake training on appointment. It would not be possible to serve on both bodies simultaneously, although CHC members in their current role would be eligible to stand for election. Once selected, the elected board members of the community health council would serve as individuals and not as representatives of that council.

Although that process may at first sight seem somewhat cumbersome, it is a proposal which enables people who are involved in their local community and who have already shown an interest in the management and operation of the health service to become more formally involved in the decision-making process and, indeed, to reach that level by a form of election. Community health councils, as we discussed during the previous Committee day debate, have sometimes come to feel rather marginalised in the new organisation of the NHS. This would be a way of ensuring a degree of community health council involvement at a very important level and would also add an element of election into new health authorities which I think could be very appropriate.

I suspect that the Minister will reject out of hand both Amendments Nos. 19 and 21 partly because they include this element of election. But I would hope that she would look favourably at the suggestion of Amendment No. 22, which would simply bring the situation in England and Wales into line with what is now happening in Scotland. Perhaps I may remind the Committee of the situation in Scotland. Last August the Secretary of State for Scotland announced the creation of a committee of five, which I believe is chaired by the Lord Provost of Edinburgh, to advise him on the appointment and reappointment of non-executive members of health boards and directors of trusts. That was repeating an earlier exercise which was conducted two or three years ago and was intended to broaden the selection base for health authorities and trusts.

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Invitations were issued in Scotland to a wide range of bodies which represented many different aspects of community life. Opposition party leaders were invited to put forward names, and advertisements were placed in newspapers across the country inviting people to put forward their names. Initial interviews are undertaken by the chairmen of relevant boards and trusts and recommendations are then forwarded to the advisory committee for consideration. In addition, reports are submitted of those existing members of boards and trusts who wish to be considered for reappointment. That seems to be a system which we could well adopt south of the Border. There seems no reason why this independent advisory body should not in some form or another be part of our system in England and Wales.

Consideration should also be given to the appointment of an advisory committee on appointments within each of the territories—in England, each of the regions—which would embrace regional chairmen or the regional non-executive members of the NHS policy boards, as they will be after April 1996, and eminent people from outside the NHS who could advise the Secretary of State on the appointments and monitoring process. That would be broadly similar, again, to the arrangement in Scotland. Once that advisory board had screened the names initially put forward, a chairman or a non-executive person nominated for such a position should be asked to attend a briefing seminar to make them aware both of the problems and the issues that may arise from being a member of a health authority board or trust and aware of the commitment that they would be asked to take on. That might absolve many of the authorities and trusts from some of the difficulties which we described as being current when we discussed an earlier amendment. People shortlisted for appointments should be asked to give the names of referees and should be interviewed by a panel established for that purpose.

I would remind the Committee that when Mr. Langlands, the Chief Executive of the Health Service, described to Lord Nolan's Committee the arrangements which the Government are now suggesting for improving the selection to health authorities and hospital trusts, the committee members described themselves as being disappointed by the suggestions. They described the suggestions for reform, which also include advertising but no formal independent scrutiny by an independent body, as "inbred", and they criticised them because there was no suggestion of any form of election and, more specifically, because of the lack of independent assessment.

These amendments, which are exploratory and designed partially to make suggestions about ways in which the present situation could be improved, would meet those three criticisms. They would meet the criticism that the Government's suggestions are inbred; they would meet the criticism that there is a lack of election; and they would meet the criticism of there being a lack of any independent assessment of those

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putting their names forward or of those whose names are put forward for appointment to these trust bodies and authorities. I beg to move.

4 p.m.

Lord Tope: I rise to support Amendments Nos. 19 and 21, but not Amendment No. 22, about which we have reservations. The noble Baroness, Lady Jay of Paddington, has made the case very well indeed for some form of independent appointments committee. She is certainly right in saying that there is great concern about the current method of appointment to health authorities. The proposals she has put forward are an interesting way of trying to address some of those anxieties. At the very least, members of health authorities should have the right and should be trusted to appoint their own chairmen. After all, that is what the Government have allowed the new police authorities to do. If the Minister is not minded to accept the amendment, I hope that she will explain to the Committee why the Government feel that police authorities can be trusted to appoint their own chairmen but that new health authorities cannot be so trusted. We support Amendments Nos. 19 and 21.

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