HC Deb 05 December 2001 vol 376 cc436-44

Motion made, and Question proposed, That this House do now adjourn.—(Angela Smith.]

10 pm

Mr. Kevan Jones (North Durham)

I am pleased to have an opportunity to raise my concerns about the procedure followed by the NHS Appointments Commission in appointing the chair of the North Durham Health Care NHS trust.

I do not intend in this debate to raise concerns about the operation of the hospital, nor to criticise personally the new chair of the trust, Ms Angela Ballatti. I intend to concentrate on the clear faults in the appointment procedure and on the disgraceful way in which the former chair, Mr. Kevin Earley, has been treated.

Mr. Earley was appointed chair of the trust in April 1998. He and his new board faced a number of challenges, the most demanding of which was the building of a new private finance initiative hospital in Durham—one of the first in the country.

Mr. Earley's term of office came up for review this year. In July, he was asked to attend a meeting for what was described as an "informal chat" with Mr. Peter Garland, the regional director of the northern and Yorkshire health region and Dr. John Marshall, regional appointments commissioner for the NHS commission.

It was made clear to him that his reappointment as chair would not be automatic and that they wanted to "road test" the procedure for the appointment of the trust's chair. A number of points were raised with Mr. Earley: first, concern over the waiting list at the hospital since April 2001; secondly, the quality of the executive management team at the trust; and, finally, concern that Mr. Earley was acting as an executive chair.

In response to those concerns, Mr. Earley explained robustly that the waiting list delays were mainly the result of down time when the new hospital came on stream in April. Until then the trust had met all its targets and the national patient action team was happy with the trust's strategy.

With regard to the comments about the executive team, Kevin Earley pointed out, rightly, that the appointments had been made with the full involvement of the regional health authority. For example, the medical director had been appointed on a recommendation from Ken Jarrold of Durham health authority, whose chair at the time was actually Dr. John Marshall.

On the concern that he acted as executive chair, Kevin Earley reminded Dr. Marshall that on his appointment he had been told by him that, in coming years, he would have to "have his foot on the pedal because the trust had a lot to deliver".

On 31 July 2001, Mr. Earley received a letter from Sir William Wells, chair of the NHS Appointments Commission, telling him that he would not be automatically reappointed, and stating that the post would be advertised, but you will of course be entitled to apply". The NHS Appointments Commission procedure, under the heading, "Arrangements for local chair appointments", states: Regional Commissioners will review appraisal reports and discuss possible reappointments with regional directors. Except where the appraised performance of the incumbent chair is good, vacancies will be advertised". Well, I have Mr. Earley's last appraisal here, and it states:

  • "Overall health of organization—good
  • Financial management—good
  • External profile of organization—good
  • Relationship with Chief Executive—good
  • Effectiveness of Board—good
  • Management of relationships with media—good."
I could go on.

During Mr. Earley's three years as chairman of the North Durham trust, he was appraised on three separate occasions. At no time were any concerns about his performance raised with him by the then regional chairman, Mrs. Manzoor, who conducted personal interviews after each appraisal. If no concerns were raised at those appraisals, why did the commission think that he should not be reappointed?

To shed some light on that, I have to return to Sir William's letter, in which he states that the views of the regional director, Mr. Garland, would be considered, as well as the appraisals. He goes on to state: In your case the Commission accepted that the difficult relationship with your former Chief Executive led to concerns about the strength of your own leadership skills and relationships within the Trust". To question that as a reason for not reappointing Mr. Earley, I refer again to his appraisal of June 2000. Under the heading "Relationships with the Chief Executive", it states: have improved many if not most issues viewed from similar perspective—assessment—good". No concerns have ever been raised with Mr. Earley about his relationship with the former chief executive by the regional chair, who, as I have said, carried out personal interviews after each appraisal. If that is not good enough evidence to show that he should be reappointed, I shall refer to The Journal—a Newcastle paper—in which, on 16 November 2001, the former chief executive, Mr. Worth, is quoted as saying that he and Mr. Earley worked well together for three and a half years and believed the two achieved a lot in North Durham". The reason for the non-reappointment does not stand up to scrutiny. Again, if there were serious questions about Mr. Earley's leadership, why did they not show up in the annual appraisals? Why were those concerns not raised by Dr. John Marshall, the then chairman of the health authority?

Kevin Earley reapplied for the position of chairman when it was advertised this September. In fact, he was shortlisted and interviewed for the post. Again, if the commission had grave concerns about his performance and leadership abilities, as was stated in Sir William's letter, why on earth was he shortlisted and interviewed?

I understand that, following the interviews, the regional NHS appointments commission made a recommendation to the national commission, but it was rejected. It is not known whether a second preference was also nominated, according to the commission's procedures, but no appointment was made as a result of the process. That effectively left the trust with no replacement for Mr. Earley.

The commission's clear conclusion was that, despite an open advertisement, no one from my constituency, from that of the Parliamentary Secretary to the Treasury, my right hon. Friend the Member for North-West Durham (Ms Armstrong), or from that of my hon. Friend the Member for City of Durham (Mr. Steinberg) could be found to fill that post. I find that hard to believe or accept.

Given that no appointment was made, I understand that the regional commissioner, Dr. John Marshall, wrote to certain existing non-executive members of health trusts inviting them to apply for the post. I have studied the NHS Appointments Commission's procedures on the NHS executive website and cannot find where the procedure used in this case is laid down. I hope that the Minister will enlighten me in her reply.

The actions by Dr. John Marshall raise serious questions. Who drew up the list of who was to be invited for interview? Where do Dr. Marshall's actions appear in the procedures laid down and what criteria were used to draw up the list? We know that some non-executives on the North Durham trust were invited to apply, because at least one wrote to Dr. Marshall refusing to be considered and strongly criticising the removal of Mr. Earley as chair. We also know that Mrs. Angela Ballatti was asked to apply. She qualified—rightly in my opinion—because she was the chair of the local priority services trust. However, we also know that the chair of the priority services trust in Sunderland, who is a Durham city resident, was not invited to apply.

The list of those approached and the reasons for it need to be made public. More importantly, we need to know why some people were not asked to apply for the post of chair of the North Durham trust. What should have been an open and transparent process has become clouded in secrecy, with the commission hiding behind its so-called "cloak of independence".

The new NHS Appointments Commission was set up to end the accusations of cronyism and, to quote from its website, it was created to ensure that the public, the NHS and Ministers have confidence in the openness, transparency and fairness of the procedures which are used". We are as far from that position as we could possibly be.

We must ask questions about not only the procedure used, but the people finally appointed. Mrs. Angela Ballatti is a senior tutor in the business school at Durham university and Dr. John Marshall was director of the business school. This, along with the appointment of Sandy Anderson—who worked with Dr. Marshall for 30 years at ICI in Teesside—to the chair of the South Durham Health Care NHS trust makes the perception of cronyism hard to refute.

Mr. Earley was removed without adequate explanation and that has left a stain against his character despite the much good work that he did for health care in my constituency and in Durham in general. The only reason given for his removal was that he did not get on with the former chief executive. We may never know the true reason but, since the controversy surrounding this appointment, Dr. Marshall has at least given some pointers as to where we might find an answer.

In a private meeting with the non-executive members of the North Durham trust after Mrs. Ballatti's appointment, Dr. Marshall said that Mr. Earley's demise had occurred because he had engineered the retirement of the former chief executive, Mr. Worth, so that he could "put his boy in", referring to the new chief executive, Steve Mason. Dr. Marshall could not be further from the truth. Mr. Worth's retirement was agreed with the regional health authority and Dr. Marshall did not object when he was chair of the health authority.

If Mr. Earley committed a crime, it was that of wanting another Marshall—Mr. Charles Marshall—as the new chief executive of the North Durham trust. That proposal was blocked by the regional director, Peter Garland and, on a point of information, the present chief executive did not apply for the post at that time. Mr. Earley had crossed Mr. Garland, so it could be interpreted that Mr. Earley's removal as chair was Garland's way of hitting back at Mr. Earley's defiance.

The NHS Appointments Commission was set up to ensure transparency and fairness. This case demonstrates that, in the appointment of the chair of the North Durham trust, it has failed badly. A chair, who even the Secretary of State for Health agreed to me privately was a good one, has been removed without good reason. Mr. Earley's only crime was that of crossing the NHS's northern regional director.

The NHS appointments commissioner for the region, Dr. John Marshall, clearly has a lot to answer for, but it appears that he is unaccountable. It concerns me that if more decisions and finance are to be devolved to a local level, as was announced last week, there needs to be greater public accountability of those we appoint to run our health service at a local level. Failure to do that will allow local health service civil servants to continue to make mistakes and not to deliver the health care that the Government and the public in North Durham demand. If speaking out and challenging the local civil service results in individuals being removed, we will not get talented and representative people coming forward, and the challenging questions on the health service that the public need to be put will not be asked.

I ask the Minister to examine the issues that I have raised tonight. I will work with Mrs. Ballatti, the new chair, for the sake of my constituents, but I will continue to ask the challenging questions that need asking.

10.16 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)

I genuinely congratulate my hon. Friend the Member for North Durham (Mr. Jones) on securing the debate. It is clear from the way in which he makes his case that he takes seriously his responsibility to represent the best interests of his constituents in the health service. I recognise and understand his concern that the North Durham Health Care NHS trust should have sound leadership. The performance of any NHS trust depends on the leadership provided by executive and non-executive directors of the board. His constituents rightly expect their local hospital to provide the best service that it can.

The new hospital, the University hospital of North Durham, which has been built on the north end of the existing Dryburn site in Durham city, is operational following a £96 million private finance initiative scheme. It rationalises acute hospital services and centralises in-patient facilities and specialised out-patient services on a single site. Almost £600,000 of additional funding has been allocated to critical care services and £500,000 has been allocated to provide equipment this year in the new hospital. My hon. Friend's constituents now have access to high-quality care.

We heard how Mr. Earley's personal and forthright leadership style gained him support from hospital staff and in the local community. I do not wish to say anything that would detract from his significant contribution to the trust or the community at large over the past three and a half years. However, it does not necessarily follow that his record makes him the automatic choice to lead the trust into the challenges of the next four years. The NHS Appointments Commission, in making the appointment of Angela Ballatti as chair from 1 November, has taken an independent view that North Durham Health Care NHS trust can move forward to even better performance under her experienced leadership. Before I deal with the detail of Mr. Earley's position, I will say why the NHS Appointments Commission was set up and how it operates.

In 1999 Dame Rennie Fritchie, in response to complaints from MPs and interest by the media, announced her intention to scrutinise all NHS appointments. Her report in March 2000 made 28 recommendations for improving the process. She concluded that there was a lack of transparency in the way those public appointments had been made and even that political affiliation had been more important than merit when candidates were considered. The Public Administration Committee became involved and its second report recommended that the Government should consider the possibility of an independent appointments commission.

The Secretary of State for Health took the view that an independent commission was the only way to provide complete reassurance to the public. The commission was set up with a chair, a chief executive and eight regional commissioners. The establishment of the commission means that the appointment of chairs and non-executives to NHS boards is no longer the direct responsibility of Health Ministers. In addition, the NHS Appointments Commission does not consult MPs on the identity of candidates. Instead, it writes to all Members of Parliament whenever a chair post is advertised to give them the opportunity to draw the advert to the attention of anyone who they think is suitable.

Mr. Jones

The process was clearly inefficient in my region, because even though I was elected in June the commission wrote to my predecessor, Giles Radice. I had to point out that I was now the Member of Parliament. Clearly, the commission does not keep on top of who are the Members of Parliament in the northern region.

Ms Blears

My hon. Friend makes an important point. When I met Sir Williams Wells today, I asked that the procedures connected with Members of Parliament be examined to ensure that they are efficient and effective. On occasion, not only have Members of Parliament not been notified that vacancies have occurred and that they should draw the advertisements to people's attention, but they have not been notified when an appointment has been made. I am anxious to ensure that all Members of Parliament are properly notified of appointments: they are important positions in every community and local Members of Parliament must be kept up to date. I stressed that to Sir William Wells.

The NHS Appointments Commission was established as a special health authority from 1 April this year to take over responsibility for recruitment and appointment of chairs and non-executives. In taking the step of establishing an independent appointments body, my right hon. Friend the Secretary of State for Health had the support of the Public Administration Committee and the Commissioner for Public Appointments, Dame Rennie Fritchie. Sir William Wells is the first chairman of the commission.

The NHS Appointments Commission itself is subject to regular audit and scrutiny by the Commissioner for Public Appointments, who has a statutory duty to audit all public appointment files within her remit. She does that by sending in teams of auditors who trawl through the files, examine processes and report on their findings. The commission will be audited annually from 2002. I hope that that reassures my hon. Friend that the proceedings and processes of the commission will be subject to intense scrutiny.

In addition, anyone who thinks that the appointments process is flawed may draw their concerns to the attention of Sir William, who has the power to scrutinise all the papers and the process. He can request the board to re-examine the appointment, and would do so if he found evidence of flawed procedure. If the complainant remains dissatisfied, they may then take up the matter directly with Dame Rennie Fritchie, who has the power to see all the papers, audit the procedures and report back. The commission would be bound to consider her recommendations and to take appropriate action. We have built in checks and balances to ensure that the commission's activities are subject to proper audit.

Transparency is crucial if the public are to feel that proceedings have been properly conducted. One of the first actions of the commission was thoroughly to overhaul the appointments process. After a comprehensive consultation exercise involving all serving non-executives, new guidance was published that has the full support of the Commissioner for Public Appointments. I understand that copies of the entire process are available in the Library. The process is open and transparent and ensures that appointments are made—and can be seen to be made—on merit alone.

There are safeguards in the system. First, all interview panels must include an independent assessor who has the right to report directly to the Commissioner for Public Appointments if the proper procedures are not followed. Secondly, appointments are not made by any individual alone. Chair appointments are made by the full board of the commission in a collective decision. Thirdly, no chair or non-executive has an absolute right to a further term of appointment. If there is any doubt about their performance, their post will be advertised, but they are entitled to apply and be interviewed along with other candidates. That may appear harsh to my hon. Friend, but the NHS Appointments Commission believes that the process is essential to encourage openness and to ensure that the NHS always has the best leaders available to it.

Dr. Ashok Kumar (Middlesbrough, South and Cleveland, East)

Those who have been rejected must be told why they were turned down. It hardly creates confidence or encourages people to come forward if they are not told.

Ms Blears

My hon. Friend makes an extremely important point—one that I raised with Sir William Wells today. All unsuccessful candidates should be entitled to proper feedback on their interview, on the process, on their perceived deficiencies, and on where they need to be stronger if they are to be appointed. I have been assured that all candidates are entitled to feedback, both orally from the members who sat on the interview panel and, if they wish it, in writing. It is an important part of the procedure that people should understand where their perceived deficiencies are.

Mr. Jones

That is not included in the procedures that have been laid down, and it is new to me. Mr. Earley has not been offered that option.

Ms Blears

That should be remedied. I undertake to ensure that it is.

My hon. Friend said that in relation to the process concerning Mr. Earley, a decision was made not to appoint any candidate on the first occasion. There was then a trawl or a head-hunting process. My hon. Friend has rightly said that that process of seeking applications is not in the written process that he has examined. Again, that matter needs to be remedied. Apparently, the process is acceptable to the independent commissioner, and it has been used on a number of previous occasions. My hon. Friend is correct to say that the process should be transparent and should be part of the written procedures. I will ensure that happens.

In Mr. Earley's case, there was a panel that consisted of the regional commissioner, another chair and an independent person. At the first session, Kevin Earley was interviewed in accordance with the process. Along with three other candidates, he was assessed as not having the particular skills needed by the trust for the challenges of the future. The details of that interview are in confidence between the commission and Mr. Earley. I do not have them, but he should be entitled to that feedback. I will ensure that he gets it.

Miss Ballatti was appointed by the commission at its board meeting on 12 November. She is already an experienced chair, and she will be supported in her new role by the induction and training procedures. I am delighted that my hon. Friend has said that he intends to work closely with her in the interests of his constituents to ensure that their health services continue to be of the highest possible quality.

My hon. Friend has expressed concern about the role played by Dr. John Marshall in this procedure. I have been reassured by Sir William Wells on behalf of the commission that Dr. Marshall is a man of the highest integrity who has worked in the north-east for more than 40 years in the chemical industry, the university sector and as chair of a health authority. It therefore follows that he knows many local people. It is an asset to have that local knowledge when trying to search out and find the highest quality people to lead the NHS within the region.

Mr. Jones

I accept my hon. Friend's point. However, if we are looking for new people to come into the NHS and into the appointments system, which is what the commission was set up to do, and if we are limiting such people to those who know Dr. Marshall and others who move in certain social circles, we shall not get new blood, which is what the process was set up to achieve.

Ms Blears

I do not think for one moment that I said that candidates should be limited to people moving in the same social circle. I said that sometimes it is an asset for people who are grounded in their communities to be able to seek good, high-quality leaders for the service.

We must be clear that it is an unfortunate fact of life that in any appointment process there will be candidates who are disappointed by the outcome and who will try directly or indirectly to take the matter further. We in the House need to be careful not to become caught up in that process. The independent commission was established to ensure that there is fair play, that appointments are made on merit and that we have transparency.

If my hon. Friend still has concerns, he should take them up with the chair of the commission, Sir William Wells, who I am sure would be delighted to see him to talk the issues through in depth. I recommend that my hon. Friend, and any other Members who remain concerned, take up these matters. They should ensure that their concerns are placed firmly before the commission. It is important to make sure that we all have faith, trust and confidence in the appointments that are made. It is in the best interests of all our constituents to ensure that we get high-quality people into the health service who are able to perform on behalf of their communities and deliver the best services to which all our constituents are entitled.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes past Ten o'clock.