Memorandum by The NHS Appointments Commission
The NHS Appointments Commission welcomes this opportunity to present evidence to the Health Select Committee. This paper outlines the responsibilities of the Commission and the way in which it has carried them out in its first year.
The NHS Appointments Commission was established on 1 April 2001 as a Special Health Authority under the NHS Act 1977. Following an open competition including public advertisement, the first Chair, Sir William Wells, was appointed from 1 April 2001 and eight Commissioners (listed in Annex 1) from 1 July 2001. An open competition led to the appointment of Dr Roger Moore as Chief Executive from December 2001. The Commission is now nearing its full establishment of 45 staff, plus the Commissioners, and has been based in its Leeds and London offices from May 2002. The annual budget of the Commission is around £3 million.
During 2001-02, the Commission was not fully funded by the Department of Health and operated through services provided by Department of Health officials acting under the direction and control of the Commission through a service agreement.
THE REMIT OF THE COMMISSION
The establishment of the Commission was heralded in the NHS Plan published in July 2000, which set out the future policy direction for the NHS for the next decade. It identified priorities for delivering healthcare and set out structures and mechanisms for improving services.
To support the delivery of the Plan, the Appointments Commission is charged with improving the effectiveness of chairs and non-executive directors on NHS boards. An essential part of its role is to bring independence and objectivity to the task of appointments. The Commission makes the appointments and, as a consequence, Ministers no longer play any part in the recruitment and appointment process.
The full remit of the Commission is at Annex 2 and since its establishment the Commission has identified its main duties as:
recruitment and appointment of chairs and non-executives;
ensuring they are properly equipped for their role through proper induction and training;
their development through a system of annual performance review; and
their pastoral care through direct support and mentoring.
The Commission is accountable to the Department of Health for the delivery of its budget. However, it acts completely independently from Ministers and the Department when making appointment decisions. It is held to account by the Commissioner for Public Appointments for the integrity of its appointment processes. Her auditors will carry out annual inspections of the processes and the Commission is required to provide her with annual statistical returns. The Commissioner for Public Appointments does not become involved in the merits of individual appointments, although candidates for posts have recourse to the OCPA if they have concerns about the quality of the process.
The Commission is also accountable to Parliament through the Select Committee system and directly to the public at its annual public meeting.
The Commission publishes an annual report and the first one will be available in the autumn.
THE NEW APPOINTMENTS PROCESS
The Commission inherited from the Department a system of appointment that was flawed in a number of ways; these were identified by Dame Rennie Fritchie in her report on NHS appointments published in February 2000. In particular, she was critical of the generic nature of the process that led to delays and gave limited voice to the local chairs in the composition of their Boards. She was also critical of aspects of the final decision-making process which lacked transparency.
Working with the OCPA, the Commission has substantially reviewed the process to increase openness and transparency. The new procedures have been widely disseminated, and are also attached.
The principal features are:
candidates are recruited in a job-specific process whereby advertisements give details of specific vacancies;
for non-executive positions, the best suited candidates are assessed at interview by a panel, including the chair of the body concerned and an accredited independent assessor against a specific set of skills and attributes;
for chair positions, the panel is chaired by the Regional Commissioner;
one or two candidates who best meet the requirements for the post are considered by the Commission; and
the NHS Appointments Commission, sitting either as a full Board or in formally constituted committees, appoints individuals who have the general qualities required set out by Health Ministers from time to time and who can also demonstrate the specific skills or background required for the particular vacancy.
The involvement of Members of Parliament in the process has also been changed to meet the criticisms in Dame Rennie Fritchie's report. The Commission now writes to all MPs as well as the Chief Executive of the relevant Local Authorities and other appropriate local bodies whenever a local advertisement is placed, drawing their attention to it and inviting them to draw it to the attention of any suitable candidates. They are asked not to make nominations directly to the Commission. This procedure enables the Commission to draw upon the valuable local knowledge of the MPs, but does not give rise to any expectation for preferential treatment from nominees. MPs are no longer invited to comment on the shortlisted chairs; a practice that had already been stopped before the Commission was established.
Once appointments have been made, it is the intention of the Commission to inform local MPs. In practice, this notification has been patchy during the current year due to the pressure of the appointments schedule, but recently all MPs will have received details of appointments to their local PCTs and Health Authorities. Additional Commission staff in our new premises will enable prompt notification as and when appointments are made in the year ahead.
The Commission has adopted a new approach to re-appointment, again in line with OCPA recommendations. All chairs and non-executives who have served only one term of appointment will be considered for an uncontested re-appointment if their appraisal performance has been consistently good. Chairs and non-executives who have already served two or more terms will be eligible to apply in open competition, provided they have not already served for 10 years.
Because the Commission has only this year introduced an appraisal system for all chairs and non-executives, it has been necessary to follow interim procedures when deciding whether to allow an uncontested re-appointment. For the 2001 appointments, this consisted of seeking the opinion of the Regional Directors on the organisation and the individual performance. The Commission then took the cautious approach of advertising the post in all cases of doubt and allowing the incumbent to re-apply,
For the 2002 appointments, a re-appointment protocol will be followed which relies on self-appraisal, star rating of the Trust, Commission for Health Improvement reports and the views of the organisation's Chief Executive, to establish the merit of re-appointment. Although more complicated than the 2001 approach, this is still an interim measure and the full protocol will not be available until the first appraisal reports are completed in April 2003.
An essential feature of the appointment process is the role played by independent assessors who sit on all short-listing and interview panels. Their job is to ensure that the OCPA guidelines are followed in a consistent and fair way.
The Commission will be taking steps to increase the number of independent assessors that it uses, and to train and accredit them for the task. The training and accreditation will be undertaken in collaboration with OCPA, with the intention of improving the standard of interviewing and increasing consistency in the judgements made by selection panels.
Since it became operational on 1 July 2001, the Commission has made over 1,600 appointments. There has been a very significant workload arising from the establishment of around 150 new Primary Care Trusts and 28 new Health Authorities as well as appointments to established NHS Trusts.
These posts were primarily advertised locally and over 16,000 people requested information packs resulting in over 9,000 returned application forms.
Such a positive response from the communities involved has enabled the Commission to appoint diverse and balanced boards.
A breakdown of appointments by ethnicity and gender is at Annex 3.
TRAINING CHAIRS AND NON-EXECUTIVES
To ensure that those whom it has appointed are able to make a contribution to the NHS as quickly as possible, the Commission has prioritised induction training. An induction booklet "Welcome to the NHS" has been sent to all chairs and non-executives (copy attached). All Primary Care Trust chairs and non-executives will have received at least two days initial training by June, delivered throughout the country by an external training consortium commissioned jointly by the Leadership Centre and the Commission.
An internally led induction day for new NHS Trust chairs and non-executives has been provided for each Strategic Health Authority area.
For the future, the Commission has commissioned research to identify the training needs of boards and when the outcome of this becomes available in June, we will work with partner organisations to ensure the need is met.
The Commission believes that an ongoing training programme is essential to maximise the value of the chairs and non-executives and to ensure they are property skilled for their important leadership role.
A systematic annual performance review or "appraisal" is an essential tool to enable chairs and non executives to develop their abilities and to enable them to be held to account for their performance. The Commission has launched a programme of review and expects all chairs and non-executives to have set objectives for the year 2002-03 over the next few months. The objectives for chairs will include their organisation's outcome objectives similar to those in their chief executive's objectives, so that they can be held to account at the year-end.
To ensure a consistent approach to the review, all chairs will be trained in appraisal skills during the autumn.
The Commissioners will appraise Strategic Health Authority chairs, who will in turn appraise PCT and NHS Trust chairs. Chairs will then appraise their non- executives. The Commission will be responsible for the quality, rigour and consistency of the exercise.
All applicants are required to complete a form designed by the OCPA detailing any political activity in the last five years and the party for which it was carried out.
A breakdown of the political activity of those appointed by the Commission since 1 July 2002 is at Annex 3. Whilst the majority of those appointed (63 per cent) have not declared any political activity, of those who have declared, a substantial majority are from the Labour party.
The Commission is anxious to dispel any suggestions of deliberate bias and believes it has already taken a number of steps to increase public confidence. First, the political activity of candidates is not presented to the Commission when they make their appointment decisions; and second, the independent assessors on every interview board are there to ensure fair play.
Nevertheless, the Commission recognises the concerns and is taking further actions. From now on the political activity statement will be abstracted from the candidates' application pack by the officers of the Commission and will not be available to any of the selection panels. As a further important step, the Commission will be commissioning an independent analyst to review the data on applications and appointment to determine whether there is any bias at any stage within the system.
It will undertake to act on the findings, as it is totally committed to appointing people on merit and recognises that applicants must have confidence in the integrity of the system.
The Commission is reviewing its appointments procedures so that a greater range of people, and particularly those without a professional background, can be appointed to boards. The Commission remains committed to ensuring the very best leadership for the NHS and, as a consequence, some of the non- executives must have a relevant professional skill in addition to their patient/ community advocate role. However, this need not apply to all appointees and a good appointments system should be able to recognise those with board leadership potential from less obvious walks of life.
This will become particularly important when the Commission considers non- executive directors from Patient Forums. For those candidates, the Commission is considering the introduction of pre-board training, a concept which, if successful, might be considered elsewhere to further increase the pool of potential non-executives.
The Commission currently recruits and appoints individuals against a specification of "qualities required" drawn up by the Department of Health. Any changes to this profile will need to be agreed by Ministers. The Commission has been given goals by Health Ministers for the involvement of women and people from the black and ethnic minorities on NHS boards. Currently these are for 50 per cent women and 7 per cent from the black and ethnic minorities and good progress has been made by the Commission. The Commission has established an advisory committee of black and ethnic minority non-executives to advise it on recruitment and other issues. The Commission believes that disabled people are presently under-represented on NHS boards and has established an advisory committee to advise on how their representation might be increased.
EXTENSION OF THE COMMISSION'S REMIT
The Secretary of State for Health has signalled his intention to direct the Commission to make appointments to a number of other bodies within his Department's responsibilities. Particularly, the Commission expects to make the appointments to the Commission for Patient and Public Involvement in Health and the new overarching NHS supervisory body announced following the recent budget.
The NHS Appointments Commission has been operational for only nine months and has made a successful start to its work. It has made a very significant number of appointments; has delivered an induction training programme and has launched an annual system of performance review.
However, much remains to be done, and the Commission looks forward to building upon this foundation in the year ahead