Examination of Witnesses (Questions 860
THURSDAY 24 OCTOBER 2002
860. It has been talked about for ages.
(Sir William Wells) However, we were asked and we
did give a lot of advice to the policy makers about corporate
governance issues on foundation hospitals and they broadly accept
the division that we suggested, that the hospitals should have
a board to run the hospital and should have a stakeholder council
to represent local views and to advise on strategy. How the people
on those two organisations are going to arrive is very much in
the melting pot. I can only tell you what I read in the press.
Certainly, as far as we are concerned, it has not been discussed
861. That is astonishing, is it not?
(Sir William Wells) I think it is because it was only,
what, 10 days ago that they actually decided what was going to
be the broad framework of foundations hospitals and I have absolutely
no doubt that it will wend its way through the system and come
back to us. I do not know if what I have read in the papers is
just conspired by the journalists. But clearly the idea wasand
I have no reason to believe that this will be any different in
the outcomethat the board runs the hospital, and they will
be people chosen very specifically to make sure that the hospital
runs as efficiently and effectively as possible, and the stakeholder
council will be drawn from a range of local people, in order to
give a much greater of feeling of ownership of their hospital
through the stakeholder council. That is the philosophy. We can
make that work perfectly well in corporate governance fashion,
but how those people arrive on each of those boards I think is
still a matter of debate.
862. Does that mean that the non-executive role
that you are used to appointing falls away at the board level?
(Sir William Wells) No. We suggested that the actual
board of the hospital should be comprised in the same sort of
balance as it is comprised at the moment. What you would do is
put in an additional local stakeholder group, which would be drawn
from local employers, local authorities, staffyou know,
a broad range of peopleto be the sort of strategic guide,
the organisation which would monitor performance and be responsible
for checking complaints and the like.
863. I want to come back to this phrase you
used of "weeding out" in relation to single issue people.
Your memorandum says, "Chairs and non-executives on NHS boards
are expected to have the general ability to challenge the executive
team . . ." Is your weeding out approach not in contradiction
(Sir William Wells) We try to ensure ourselves that
everybody whom we appoint as a non-executive will challengebecause
that is the key part of their job, to challenge the executive.
What tends to be or can be quite disruptive on boards is if a
particular director is only prepared and only willing to talk
about a particular issue. I am afraid, that can be the case. They
are a passenger. For the other 95 per cent of the activities of
the board they do not play a part. It is a team.
864. How would you make the judgment about the
unsuitability of that person? It seems to me that the range of
skills that you need to apply in your single issue is transferrable
to the role of general ability to challenge.
(Sir William Wells) I agree. If someone demonstrates
that they are able to do that at interview, then they get appointed.
If somebody makes it very clear that they are only interested
in the care of the elderly, for example, and that is what they
would contribute and that is all they want to do, then you are
starting to create an unfortunate tension in the board. But a
lot of people would say, "Yes, we are very interested in
the elderly, that is our key, but we understand that we have to
play a broad-ranging role on the board," and we certainly
would not not consider them.
865. You say also in your memorandum, "There
is no evidence of public cynicism about getting involved in health
related bodies." I assume you mean cynicism about the process
of getting involved. How did you test that? How do you know that
there is no public cynicism?
(Dr Moore) I think the fact that 32,000 people respond
to advertisements is some indication that people think it is worth
getting involved and worth applying.
866. That is the only test?
(Dr Moore) That is part of the test. I think the other
test is drawn from the fact that the principal focus on the health
service at the moment is to put the patient at the centre and
to encourage patient involvement at all levels, and the trusts,
and particularly our primary care trusts, are taking quite major
steps to encourage the public to come forward to take part in
focus groups, to ask patients to complete questionnaires and the
like, and to respond on the direction of travel in terms of treatment
strategies and whatever, and the public are coming forward and
patients are responding to those requests to play a part.
(Sir William Wells) We will have, of course, as from
next year, patient fora around the country: each patient forum
will be able to elect one of their number to become a non-executive
director of the relevant trust. So that all the time you are pushing
out the ability of people to get involved. Certainly from my experience
there is a growing interest in getting involved in health care
issues. What we want to do is to try to coral that locally because
the whole of Government policy is to decentralise back to the
local communities so that they feel it is their health service
rather than someone else's who is being paid to run the board.
867. I press this point because I have picked
up some small scale, local, anecdotal evidence of public cynicism
amongst individuals who have been through the application process,
who in some cases have been interviewed. People who, from my personal
knowledge of them, I would have thought would have made potentially
quite suitable candidates have found themselves rejected and have
talked aboutand maybe there is some post-hoc rationalisation
workinghaving been interviewed by people who they know
to have very strongly held political affiliations that are not
the same as theirs. That is certainly the cause of some cynicism.
Perhaps you would like to discuss that.
(Sir William Wells) Unfortunately, we do have to turn
people down. That is a matter of fact. And I think it is very
healthy. Previously nobody complained about the system at all
because they knew there was absolutely no point in writing a letter
to the minister because they never got a reply and therefore they
did not. I am afraid that is a matter of fact. That has been going
on for years. We do reply and we do actually give them reasons
and we do get the involved. I would say that 999 out of 1,000
people sometimes do not like being told why they were not appointed
but huge numbers actually accept that we have come to an opinion.
They may not agree with that opinion but we have done it in a
fair and open way and we have told them what it is.
868. I was going to ask you to describe your
system of feedback. Is it systemised? Is it available on request?
(Sir William Wells) I reply to every single major
869. Complaint? Rather than a systematic offering
of feedback to anyone who requests it rather than to make a complaint.
(Sir William Wells) Okay. Yes.
870. I think you take my point.
(Sir William Wells) What happens is someone does not
get appointed and they are written a letter saying they have not
been appointed, thank you very much indeed. They then say they
want to know why. They either ring up or write and they will be
asked by the relevant person on the staff would they like to see
a copy of their interview notes or the sift panel notes. If they
say yes, they get sent those. If after thatand I have to
say this is a relatively small numberthey feel that an
injustice has been incurred, then they write to me. If I am unable
to satisfy them and they are concerned about the process rather
than the quality of the decision, then they write to Dame Rennie
Fritchie. That is the process.
871. Forgive me, that sounds like a complaints
process rather than what I understand a feed-back system to be
and one that I would hope we would want to advocate. If people
have gone to the trouble of making an application or have gone
through the interviewing process and then have in some way failed
to meet the criteria, then surely those are the people, who have
expressed that interest, who are worth sustaining and encouraging
and supporting to make further applications.
(Sir William Wells) I agree.
872. Either to a health appointment or to some
other public sector appointment and an objective, constructive
sort of feedback is very different to the complaints system you
have described. Are you saying that does not exist? It is an opportunity
(Sir William Wells) I agree. We were only discussing
at the Appointments Commission board last month, now that we have
a bit more time, now that we have got through the bulk of the
huge amount of appointments we had to make because of the reorganisation
in the health service, that we need to be more selective and pro-active
about the way in which we tell people that they have not been
appointed. In some cases it is only fair and right to tell them
that they have not been appointed and not to give them any hope,
because there are a significant number of people, frankly
873. That can be achieved in a good feedback
(Sir William Wells) In a perfectly and decent and
nice way. There are some people who have not quite made it, for
a variety of reasons, and we feel somehow or another we need to
keep them much more interested than we are at the moment and we
are working on that. People who are near-misses we do write to
especially and say, you know, "You have been a near-miss.
Hang on in there because we think you could stand a very good
chance of getting something in a shortish period of time."
874. Could I just push you a little further.
You talk in your memorandum about encouraging people from ethnic
minorities and people with disabilities to come forward, and you
have established advisory groups from black and ethnic minority
non-executives and disabled non-executives to advise on how you
should do that. It seems a little bit incestuous to me. Have you
made any arrangements for taking external advice? You are taking
advice from people who have made it through the existing system.
(Sir William Wells) In fact some members of those
groups are actually not non-executives. They are not involved
in the health service. To the two people that we put together
to chair these groups we said, "You should draw mainly from
the NHS but if there are other people you think could make a really
good contribution to that, please use them". There is certainly
one, if not two, on the BME group who are not anything to do with
the National Health Service.
875. It is easy to think of voluntary sector
organisations and statutory organisations that might have a useful
input rather than just trying to do it from internal sources.
(Sir William Wells) We are making use of standing
groups, advisory groups, because they are extremely valuable to
us, but we are also encouraging them to bring in people who they
feel can help in a particular thing in order to advise them. Although
broad statistics of gender and ethnic balance are pretty good,
they disguise some areas where we are not at all good, and that
is the real challenge for us. There are certain geographical areas
where we have very significant ethnic populations where we are
not scratching them. We are very good in London but we are less
good in some parts of the Midlands and the north. A lot of that
is actually getting the right people in those communities, to
get them along and find out from them how we can best penetrate
those populations and then go out and do some really pro-active
spreading of what it is all about to be a non-executive in order
to get some representation.
876. In the notes we have it says that part
of the selection process is to ensure that non-executives understand
legal needs and issues and that through them the community feel
a sense of ownership and participation, and you just touched on
those same terms in regard to the question of foundation hospitals.
In what way is your selection process actually tapping into the
community to find out what they want in terms of skills and merits
and so on on these bodies? I am particularly concerned about PCTs,
which I feel should be very close to the local community but in
my experience do not seem to have that feeling of ownership and
(Sir William Wells) Can I answer the question in a
slightly different way, and I will come back to the PCT point
which you made. The responsibilities and accountabilities of members
of these boards are pre-prescribed, and they are very considerable.
This is the thing that many people do not understand. When you
come on to the board of a trust or a health authority, you are
accountable for the financial well-being of that organisation,
personally and corporately, and we are not talking about small
organisations; the minimum size is about £100 million, and
a lot of them are half a billion pounds. You are also accountable
directly to the Secretary of State for delivering his targets,
government policies and the like. You are also, obviously, charged
with making sure that you improve the health care of the people
for whom you are responsible. A lot of people, when they realise
that, withdraw their application, because it is not what they
thought it was, and we must not live a lie here. This is something
I feel very strongly about. I think it would be quite wrong not
to level with people as to the responsibilities they are taking
on. They are very considerable, and things can go wrong. Those
of you who have no-star trusts in your constituencies and see
the chairmen and non-executives disappearing very quickly out
of the door will know this, because that is what they do if they
have failed. This selection severely affects their local standing,
and people need to be aware that accountability means accountability,
and it is not just a talking shop to reflect what everybody might
want to do. As far as PCTs are concerned, they, of course, have
got to reflect what people want, but they have the same accountabilities
and responsibilities as all of the other trusts. They have to
deliver their budget, they have to procure the health care in
an efficient and proper way, and they have to deliver the Government's
targets. I was only saying at the PCT Conference last week in
Harrogate that what we want PCT non-executives to do is to create
an infrastructure which will enable patient and public involvement,
so that they know what the public want. They should not spend
a huge amount of their time doing that themselves. We are going
to have patient forums, which will be considerable, attached to
every PCT. Every PCT will have up to 20 people on a forum. We
want them to be able to set the infrastructure so that they can
find out from those organisations what it is that is going on
and what it is that their public wants of them.
877. This just goes deeper and deeper. Anybody
who has questioned treatment and what they have been offered one
would think might well be weeded out of even that process. It
does seem to me you have really quite a problem when you make
a claim that the community has got to feel a sense of ownership,
yet there is such a huge gulf.
(Sir William Wells) Dare I say it: I imagine the people
who will go on to patient forums will be the people who are on
CHCs. They will be drawing from the same poolvoluntary
organisations, normal people and the likebut people have
to volunteer. They do not get any remuneration for it. It will
differ from area to area. I know that we have appointed the Chairman
of the over-arching national body recently, Sharon Grant. I was
talking to her the other day and I know she has some very firm
ideas about ensuring that we get people on to these who do truly
represent the communities for which they are responsible, and
that is going to be easier, because they do not have the considerable
range of responsibilities and accountabilities that a non-executive
director sitting on a board has.
Sir Sydney Chapman
878. Sir William, there is a contradiction between
what you submit in your memorandum and what you told us earlier
on. You may have cleared this up just now, but I would like to
press you. You said you had had in the last year or so, I think
since June 2001, 32,000 applications for 2,000 posts.
(Sir William Wells) Expressions of interest.
879. That is what I wanted to pick you up on,
because in your memorandum you say "generated 32,000 expressions
of interest resulting in 14,000 applications," so less than
half. Did someone in your office go through those expressions
of interest and find some people were under a misapprehension
about the sort of job it was?
(Sir William Wells) No. We send a pack to every single
person expressing an interest. This pack sets out the information
pretty simply, and we think very clearly. In fact, everybody does
say this is very good. It is at that stage that peple say, "Crikey!"
Eighteen thousand of them say, "Crikey!" and put it
into the waste bin.