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Lord Elton: My Lords, I listened with great interest to what the noble Baroness said. Of course many of us are aware of the extent of government patronage and of the concern that it should be responsibly used. However, I am not at all sure that I see anything reassuring in this amendment because it does nothing more than require the Secretary of State to set up an advisory committee. At the moment he is allowed to take advice from whomever he will; under the Bill as it would be amended, he would merely be required to get the same people into one room with a chairman, so nothing whatever would change. I suspect that not very long after that the noble Baroness would seek an opportunity to move an amendment which would require there to be a committee of advisers on who should be appointed to that committee and thus to get it out of the Secretary of State's hands. This manifestly does not do that.

Lord Desai: My Lords, I support my noble friend in the amendment she has moved. I think the noble Lord, Lord Elton, is trying to damn it with faint praise, or perhaps faint criticism. The principle is openness. We must have an open system which is seen to be above criticism or above charges of favouritism. In many areas of life in this country over the past decade or so more and more matters have been made open. It is time

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National Health Service appointments for non-executive directors were made open. The kind of questions which are emerging in the business area as regards the responsibilities of non-executive directors and their liabilities will also emerge as regards the National Health Service as it becomes more and more market oriented. When that happens we may find that some of the people who fill non-executive appointments may not be up to scratch because they may not have the expertise required of non-executive directors in the business area. I believe it would be a good idea if we adopted the amendment moved by my noble friend. If the noble Lord opposite wants to makes it a statutory and completely independent body, perhaps we should move an amendment to that effect.

Lord Peyton of Yeovil: My Lords, I wish to support what my noble friend Lord Elton said. The noble Baroness opposite moved this amendment with her usual skill and made a persuasive case for it. However, I am not convinced, even by the cogent way in which she put her arguments, that we are really in need of another advisory committee. This country is not perhaps as rich as it was in the amount of advice and counselling which is made available at almost all levels, regardless of its value.

Lord Milverton: My Lords, I also do not see the point of this amendment. I am sure my noble friend the Minister will be able to give good reasons why we should dismiss it. As my noble friend Lord Peyton of Yeovil has just said, it seems to me the amendment would make things just as top heavy, or more top heavy. We want less of that. The amendment has not impressed me. I believe the National Health Service is open; it is not a closed shop.

Lord Ennals: My Lords, I was not present in the Chamber during the Committee stage and I greatly regret that. I rise to put a question. In moving the amendment my noble friend referred to the Nolan Committee. We are led to believe that its report will be brought forward fairly quickly. If the committee made a recommendation relating to the National Health Service and its structure and its appointments but the Government had decided to reject this amendment, what would they do? Would they take another stage of the Bill to find a way to respond to the Nolan Committee? I should have thought that in view of the importance of the Nolan Committee—I refer to its chairman, its membership and its role—they would want to respond in a positive way. Perhaps the Minister will deal with that point when she replies to the amendment.

Lord Carter: My Lords, before the Minister replies, I hope she will be sure to deal with the point raised by my noble friend on why the arrangement we are discussing is in place in Scotland but not in England and Wales. I noticed that she said that point was made by the National Association of Health Authorities and Trusts (NAHAT) in its evidence to the Nolan Committee, and it obviously supported that point. I hope that the Minister will deal with that point in her reply and that she will explain to the House exactly why the provision is required in Scotland but not, apparently, in England and Wales.

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Lord Rea: My Lords, I should have thought that the Government would welcome the opportunity to have an advisory committee such as is suggested in order that fair play should be seen to be done. There is a certain amount of evidence that health authority and trust non-executive members have been drawn from those rather close to the Government and the Conservative Party. If there were to be such an advisory committee, that accusation would not be made so often. I should have thought that would be very much to the Government's advantage in the eyes of the electorate.

Baroness Cumberlege: My Lords, the point that has just been raised is one of which I have studiously fought shy during the course of these debates. However, the noble Lord will be aware that even in your Lordships' House there are Members who sit not on our Benches but on the Benches opposite who are closely involved in the health service. We very much value the contribution that they make. It is wrong to believe that one has to be a paid-up member of the Tory Party to get a position on a trust or health authority.

So far as concerns Scotland, I believe that this procedure is a new one and that the committee has not as yet made many appointments. We will watch with interest to see how that committee operates. There is an issue about size. What we propose is not totally unlike the Scottish system but it is relevant to our regions, each of which is roughly the size of Scotland.

We endorse the views of the noble Lord, Lord Desai, and the noble Lord, Lord Ennals—whom I am delighted to see back on your Lordships' Benches—that the NHS should be an open organisation. As the noble Baroness has said, on 14th February my right honourable friend the Secretary of State published new guidelines for the appointment of chairmen and non-executive directors of NHS authorities and trusts. The guidelines, which draw together examples of existing best practice in appointment procedures, demonstrate our commitment to a fair and open appointments system based on merit, not patronage. The new guidelines make it clear that potential candidates for non-executive appointments will be sifted by a panel of at least three people. These people will be serving chairmen and non-executive directors of local NHS authorities and trusts. We believe that people who are already working as non-executives are well placed to judge whether a candidate is suited to the demands of service as a non-executive director.

We recognise the need to avoid possible accusations of bias in the appointments system. We have said in the guidelines that the members who do the sifting must not be drawn from the same health authority or trust board and that the panel may include an independent member. We have suggested that this may be, for example, a member of a local community health council or a local justice of the peace. The new guidelines are designed to be flexible to meet local demands without compromising standards in the appointments process. This is reinforced when we look at the role of the sifting panel. The guidelines make clear that all new candidates for non-executive appointment will be sifted against agreed criteria to ensure that all those recommended for appointment possess the skills, personal qualities and experience required.

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It is this use of nationally agreed criteria against which experienced NHS chairmen and non-executives will judge candidates for non-executive appointment that is the most important element of the sifting process, and will ensure that those recommended for appointment are of a uniformly high standard.

Perhaps I may clarify the position of regional chairmen in future. If the Bill is passed and regional health authorities are abolished, it is our intention to retain a non-executive who will be a member of the policy board and will have the role and title of regional chairman. That person will be the chairman of the health authority and the trust chairman within that region. It is important that that person is involved in the appointments process. Indeed, the guidelines emphasise that he should be. Ministers will look to regional chairmen to make their own assessments of candidates before making their recommendations to Ministers. This means that the suitability of any individual candidate will be double-checked to ensure that the process has been conducted objectively and fairly. Those finally appointed—your Lordships will be aware that many are called but few are chosen—will rest in the knowledge that they really are the best people for the job.

I endorse the views expressed by my noble friends. One can go on and on with further tiers of advice as to who eventually appoints these people. We believe there is no need to strengthen the arrangements that are already in hand. I hope that the noble Baroness will be reassured and will not press this amendment.

Lord Cledwyn of Penrhos: My Lords, the noble Baroness has dealt with the Scottish position with great care. I was concerned that she might tell us about the Welsh position before this debate ended. When I was at home in Wales over the Recess two or three people who were deeply concerned about the National Health Service asked me why Wales was being treated as if it was a region of England. Of course, it is not; it is a separate nation in these islands and has the right to be treated with the same respect as Scotland, which seems to be treated with respect at all times. Before we complete this Bill I hope that she can satisfy us that there is a good reason for not giving Wales the same independence in this matter as Scotland has enjoyed.


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