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The noble Baroness said: The amendment would add a new clause, the first part of which would create a requirement for any patients forum appointment to a primary care trust to be made on the recommendation of the NHS Appointments Commission.
Although there is nothing in the Bill that requires the appointment of patients forum representatives to PCTs or NHS trusts, I understand that the Government have stated their intention to do that. There are grave concerns about that among NHS trusts, and they were expressed forcefully by my noble friend Lady Hanham at Second Reading. There is a worry that patients forum people will not be subject to the selection procedures operated by the NHS Appointments Commission and that—not to put too fine a point on it—they will not be of the quality established by the conventional selection procedures. I imagine that PCTs will have similar concerns.
The second part of the amendment makes it clear that a person appointed from a patients forum has exactly the same responsibilities as other NHS trust directors or PCT members. That is a response to the concerns—also expressed by my noble friend Lady Hanham at Second Reading—that the patients forum members will not regard themselves as full corporate members of the NHS trusts or PCTs. There is a danger that they will see themselves as patients forum representatives and not as part of a whole corporate team, carrying collective responsibility for the affairs of the NHS trust or PCT. There is grave concern in the NHS about that.
The NHS Confederation fully supports the amendment. Nothing short of a statutory declaration that patients forum representatives must behave in exactly the same way as other directors or members will deal with the point. I beg to move.
Lord Clement-Jones: I support the amendment. It is interesting that the NHS Confederation, as the noble Baroness, Lady Noakes, said, supports the amendment. There are concerns relating to the role and selection of the patients forum non-executive director on the board of each NHS trust and PCT.
It is important that the patients forum-elected non-executive director becomes an ordinary board member with full corporate responsibility and that he or she fully understands the implications of the need for corporate responsibility. Failure to ensure that could inhibit the good operation of the board. That is an important factor. It is also important that the patients forum-elected non-executive meets Nolan criteria and that individuals go through a selection process similar to that for the other non-executives.
It is right that all non-executive board members should bring the requisite competencies to the board. For that reason, we support the amendment.
Baroness Hanham: I am extremely grateful to my noble friend Lady Noakes for having taken on the burden of working out these amendments and putting them forward. Noble Lords will recall that I have been banging a rather lone drum on the question of a patients forum non-executive director on the board of a trust through our debate on Second Reading and in previous discussions. The amendments very much encompass my concerns. I am also grateful for the
It is extremely important that we get this right. If someone is to be imposed on a board, there must be a process by which the board can accept the appointment. On Second Reading, the Minister was kind enough to suggest that I should talk to him not only about my general concerns, but also about the detail here. What has been lacking all along has been a general acceptance that a great many details have to be worked out. I should like to acknowledge the fact that the Minister was kind enough to spend some time with me over this. I hope that that time was fruitful for him and that now I shall find that it will have been fruitful for me.
Briefly, my concerns remain the same and I hope that the Minister will be able to respond to them. At present, non-executive directors are appointed to a board by the new NHS Appointments Commission. Formerly they came via a different route, but they have always been appointed either by the Secretary of State, or now by the NHS Appointments Commission. It is absolutely inconceivable to me that the non-executive directors of patients forums should in some way by-pass that process or, indeed, that the chairman of the board should have no role in seeing or otherwise, and accepting or otherwise, who is to be appointed. The NHS Appointments Commission could play an important role here by ensuring that there was some effective choice before the chairman of the board. I hope very much that now that will be part and parcel of any new proposals.
I am also concerned about several other elements. I understand that the patients forum representative will not be supernumerary to other non-executives. At present, there are five non-executive directors on a board, or six if, as I have, there is a university representative as well. When we have discussed this on previous occasions, I have always been led to understand that one patients forum representative would replace one of the non-executives. The question lies in how and when that is done.
Non-executive directors are usually appointed for a minimum of two, four or eight years. The two-year appointments almost always carry on for six years, while the four-year appointments, by definition, often carry on for eight years. That extended experience is absolutely invaluable to the stability of a board and helps it to continue and develop. What would be unacceptable and very difficult to understand would be a situation where someone is parachuted in and replaces, in the short term, a person already in place, who has already been through the "Nolanisation" process referred to earlier, who has been approved by the NHS Appointments Commission and who has been appointed for a set term with the possible expectation of being reappointed. If that were allowed to happen, it would set a poor example and establish a bad precedent. I hope that the Minister will be able to reassure me on that point.
As our discussions on patients forums have developed today, I have become increasingly concerned about exactly to whom this representative believes that he or she will be accountable. This matter forms the second part of the amendment moved by my noble friend Lady Noakes. If there is to be a non-executive director, it would be quite wrong for the accountability of that non-executive director not to rest with the board; that is, that they might have a completely different line of accountability out to someone else. It would make the corporate role of non-executive directors very difficult to manage. The last thing one would want from such a representative or, indeed, for such a representative, would be for them ever to be treated with suspicion by the rest of the board. We must ensure that the incorporation is carried out in a way which leaves no rancour or worry for other members of the board. They must be assured that the person forms a full part of the corporate body.
That point becomes even more important when one considers the inspectoral role of the patients forum. Again, it is quite possible that a patients forum with such a non-executive director could find itself at odds with a trust board because either the forum or the non-executive director would be the bearer of an adverse report. I would not expect that to happen in my case, but I see that it could happen in some trusts, either fairly or unfairly.
I hope that we shall see a little more roundedness introduced into this appointment. I look forward to what the Minister has to say. However, although I do not know whether I have a right, I shall reserve my right to respond once more before he sits down if I am not totally content with his remarks.
Baroness Masham of Ilton: Having listened to the noble Baroness, Lady Hanham, perhaps I may ask the Minister a question. Will the patients forum representative be paid if he or she replaces a non-executive director, and will the appointee have time to do both jobs?
Lord Hunt of Kings Heath: I am grateful to the noble Baroness, Lady Noakes, for giving us a further opportunity to debate this matter. I recognise that, in particular for the chairs of NHS trusts, the appointment of a patients forum non-executive director to the board of a trust represents a challenge. However, my contention would be that the NHS is not unused to appointments such as these. For example, one of my first introductions to the NHS was in the mid 1970s as an appointee of Oxford City Council to the board of the Oxfordshire Area Health Authority. We know that, in general, NHS authorities are composed of people who come from different backgrounds and have different interests, but once they arrive at the boardroom they should be expected to take part in collective responsibility. Ultimately, I do not see any difference between the patients forum
I turn to the point raised by the noble Baroness, Lady Masham. The person appointed to the patients forum will receive the honorarium that non-executives generally receive for serving on NHS trust boards. With regard to timing, I fully recognise the major time commitment to be made by non-executive directors. We are very grateful for their contribution and obviously time is a factor that must be considered by the members of the patients forum when they come to discuss who should go forward for nomination. It is one of the criteria for successful appointment. A candidate must be able to devote the time required to meet the responsibilities of the job.
Having said that by way of introduction, I hope that I can reassure noble Lords that we have in place the mechanisms to make this work effectively. First, let me make it clear that the NHS Appointments Commission is the appointing body for all non-executive appointments to NHS trusts and PCT boards. We have made our intention clear, through the listening exercise and so far during the passage of the Bill, that patients forums will each elect one of their members to go forward to the NHS Appointments Commission for appointment through the standard process. That will mirror the way in which university representatives are currently appointed.
The forum nominee will be assessed by the NHS Appointments Commission against the same criteria of probity and expertise used in the selection of other board members. We can expect patients forums to take this into account when electing their nominees. I am confident that we will see very high quality candidates put forward.
In the exceptional circumstance that, for some reason, the nominee elected by the patients forum is found wanting in some important respect, the appointments commission will be expected to reject that nomination. The patients forum then will be required to carry out another election. I do not expect that to happen very often, but it is an important safeguard.
Once appointed, the new board member will be expected to accept corporate responsibility for board decisions in the same way as any other non-executive member. That is very important and I am happy to reaffirm that principle. They will undergo the same induction process that is given to other board members to explain exactly what corporate responsibility means and to help them to be effective across the range of board member responsibilities.
I do not depart from the point made by the noble Baroness, Lady Hanham. For the chairs of trusts there will be challenges ahead to ensure that corporate responsibility is discharged and that the patients forum non-executive is able to play a full part in the discussions of the board. Surely the value of having a patients forum representative on the board is that it will be a powerful route through which patients' views and issues of direct relevance and interest to patients
The noble Baroness, Lady Hanham, asked about the position of current non-executives on trust boards who may be affected by the appointment of a new patients forum non-executive. I can go some way, but not the whole way, that she would like me to go. Clearly someone who is already on a board will complete his or her current terms of office. In the future, we will have a fluid situation. While it may be expected that most trust boards will continue to have five non-executive directors in the fullness of time—including the patients forum non-executive director—I should remind the noble Baroness that the trust regulations 1990, as amended, allow NHS trust boards to have up to seven non-executive directors. I accept that, like her own trust board, the majority of NHS trust boards have five members, but there is some flexibility in this issue. No doubt we shall need to reflect on the matter in the future.
I hope that I have gone at least some way towards convincing the Committee that we accept that there are challenges. We believe that the role of the appointments commission ought to reassure the noble Baronesses on the substantive points that have been raised, but, ultimately, the advantage of having a patients forum non-executive on the board will, in the round, bring distinct advantages to the NHS and to the individual trust boards.
"PATIENTS' FORUM MEMBERS
(1) No member of a Patients' Forum may be appointed as a director of an NHS trust or a member of a Primary Care Trust to which the Patients' Forum relates unless that person has been recommended for appointment by the NHS Appointments Commission.
(2) Where a member of a Patients' Forum is also a director of an NHS trust or a member of a Primary Care Trust to which the Patients' Forum relates, his responsibilities as a director of the NHS trust or member of the Primary Care Trust shall be the same as those of any other director or member of such trust."
6.15 p.m.
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