NHS Policy Board: Composition (Hansard, 14 June 1989)

§ Lord Henley
My Lords, the composition of the NHS policy board reflects the desire of my right honourable friend the Secretary of State for Health for independent advice about the determination of policies for the NHS. Members were chosen not to represent any particular groups of NHS staff but to bring wider management perspectives to bear on the setting of strategy for the NHS.

§ Baroness Cox
My Lords, I thank my noble friend for that Answer, which I am afraid I do not find very encouraging. Is he aware that nurses comprise nearly half the workforce of the National Health Service? Is it not inept at best, and, I am afraid, insulting at worst, to exclude from membership of such a key policy-making body anyone with direct experience of nursing, particularly as a shortage of nurses will be one of the most acute problems facing the National Health Service over the next few years?

§ Lord Henley
My Lords, I am aware of the fact that nurses comprise around half the employees of the National Health Service. However, the composition of the policy board is intended not to be representative of health service interests but to bring together a group of people who can provide a range of specific contributions to the board's role of determining strategy for the National Health Service. An essential nursing contribution to the management of the NHS will be made through the management executive.

§ Lord Hunter of Newington
My Lords, one reads in the newspapers that the chief medical officer is in attendance at the policy board by personal invitation. Will the Minister tell us whether he represents the interests of the nurses or the medical staff? Or would the policy board prefer not to have him there at all?

§ Lord Henley
My Lords, the chief medical officer is appointed to the policy board not as chief medical officer but for his personal attributes. He was appointed because of his wide and valuable experience in the spheres of epidemiology and public health, and not ex officio as chief medical officer.

§ Lord Molloy
My Lords, is the noble Lord aware that all the great professional organisations of our 1418 National Health Service want the chief nursing officer on the policy board? Why are the Government resisting the views of these top-flight specialists? Can we have some valid reasons and not the lame excuses that he has given up to now?

§ Lord Henley
My Lords, I have given a perfectly good explanation. The policy board is not there to represent sectional interests. The role of the chief nursing officer, Miss Poole, is in no way diminished. My right honourable friend was surprised at suggestions that her position and authority were diminished by not being appointed to the policy board.

§ Lord Campbell of Alloway
My Lords, is my noble friend aware that there is genuine concern about the wisdom of the policy of total segregation of the administrative arm? Is there any valid objection in principle to having the chief nursing officer to assist in the administration? Surely one ought to be flexible about something regarded by people of all political persuasions as so important.

§ Lord Henley
My Lords, there is not total separation between the two. The policy board will agree with the chief executive of the management executive on the annual statement of key aims and objectives of the National Health Service. The executive will then report back to the policy board. The chief nursing officer will not be on the policy board; nor will anyone be on it ex officio other than my right honourable friend and his colleagues, the Permanent Secretary and the executive of the management executive. The deputy to the chief nursing officer will be on the management executive.

§ Baroness Seear
My Lords, does the noble Lord agree that there is all the difference in the world between being asked as an executive to comment on and explain how one will implement a policy which has already been formulated and being in on the formulation of the policy? It is perfectly arguable that one should not have people in a representative capacity, but one needs the knowledge in policy formation that only a professional nurse can bring.

§ Lord Henley
My Lords, the policy board is there to advise my right honourable friend the Secretary of State. He will also receive advice from the management executive. On the management executive we will have a representative of the chief nursing officer.

§ Lord Dean of Beswick
My Lords, is the noble Lord aware that his answers clearly indicate that the nurses will have no input into this area? Is it not strange that the advice of three prominent industrialists seems to be more eagerly sought than the views of the nurses who are a tremendously vital component of the health service? Will the noble Lord take this back to the Government and ask them to reconsider the matter in the interests of the patients and all concerned?

§ Lord Henley
My Lords, my right honourable friend will certainly read what the noble Lord has 1419 said. He implies that this is a kick in the teeth for the nurses. It is not. No one could value the nurses or the nursing profession more than my right honourable friend, and no one could value more the advice which the chief nursing officer gives to my right honourable friend. He will continue to take her advice into account.

§ Lord Ennals
My Lords, if that is the case and the Secretary of State takes her seriously, why is she not on the board? Can there be any logic in deciding to have the chief medical officer but saying that he does not represent the medical profession? One could ask—I shall not do so—in respect of all 18 members of the board, "who do they represent?" and "why were they chosen?"
From the exchanges on the Floor of the House this afternoon does the noble Lord not recognise that there is deep concern on all sides about this matter? Rather than simply asking his right honourable friend to note what has been said, will he put to him the views of the House? Although the noble Lord says that this was not intended as a slight to the nurses, can I assure him, as the noble Baroness has done, that all nurses take it in that light? Is it not a bad thing for the National Health Service that people who work for it and give it their dedication, commitment and skills should feel that they have been kicked in the teeth? That is how they feel.

§ Lord Henley
My Lords, I have said that nurses are not being kicked in the teeth. I hope that the nursing profession will take note of that. I think the noble Lord possibly misunderstands the role of the chief nursing officer and that of the chief medical officer. Neither is there to represent professions; they are there to give a lead to the medical and nursing advice used by the department. The noble Lord knows that perfectly well.
As I said, the chief medical officer has not been appointed in that capacity; he has been appointed for the personal contribution he can make. The noble Lord will understand that I cannot comment upon the personal reasons for which the chief nursing officer in her own right, and not in her capacity as chief nursing officer, was not appointed. It would obviously not be proper for me to do so.

§ Baroness Elliot of Harwood
My Lords, I find the Minister's reply most unsatisfactory. Who appointed the members of the National Health Service Policy Board without including the chief nursing officer when nursing is the most important—or, possibly the second most important—aspect in the National Health Service? It seems absolutely crazy.

§ Lord Henley
My Lords, my right honourable friend appointed the members of the policy board. He chose to appoint the chief medical officer but, as I have already stated, not in his capacity as chief medical officer.

§ Lord McCarthy
My Lords, the Minister is making the situation worse for himself. He says that the personal attributes of the chief medical officer get 1420 him on the board and that the personal attributes of all industrialists also get them on the board. However, he then says that the personal attributes of the chief nursing officer actually keep her off the board. Does he really mean that?

§ Lord Henley
My Lords, it is possible that I expressed myself rather badly. However, I am sure that noble Lords would not expect me to discuss the merits of individual candidates for the policy board in this way. As I said, the Secretary of State has expressed every confidence in the chief nursing officer. That is all that it is proper for me to say on the matter.

§ Baroness McFarlane of Llandaff
My Lords, would not the Minister agree that nurses have a contribution to make to the policy of the National Health Service which is far broader than their narrower sectional interest? Indeed, they have an intimate acquaintance with the National Health Service and the needs of patients. It is a contribution which is complementary but distinctive from medicine. In view of that contribution to policy, would the Minister agree that there is a lamentable lack of expert opinion on the policy board?

§ Lord Henley
My Lords, I do not accept that there is a lamentable lack of expertise on the policy board. I stated that there was a representative of the chief nursing officer on the management executive and that that executive will feed advice through to the policy board.

§ Lord Cledwyn of Penrhos
My Lords, will the noble Lord clarify one point? What part of the United Kingdom will the new policy board cover? Will it apply to England only, or will it apply to Scotland, England and Wales? Further, in the event that it covers only England, why then are Welsh and Scottish members on the board?

§ Lord Henley
My Lords, so far as I am aware the board covers the whole of the National Health Service. I am not, however, aware whether there are any Welsh or Scottish members on the board. But, as I said, the board is not there to represent individual interests.