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Baroness Cumberlege: The appointment of the chairmen of health authorities by my right honourable friend the Secretary of State provides a direct line of accountability from the chairman, through her, to Parliament. To break that line by the election of the chairman by his or her colleagues on a health authority would reduce that accountability rather than improve it. An internal system of making such an important appointment flies in the face of all our moves to open up the appointments process. It would only lead to more allegations of "jobs for the boys and girls".

The Committee will be aware that on 14th February the Secretary of State published new guidelines on the appointments process. They reinforce the key principles of the appointments process that all appointments should be made on merit and individuals appointed solely for the skills, experience and the commitment that they bring to the National Health Service. Appointments should be open to as wide a range of people as possible. The process for identifying appointees should be transparent and clearly understood by candidates and the public. A policy of equal opportunities should be pursued.

We could not ensure that these very simple principles were adhered to if the appointment of the chairman was conducted by the members of the health authority. This amendment would do nothing to make sure that appointments were made openly on the basis of merit.

The Secretary of State is able, when making the appointment of chairmen, to look at the matter impartially, with due regard to the advice of others. She can ensure that her decision is based on what is best for the health service rather than on what is best for those appointed to serve on the authority.

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The appointment of chairmen by the Secretary of State means that national standards are applied to these key appointments, ensuring that every health authority across the country will benefit from the appointment of the highest calibre chairman.

The new guidelines on appointments made it clear—

Baroness Robson of Kiddington: The noble Baroness spoke about people having not the same feeling and desires to do the right thing by the health service because they have not been appointed by the Secretary of State. That is absolutely unforgiveable. The fact that people are members of an authority and elect their own chairman does not make that chairman less responsible to the Secretary of State. It certainly does not make them less able.

Baroness Cumberlege: As I continue the noble Baroness will realise that what we are also trying to achieve is criteria against which the chairmen are judged. The criteria are set out; they are public and people can then judge. We feel that that would not be possible if health authorities elect their own chairmen from within. Having been a former chairman, as I was, the noble Baroness will be aware that special responsibilities are laid on chairmen. It is a national health service. The Secretary of State is accountable to Parliament for the whole of the National Health Service. We believe it right that she should have confidence in the chairmen who represent her at local level.

Baroness Jay of Paddington: I am sorry to interrupt the Minister. That is a rather peculiar argument. If, on the Government's arrangements, all the members of a health authority are appointed by the Secretary of State—and certainly in the subsequent amendments it is simply to improve the method of assessing the people who are appointed—presumably they all enjoy her confidence. Therefore, what is to prevent members of the health authority, if they are all responsible people, from electing the person whom they feel is most appropriate judging, if one wishes, on the criteria which the noble Baroness says are published and available?

4.15 p.m.

Baroness Cumberlege: Serving on a health authority, the noble Baroness will appreciate that when one is trying to build a board one chooses people with different skills because they bring forward different talents. The chairman has a different role from many of those people. One would perhaps choose as a non-executive someone who has special skills in finance or special knowledge about voluntary organisations in that area. But the leadership role of the chairman is different. It is very logical that the Secretary of State, who has to have confidence in the chairman, should appoint that person, believing that that person has the special skills to lead the team and is not someone who just makes a contribution to a team.

I now turn to Amendment No. 21. The new guidelines on appointments make it clear that all new candidates for non-executive appointments will be sifted by a panel of at least three people. Those chosen to serve on sifting panels should be local health authority or trust chairmen

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or non-executives. We believe that they are best placed to judge whether a candidate is suited to the demands of service as a non-executive director, because they are already working in this area.

The noble Baroness mentioned the Nolan Committee. The Government are committed to a transparent, fair appointments process for NHS boards. We will consider carefully any recommendations that come from the Nolan Committee.

We recognise the need to avoid bias. The guidelines emphasise that the members of sifting panels should not be all drawn from the same NHS health authority or trust board and that the panel may include an independent member. This might be a member of a local community health council, or, for example, a local justice of the peace. The views of people who are more detached from the NHS can also be valuable.

The panels will sift all new candidates against agreed criteria so that all those recommended for appointment possess the skills, personal qualities and experience required. This use of nationally agreed criteria, against which experienced NHS chairmen and non-executives will judge candidates for non-executive appointment, is the most important element of the sifting process. It will ensure that those being recommended are of a uniformly high standard.

The new guidelines also emphasise the role of regional chairmen in the appointment process. They will make their own assessment of candidates before making recommendations to Ministers. This means that the suitability of any individual candidate will be double checked before he or she is recommended. So the appointments process will be conducted objectively and fairly and those finally selected really will be the best people for the job.

The noble Baroness, Lady Jay, mentioned the Scottish system. We do not agree with the noble Baroness that the Scottish system of appointments, where Ministers are advised by an independent panel comprising people from outside the NHS, should be adopted in England. The population of Scotland is broadly equivalent to one of the eight regions in England. Problems of scale would make it extremely difficult to adapt Scottish practice for use in this country. In England the regional chairmen, who are themselves appointed for their independence, will be responsible for the rigour and integrity of the new system and will advise Ministers on appointments.

As regards Amendment No. 22, we have already spoken during earlier debates about the valuable role of community health councils. They are the patients' defenders, friends and representatives and we know that they are diligent in monitoring the service. They have a well deserved reputation for independence, authority and insight.

Community health councils have a statutory responsibility to represent the interests of the community in the National Health Service. Indeed, they have the right to be consulted on any substantial changes in services to local patients. These are important safeguards which ensure that CHCs have a voice in the

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management of the NHS. In addition, CHCs have observer status on health authorities and the right to meet them annually.

As I made clear in an earlier debate, there will be no change in the requirements of health authorities to consult community health councils.

But the Government are not convinced that the proposals in this amendment would improve the workings of health authorities or of CHCs. We have the same reservations as the noble Lord, Lord Tope. As I understand it, this amendment will add community health council nominees to the executive and non-executive members. I would be very concerned if, as a result, the health authority began to get much larger than the dozen or so members we now envisage.

More importantly, we need to keep CHCs and HAs quite distinct. Community health councils speak with an independent voice. They act wholly on behalf of the local community. There must be no risk of a conflict of interest or confusion about that role. The community health council should speak clearly from outside health authorities, or trusts for that matter.

Indeed, that is why the current regulations governing community health councils specifically disqualify members of health authorities and trusts from membership of a community health council. If we include on a health authority members elected by the community health council we risk eroding the distinct roles of the two bodies; and we risk undermining the effective working relationships developed over the years.

Health authorities and community health councils perform two completely different functions. The new health authority is responsible for ensuring that the health needs of the local communities are met. The community health council is there to provide a voice, although not necessarily the only one, for the views of the local community. It is important that these two functions remain distinct if they are to be performed effectively.

Having listened to my remarks, I hope that the noble Baroness will not wish to press these amendments.

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