NHS Appointments

HC Deb 12 July 2000 vol 353 cc200-21WH

11 am

Mr. Graham Brady (Altrincham and Sale, West)

I am grateful for this opportunity to raise the important matter concerning the report of the Commissioner for Public Appointments, but I preface my remarks with a note of regret: that we are having this debate in Westminster Hall when the House of Commons Chamber is not in use. That is indicative of the way in which the Government treat the matter. It is also regrettable that it is necessary for an Opposition Member of Parliament to raise this subject for debate. The issue is of great importance. It has arisen from a report presented to the Government by an independent public body. The Government should have responded quickly in the House and, ideally, allowed an opportunity for debate.

It is almost four months since the report was published. It is unacceptable that the Government have taken that long to make a serious response to the commissioner's findings. It is typical of the Government's arrogance and their contempt of parliamentary scrutiny. It is also typical of their contempt for the public, who deserve an open exposition and discussion in Parliament of the findings of Dame Rennie Fritchie's report as part of our country's proper democratic process. The fact that the Government have sought to avoid that process and scrutiny is unfortunate.

However, as I say, I am pleased to secure the debate. I am fortunate that the balloting process has allowed me to bring the Under-Secretary of State for Health, the hon. Member for Birmingham, Edgbaston (Ms Stuart), to this Chamber to comment on the matter, but had the Government been prepared to make a statement or to allow debate in Government time, hon. Members of all parties would have found it easier to take seriously the Government's commitment to improve the process of public appointments in the national health service. It would also have been easier to accept that they were taking seriously such a careful and rigorous piece of work.

The Government's failure for so long to respond to the report reveals an unfortunate attitude towards the Nolan process and the drive to improve standards in public life. The Nolan rules were not intended to be a party political tool for the use of the Labour party when in opposition. They were a serious attempt to raise standards in public life and, in this context, to raise standards in the public appointments process. The Government's treatment of the report shows that they want to take Nolan à la carte. They want to decide when it suits them and when it is politically expedient to listen to the Committee on Standards in Public Life, without understanding the important principle that the public have a right to fairness and higher standards in public life and in the Government's conduct with respect to public appointments.

The Government have abjectly failed to take seriously a matter which is vital, not just because of the need for political balance in appointments—although of course that is important, as a matter of natural justice and because the general public do not like the smell of an appointments process that is patently politically biased. The most important aspect of the question is that relevant appointments are being made to the boards of health authorities, NHS trusts and, now, primary care trusts. The people concerned are entrusted with the responsibility of providing, through the national health service, health care of the standard that the public have a right to expect. It is a matter of serious concern if appointments to those senior national health service positions are not based on ability or merit, because the public are being short-changed by the appointment of people who are not up to the job.

I have said that the Government have not taken the matter seriously. The report from the Commissioner for Public Appointments was published on 22 March. Ironically, in an example of what has perhaps become a new hallmark of the Government—the failure of their attempts at spin and news management—the report happened to be published on the day when the Prime Minister presented a rather empty statement in the House on NHS modernisation. Hon. Members may recall that he offered little besides platitudes. However, one significant matter was on the agenda: the report on the Government's actions with respect to public appointments in the national health service.

My right hon. Friend the Leader of the Opposition raised the matter, telling the Prime Minister that he had produced a system of appointments debased, corrupted and contorted by the crony culture that he has built all around him. The Prime Minister did not even respond to that point. The hon. Member for Isle of Wight (Dr. Brand) may be pleased to hear that his party leader, the right hon. Member for Ross, Skye and Inverness, West (Mr. Kennedy), to his credit managed to wring a little more from the Prime Minister. After he had raised his concerns following the publication of the report, the Prime Minister began his response with the comment: On that last point, the Secretary of State is announcing our proposals in response to what Dame Rennie Fritchie said. That is all well and good, but the Prime Minister gave no details of his views on the matter or of the importance that should be attached to it.

When I was fortunate enough during the same exchanges to be called to put a question to the Prime Minister, I asked what action he would take to root out those who had been appointed other than on merit, and to appoint to NHS boards the best people for the job to ensure an adequate and appropriate standard of management. Frankly, the reply that I received was insulting. The Prime Minister said: I shall simply refer to the following sentence of the Fritchie report. He quoted not a sentence, but part of a sentence—a tactic that we have seen more often than we would like from the right hon. Gentleman. He quoted: The issue of…politicisation…is not new. The practice of inviting MPs to comment on the shortlists of candidates was first introduced by the Conservative Government…"—[Official Report, 22 March 2000; Vol. 346, c. 986–94.] Had the Prime Minister completed the sentence, he would have added the words: but has gained a new momentum since the last general election. At the very least, the Prime Minister's response was evasive, and it set the tone for the Government's reaction to an important public document that raised a matter of public concern. The Prime Minister told us that the Secretary of State for Health would set out the Government's response to the report—but when? It was not later that day, when the Secretary of State for Health had the first opportunity to do so during debate on the Budget resolutions. The Government were hardly short of opportunities to put the matter before the House and stress the seriousness with which they regarded the commissioner's report. They were hardly short of opportunities to demonstrate their commitment to improving the process. Nevertheless, the Secretary of State did not set out the Government's response during the following month of April—nor in May, nor in June. I cannot help but think that he would not have done so in July had it not been for my good fortune in securing this debate.

We have already seen increasing press interest and speculation in the matter. A report in The Times suggested that the Commissioner for Public Appointments was "irritated" that the Government had not replied to her report, and reported that she had suggested that politicisation was still occurring in appointments to the new primary care trusts that oversee general practitioner services. Again, the Government do not appear to be taking those matters sufficiently seriously.

Mr. Crispin Blunt (Reigate)

I suppose one of the reasons why the Secretary of State for Health would not have been keen to reply in May was that the Labour candidate in the Romsey by-election was Andrew Howard, who was my opponent at the general election. Following the general election, he was appointed as chairman of the Croydon and North Downs Community Health NHS trust, but he resigned after 18 months to fight the Romsey by-election for the Labour party, leaving behind a bad taste among the people at the health trust whom he had abandoned. I am not alleging that Andrew Howard would not have been up to the job, but the fact that he has been popping in and out of a political career has not done the service of that health trust any good. I hope that my hon. Friend, and perhaps the Minister, will comment on that.

Mr. Brady

I am grateful to my hon. Friend, who makes an interesting and valid point. Perhaps, in the best tradition of political expediency, there has been a similar reason in each month since the report was published why the Prime Minister or Secretary of State for Health has found it inconvenient to respond to a report that has called into question the whole process of appointments in the NHS during this Government's term of office.

We saw little activity until Wednesday 5 July, when I heard that I had been successful in the ballot for a debate in this Chamber. Miraculously, two days later, on 7 July, the Minister sent a letter to the Commissioner for Public Appointments, partially responding to the report. The letter was placed in the public domain only yesterday by means of a written answer in the House of Lords, and the text of the reply was available only in the Library.

The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)

Will the hon. Gentleman remind me in reply to whom that answer was given? Is he suggesting that there was collusion between a member of another party over that question in the House of Lords?

Mr. Brady

I am sorry; I did not hear the Minister.

Ms Stuart

Does the hon. Gentleman know who asked the question in the House of Lords and to which party that Member belongs?

Mr. Brady

Yes, I do know, but I fail to see its significance.

Ms Stuart

Would the hon. Gentleman mind telling the Chamber to which party the Member who asked that question belongs?

Mr. Brady

I understand that it was Lord Clement-Jones, the Liberal Democrat Whip. I still fail to see the significance of the momentous point that the Minister is drawing to our attention.

Ms Stuart

It has been suggested that there was a connection between the timing of that question and our response. I have failed to establish a connection.

Mr. Brady

I now see what the Minister is driving at. Even if one leaves aside the obvious, well known and public connections that exist from time to time between the Labour and Liberal Democrat parties—I shall leave it aside, Mr. Deputy Speaker—the Minister will be aware that the Department of Health had another opportunity during the previous week, when I asked in a written question when a reply would be given to the Commissioner for Public Appointments. The response, which I received on 4 July, the day before the ballot for Adjournment debates in Westminster Hall, was that a reply would be given shortly.

Perhaps I am being uncharitable, but if Ministers had it in mind to sign a letter that was to be sent on 7 July, just three days later—they are not always punctilious about the timing of their written answers—would they not have either delayed the written answer so that they could give a substantive reply or said when a response would be given?

Mr. Philip Hammond (Runnymede and Weybridge)

Will my hon. Friend remind me when the ballot took place that selected this subject for today's debate? Could that have influenced the timing of the Minister's letter?

Mr. Brady

Indeed; I draw what I think is the inescapable conclusion that it did influence the timing of the Minister's letter. The ballot took place on Wednesday 5 July. I say this in a charitable sense, because the Minister is an honourable lady and she used to live in Altrincham—I have a great affection for people who used to live there—but the reply was rather bland and anodyne. It did not add much to the sum of public knowledge, and it left Ministers with the flexibility to reply to the Commissioner for Public Appointments during July, or even during the summer recess, when they might have thought that they could sneak something out without scrutiny.

Ministers might have found further reasons why it was not yet possible to reply—perhaps because another great review, this Government's favourite tactic, was being undertaken—and might not have replied before the autumn. We would then have had the wonderful prospect of returning in the autumn and once again trying to encourage Ministers to reply. If they had the best interests of the national health service at heart, and if they took seriously the importance of rigorous and proper scrutiny, fair conduct and the proper application of the Nolan rules in the appointments process, they would have chosen to reply much sooner than yesterday.

Instead, however, a report in The Times—not a theological text, but generally reliable—suggested last week that the Commissioner for Public Appointments had not been invited by Ministers to discuss the contents of her report, which was published nearly four months ago on 22 March. Ministers have now given a partial reply, but it is somewhat disturbing that that reply should be sent before they had taken the trouble to speak to the commissioner and to discuss her findings in detail. What kind of a reply can that be?

I started taking an interest in the matter owing to my experiences locally. It was impossible to avoid noticing the way in which the Government operated a process of political appointment in my area. It was so obvious, determined and regular that it was plain to everyone, whether greatly interested in politics or not, that a deliberate politicisation of national health service management was taking place. The term of the chairman of the Salford and Trafford health authority was not renewed—she was effectively removed—and a Labour councillor from Salford replaced her. A Labour councillor from the borough of Trafford joined as a non-executive director, which meant that a third of the non-executive directors on the health authority not only supported the Labour party, but were active Labour party politicians. That was compounded by the situation in my local health care trust, the chairman of which was replaced by a Trafford Labour councillor. The Government were not content merely to give him a single companion; instead, they added two further Trafford Labour councillors as non-executive directors.

The borough of Trafford has always been an interesting political microcosm. It is a mixed borough, and there are sharp divisions between different parts of it, not least in politics. The political make-up of the borough is now broadly even. The Labour party has a narrow majority on the council, but in each of the past three years—the whole electoral cycle—more people in the borough have voted for the Conservative party than the Labour party. In the local elections this year, that was an absolute majority.

I shall not argue for proportional representation—immediately the Liberal Democrat spokesman, the hon. Member for Isle of Wight perks up to contribute—on NHS boards. It would not be viable for the Government to argue that it was necessary to appoint three Labour councillors to the board of the Trafford Healthcare NHS trust to reflect the views of the local community. Doing so emphatically and demonstrably did and does not reflect those views.

Mr. Nicholas Winterton (Macclesfield)

I am following the good case that my hon. Friend makes, and he is clearly as concerned as I am that there should not be flagrant politicisation of appointments to the national health service. In his view, were the people who were not reappointed as chairmen and non-executive members of the health authorities in his area competent? In my area, we currently have an outstanding chairman, who is well respected across the political spectrum. He has done a wonderful job and has increased the morale of health service staff, but is threatened with non-reappointment, on grounds about which I have no idea. It would be a disaster for the continuing success of my trust if he were not reappointed later this year.

Mr. Brady

I am grateful to my hon. Friend, who is right to raise that important matter. In the local instances to which I referred, able people were not reappointed. I shall not comment generally on those who replaced them, as I should make it clear, from a sense of even-handedness, that I am not saying that all political appointees are not up to the job.

Ms Stuart

I ask the hon. Gentleman to comment on the letter sent to him by the chairman of the north-west branch of the NHS executive, Professor Joan Higgins, who wrote: We looked for the relevant experience, appropriate skills and the potential to make a success of this challenging new post. The two candidates whose names have been submitted both scored very highly on these criteria. There was certainly no intention to promote individuals with a particular political affiliation at the expense of better qualified candidates. Is the hon. Gentleman saying that there were better qualified candidates who were not promoted because they were not affiliated to the Labour party?

Mr. Brady

That is possibly so. I know of candidates of other political persuasions who, strangely, find that they are never called for interview or are called once and never again. That picture is reflected throughout the country. The Minister waves the letter in front of her but, in the case in question, I believe that there might have been people at least as well qualified, but with different political views, who were not offered the job.

The Minister raises an interesting case. An initial letter was sent to me on 11 April, in which my comments were sought on the shortlist for the appointment of chairman of the Trafford South primary care trust. I gave limited comments on the candidates because I know only one of them a little, but I commented on the process. I did not criticise the regional chairman, who was left to implement the rules given to her by Ministers and the Department of Health. I will not be diverted into a discussion of the political affiliations of the people involved in the process, because I do not know those of the regional chairman.

Mr. Hammond

The Minister is seeking to cite a particular case and has asked my hon. Friend to comment on it. Does he think that the Minister is in any way disputing Dame Rennie Fritchie's conclusion that less successful candidates have been brought forward to replace those already identified on merit? Dame Rennie's report was categoric about that, and the Minister's citing of an individual case will not alter those conclusions.

Mr. Brady

My hon. Friend makes an important point and is right to underline the significance that the commissioner's report attaches to the matter. The Minister has been bold enough to quote an example of an appointment, in relation to which an interesting situation has developed. I raised the issue of that appointment with the Commissioner for Public Appointments because I was concerned that it was evidence that the Department of Health had taken no action following her report of 22 March. I mentioned the fact that Members of Parliament were still routinely consulted on shortlists. One of those two candidates was a local Labour councillor who had already been appointed as a non-executive director of a health authority. We are getting into a compound situation in which such appointments are flowing thick and fast.

I was told by the regional chairman that the Labour councillor was the preferred candidate and that the process had been properly observed. I was left to conclude that that was the end of the matter and that the appointment would go ahead. I received no further communication until I received a newsletter from the health action zone, the front page of which told me that Professor Norma Raynes, a dynamic new chairman, had been appointed to the primary care trust. It is hard to understand what happened behind the scenes of that appointment. It was certainly a closed and odd process, in which the preferred candidate was not appointed. Perhaps the Minister can enlighten me further when she replies, or write to me on the matter.

I am conscious of time and of the fact that several hon. Members want to contribute to the debate. However, I want to raise some specific examples. I want to return to the point made by my hon. Friend the Member for Macclesfield (Mr. Winterton) about the competence or conduct of those in office. Last year, I was greatly concerned about the conduct of the Labour councillor who was appointed to chair the Trafford Healthcare NHS trust. That concern was shared by the medical advisory committee of the trust, which, as the Minister will know, complained that the Labour councillor had made a decision on party political grounds.

The decision in question related to the closure of wards, which was announced just one working day after the local elections. Statutory consultation would have been necessary prior to the decision, and it was explicitly stated that the decision should be kept quiet until after the local elections. I raised concerns about the matter, as did clinicians in the trust. In response to their complaint, an internal investigation was held. That investigation may have been thorough, but, ultimately, it sat on the fence a little. However, some of its comments were interesting. It stated: a very real suspicion has been created in the minds of the senior doctors (who are actually very reasonable and feel they have a genuine grievance), and with some other senior staff who are not prepared to articulate this. One can only speculate on why they are not prepared to articulate. None the less, when the decision on the chairman's term of office came up, she was duly reappointed.

I mentioned that story in an Adjournment debate last year on ward closures. I am pleased to say that, because due statutory process had not been followed, we managed to reverse the ward closures. I am therefore delighted that the three wards at Altrincham general hospital are now open.

I raise that issue because it relates to the important point made by my hon. Friend the Member for Macclesfield. It shows the contrast between the reappointment of a Labour councillor whose conduct, at least in one instance, has been open to serious question, and the failure to reappoint other people who have done outstanding work for the national health service. I will give another example to show the contrast. It concerns a gentleman by the name of John Dutton, who has never been interested in politics or been a member of a political party, but is an active servant of the local community. He is a magistrate in Trafford, and I met him in that connection. His story gives rise to considerable concern.

Having been made a non-executive director of the Salford Royal Hospitals NHS trust in—I think—1996, John Dutton's appointment was terminated at the end of October 1999, despite outstanding service. Notably, he led a disabled access and disability discrimination programme, which became accepted as a leader in its field and was taken as model of best practice for many other hospitals. He was the chairman of the audit committee for three years, and the district auditor said that he had moved the hospital trust into the top three of his regional portfolio. His ability, commitment to the national health service and record of success in post could not be open to doubt. His only sins were that he was not politically affiliated, not a woman, and not a member of an ethnic minority.

In responding to concerns about the removal of capable members of trusts and health authorities, the Government claim that it has been necessary to increase the representation of women and ethnic minorities. I have no objection to that. Indeed, I support the increased representation of women and members of ethnic minorities in national health service management positions—but not under any circumstances, if those people are less able than those whom they replace.

Mr. Winterton

My hon. Friend has been extremely courteous in responding to my earlier intervention, so perhaps he would further say whether he is as concerned as I am that people who have given devoted service and outstanding commitment to the health service, and who are wedded to it, are being removed. He talked earlier about the process of appointment or reappointment. Is he not worried that the individual who has a major say in the north-west—the chairman of the north-west branch of the NHS executive—could be a member or strong supporter of the Labour party, as is my personal belief? She was appointed by the Government. I work closely with her; she is an able person, but might she not be prejudiced against people who do not meet what she perceives to be the Government's requirement in respect of appointments to such important positions? I am committed to my East Cheshire NHS trust and the work of its chairman, who is highly respected throughout the medical profession and political parties.

Mr. Brady

I am grateful again to my hon. Friend. The Minister challenged me on the political affiliations of Lord Clement-Jones. I do not know the political affiliations of the regional chairman, but perhaps the Minister does. Can she enlighten me?

My local experience led me to table some written questions, which yielded some important statistics. Between 1 May 1997 and 11 November 1999, a large number of councillors were appointed to trusts and health authorities. It amounted to one in seven of all appointments—that was noted in the Fritchie report—and meant that there was at least one councillor on most NHS boards. There was always someone with a political allegiance to communicate with others with the same political view.

Of those councillors, 284 were Labour councillors—83 per cent. of the total—36 were Liberal Democrats and 23 were Conservatives. In 1997–98, 27.8 per cent. of all appointments were politically active. In the following year, 22.8 per cent. of all appointees were politically active and in 1999–2000, the figure was again 27.8 per cent. Of appointees who had a political affiliation but were not local councillors, Labour party supporters comprised 77.7 per cent. in 1997–98, 77 per cent. in 1998–99 and 62.3 per cent. in 1999–2000.

Contrary to the views of the hon. Member for Brent, East (Mr. Livingstone), we are all grown up. I fully accept, as did the commissioner, that there may be political appointments. That is not a new worry, but after exhaustive scrutiny of what has been happening, she found that the process had gained new momentum and that the NHS had become subject to systematic politicisation.

The only other evidence that was available on previous political activity came from a survey conducted in late 1995 and early 1996. It stated that 8.5 per cent. of appointees declared no political activity, while 8.9 per cent. were Conservative and 7.6 per cent. were Labour. Quite rightly, the commissioner notes that it is not possible to say whether that was representative of the preceding years.

Ms Stuart

As we are all being grown up, I point out that, judging from the success rate according to political activity of those shortlisted in the hon. Gentleman's region of the north-west for NHS appointments since 1 January 1999, someone who declares a Labour activity has a 39 per cent. chance of being appointed, whereas a Conservative has a 56.3 per cent. chance. Will he comment on that?

Mr. Brady

I am tempted to take that as a compliment from the Minister. Perhaps I am making some headway on the matter. I suspect that it would be more relevant to consider the large number of appointments of Labour party members and councillors in my region. If the Minister looks at the numbers involved, a rather different picture may emerge. The commissioner stated in her report that Certainly the figures since the General Election reveal a large influx of appointees who were and are politically active, particularly on behalf of the Labour party. That is not new, but it has gained momentum since the election.

Dame Rennie Fritchie uncovered in her report an appallingly corrupt political culture, which is prepared to appoint people to public office entirely on the basis of their political outlook, without reference to their ability—a clear breach of the code of practice that the commissioner was appointed to uphold. Political affiliation dictates appointment and the best people for the job may not be appointed. The commissioner noted that many of the principles in my Code of Practice have either been, or risk being, breached in both their letter and spirit. On political bias, the report states: It is clear from the evidence presented to the Group that there have been examples of this, and that appointments have not always been made on merit… I would go further and conclude that the process has become politicised in a systematic way. There are clear doubts about whether appointments have been made on merit. The commissioner was moved to comment: Appointees are not honorary or "grace and favour", but full working members of the board. If members appointed to NHS boards take the view that their appointment is a sinecure to reward them for other service, for loyalty or for keeping quiet, that is of particular concern.

I established from written answers that in March 1999 around £1.4 million was paid annually in fees via NHS boards to Labour councillors. Again, I do not claim that they were in all instances doing a bad job or were not fit for purpose, but as the commissioner pointed out in her report, in some instances they were—and that is wrong. The report states: on occasion, the Government's goals for the representation of women and ethnic minorities have taken precedence in the process over the needs of a board. I say in the strongest terms that, although increased representation by women and people from ethnic minorities is welcome, if those objectives take precedence over the needs of a board, the quality of NHS health provision will suffer for women, ethnic minorities, and the whole population. It is bad practice, which must be stopped.

It is disturbing that a recent written answer, which I received on 4 July, said that the process for appointments to primary care trusts is continuing in much the same tone. Not so many councillors are being appointed—I do not know whether that is because Labour is running out of councillors or because it is worried about the publicity that the process is attracting. Of those declaring political activity who were shortlisted for appointment to primary care trust non-executive director positions, 28.9 per cent. declared Labour party activity; of those appointed, 17.3 per cent. declared Labour party activity. Of the primary care trust chairmen, 30.6 per cent. of those shortlisted were affiliated to the Labour party and 23.5 per cent. of those appointed are Labour party supporters.

A week ago, a headline in The Times stated: "Milburn chided over NHS trusts". The article noted that there had been no response to the commissioner's report. Yesterday, however, there was a response from the Under-Secretary, which was sent to the Commissioner for Public Appointments. It was, at best, half-hearted. It is obvious that it was rushed out because the political imperatives were starting to catch up with Ministers.

Mrs. Virginia Bottomley (South-West Surrey)

Does my hon. Friend think that it is disgraceful that the reply came from the Under-Secretary, not the Secretary of State? Is not that an indication of how insignificantly the Government regard the matter? Does my hon. Friend share the worry of those who believe that combining the role of chief executive in the NHS with that of Permanent Secretary means that integrity and propriety in public life will not be so carefully safeguarded?

Mr. Brady

I am most grateful to my right hon. Friend, who makes an important point about the proper management of the national health service. As the debate is being held in this odd hemicycle, I had not noticed that my right hon. Friend was here; her very presence shows the importance that some former Secretaries of State attach to these matters. They are still prepared to devote their time and energy to proper management and structures in the national health service and Ministers could learn a great deal from their example.

I have annotated the Minister's letter; I do quite a lot on education policy and I have been accused of behaving like a school teacher. I have marked the hon. Lady's response because it is at best half-hearted and inadequate. It does not say what it means, which is typical of Ministers in this Administration.

The Government say that they will "implement immediately" several recommendations of the Fritchie report. On recommendation 4, their response is halfhearted. They say: We already make it clear that nominees are treated in exactly the same way as candidates from other sources. That suggests that what is recommended has already been done, but although it is in the rules, it is not being enforced or implemented. The response continues: The Government accept that Members of Parliament should not routinely be consulted on short lists for appointment, which is welcome. It goes on: We agree that secondary appointments should be exceptional and subject to open competition. They have agreed to publish the full guidance about NHS appointments on the internet, which is also welcome.

Under the heading Recommendations on which action has already been taken are recommendations followed by the action that the Government claim to have taken: Recommendation 1. Ministers should commission a fundamental look at the role and purpose of NHS boards. That is what they say is being done. Recommendation 2. In the light of that review, Ministers should draw up fresh job descriptions. The Government reject that recommendation completely; they state: The job description and person specifications have been satisfactory in recruiting people currently on NHS boards. That is not what the Commissioner for Public Appointments stated in her report; she found that the specifications were inadequate and resulted in people being appointed who were not fit for the purpose.

Recommendation 3 is that there should be a review of the appointments process. The Government responded as follows: We have introduced a system of regular appraisal to assess the performance of those who have been appointed. That does not answer the point. Recommendation 8 was not accepted, and nor was recommendation 12, although recommendation 13 was agreed to.

Recommendations 16, 22 and 26 were not accepted. They are listed under Recommendations on Which Action Has Already Been Taken but many of them are flatly rejected by Ministers who say one thing and do another. Those recommendations are followed by a list of Recommendations Which We Do Not Intend To Implement. With unusual candour, the Government say that they do not agree that local authorities should not be permitted to nominate people for such purposes. In response to recommendation 9, which questions whether having so many councillors on NHS boards is a good thing, they say: Councillors constitute only 10.6 per cent. of non-executives on NHS boards. That seems quite a lot.

I am conscious of the time. I wish that I had time to go through all of the requests, platitudes and drivel in the rather rushed reply from the Minister to an important, serious, thorough and rigorous report. It is sad that the Government have not taken the commissioner's report seriously. It is even sadder that they do not take the fundamental issue seriously and are not concerned about whether the right people are being appointed to do the best possible job in NHS trusts and health authorities.

Several hon. Members

rose—

Mr. Deputy Speaker (Mr. Frank Cook)

Order. I have reserved the comments that I am about to make until this point because I wanted to make certain that I did not engage in the argument of the day. The hon. Member for Altrincham and Sale, West (Mr. Brady) gave the impression in his opening remarks that this Chamber is somehow subordinate to other parts of the House. I must correct that for the benefit of all hon. Members present. This is as much part of the House as any other Chamber. Any right hon. or hon. Member seeking a 90-minute Adjournment debate, which this debate is, used to be free to apply for a 90-minute slot in debate on the Consolidated Fund Bill. It is not possible at the moment to get a 90-minute slot any other way than in this Chamber under the system that the House has decided to operate.

11.52 am

Mr. Andrew Tyrie (Chichester)

I shall be very brief. My hon. Friend the Member for Altrincham and Sale, West (Mr. Brady) has said a great deal, very effectively, about an issue that has become of increasing concern to many of us over the past three years. Perhaps I should make things even briefer by asking three questions. Where has the problem come from? How bad is it? What should we do about it?

On the origins of the problem, it is clear that the Government decided early on to put large numbers of councillors on NHS trust boards. At first, it seemed like a reasonable attempt to increase local representation, but soon people became concerned that it was a ruse to put a higher proportion of Labour and Labour-inclined people on trust boards. At the time, the Conservatives had been in power for so long that Labour was disproportionately represented in local government. We heard that concern in our constituencies as early as late 1997.

Independently, Sir Len Peach, Dame Rennie Fritchie's predecessor, also became concerned. In particular, he noted that the consultation process for getting nominations from councillors to the boards had been sent to council leaders and not to chief executives. As a result, many Conservative councillors never got to hear about it and could not apply. As the ultimate in bias, they were not even given the opportunity to put their names forward.

I raised the matter with the right hon. Member for Holborn and St. Pancras (Mr. Dobson), the then Secretary of State for Health, when he came before the Select Committee on Health in February 1998. He denied that a slapdash approach had been taken to soliciting nominations impartially. I did not accuse him of political bias. I did not know whether political bias had been involved, but I was aware of widespread anxiety about at least the impression of political bias.

The then Secretary of State's response was that the issue has only generated an impression of political bias with the Conservative Party and that the suggestion had been generated by the Conservative Party and most of the things that they have drawn attention to have been factually incorrect. He dismissed my anxieties by repeating those words over and over again.

We now have some evidence, in the report. I shall not go through all the evidence, because I do not have time, but it is overwhelming. I draw the Minister's attention to page 15, which shows that, of local councillor appointments made between 1 May 1997 and 11 November 1999, the number of Labour appointments was 284 and the number of Conservative appointments was 23.

Is that a fair reflection? I am not suggesting that the figures should constitute an exact proportional representation of the current disposition of political forces in this country, but what possible justification can there be for 284 against 23? Might it be that Conservative councillors were of such poor quality that they could not be appointed on merit grounds, whereas Labour councillors were of such outstanding quality that they were all swept into appointments? It is absurd and disgraceful that such an appointment rate should have been allowed to persist.

The first of Dame Rennie Fritchie's conclusions has already been clearly set out by my hon. Friend the Member for Altrincham and Sale, West. She says clearly and unequivocally that the process has become politicised in a systematic way. The Government have a great deal of explaining to do if, in light of those numbers, we shall not have to conclude that she is right.

Dame Rennie Fritchie's second major conclusion is that her code of practice for appointments has been completely ignored. The conclusion of the section on the code of practice, on page 33 of the report, states: This assessment reveals that many of the principles in my Code of Practice have either been, or risk being, breached in both their letter and spirit. That is strong stuff from the public appointments commissioner, and I am deeply worried that the Government have been rather cavalier in their response.

It is true that anxiety has been expressed about public appointments for many years and that many accusations have been made by Labour Members about Conservative appointments to trust boards and other quangos. In the past, the Conservatives appointed a disproportionate number of business men to such posts, and in particular to NHS trust boards. They did so with the worthy intention of trying to bring more business practice and understanding into the NHS, which was a valuable step forward. As Conservatives may be more plentiful in the business community than in other parts of the community, that may have resulted in some bias, but nothing could possibly compare with the figures—284 to 23—that I cited.

We desperately need, as a response from the Government, a clear statement that they will do what is required to restore public confidence on the issue. Public confidence has been badly compromised as a result of the findings in Dame Rennie Fritchie's report. In particular, it is essential that the Government get out of their state of denial on the issue—their conviction that nothing has gone wrong. We need to hear the Minister admit today that mistakes have been made in the appointments system—that there has been some political bias, and appointing on grounds other than merit—and that the Government will do something about it. The best thing that they can do is endorse the recommendations in Dame Rennie Fritchie's report. I hope that the Minister will feel able to do that, because it is the only way in which we can restore public confidence on this crucial issue.

12 noon

Dr. Peter Brand (Isle of Wight)

I congratulate the hon. Member for Altrincham and Sale, West (Mr. Brady) on securing the debate. However, I am not too sure whether his concern is about the national health service or the scoring of party political points, which he did at tremendous length.

A long time ago, I served as a member of a health authority for some 10 years. I was nominated by our local medical committee, the British Medical Association and my royal college, as was my consultant colleague. We had nominations from the voluntary sector and from local authorities. That made for a broadly based health authority, which, although not very efficient, was certainly effective in meeting the criteria of involving the community that the hon. Member for Southampton, Itchen, (Mr. Denham), the Minister of State at the Department of Health, mentioned.

The first warning signs went up under a previous Government when nominating bodies were told that they had to nominate more people to fill a post than the number of vacancies in it, to ensure an opportunity for central direction by the Secretary of State. I am pleased to say that the bodies that nominated me failed to heed that instruction because it was thought to override local interest. We then had one of the organisations that we in the NHS suffered as time went on. The nature of health authority members changed dramatically and they became more akin to the non-executive members of public quoted companies. It was clear that the Secretary of State was seeking a different type of being to serve on that board. There was no longer a requirement to live in the area that one was serving, and all the concentration was on getting people with business and financial experience.

It is in the nature of such people that they do not have time to enter public life through the political process. Therefore, it may be true that no overt political activities were involved with those appointees. From my experience, however, it was also clear where their political allegiances lay. Today's debate is something of a sterile exercise. I am not surprised that the Government made changes after the last general election. They did so most inelegantly, somewhat brutally and at times stupidly. They overdid it, and I believe that they have recognised that things did not go well.

I am amazed at the tone of this morning's debate. It has been suggested that there is something disreputable about being politically active, that the political process should not be a route to making a contribution within the NHS. That is wrong. I welcome people of all persuasions taking an active part in public life rather than doing so through—

Mr. Tyrie

The hon. Gentleman says that people of all persuasions should participate. Does he think that participation of 284 Labour councillors and 23 Conservative councillors is participation of people of all persuasions?

Dr. Brand

I pointed out that the Government overdid it and that we were critical of them at the time.

I am concerned not about the politicisation of the process but about the continued patronage involved. That has gone on under succeeding Governments. Appointment to a national health body has become a second or even first career for some people, leading to well-paid appointments in quango-land. Those appointed have lost the independence of spirit and mind that comes from being democratically elected by a hinterland representing the community.

I shall differentiate between commissioning bodies and provider bodies. The democratic deficit in commissioning bodies is regrettable. The Government should rethink their response to Dame Rennie's report, which is extremely useful as a starting point for dealing with the issue. Commissioners of health services should be firmly based in the local community and democratically accountable, perhaps at local authority level and certainly at regional level. In provider trusts, it is right for a spread of expertise in the non-executive functions to be available to managers and commissioners. I welcome the fact that people from different backgrounds are being appointed on the merit of their contributions. Dame Rennie Fritchie's recommendations in that regard are extremely important.

In the past 20 years, the process has involved an unhealthy power of patronage. I applaud the many people who have made enormous contributions as non- executive members of health authorities and trusts, but they have always had to look over their shoulders in exercising their functions. It is important that the Government produce a substantial response to the report, which also examines the role of NHS boards. Is it the purpose of the boards to control the bottom line—the financial outcome? Is it their prime function to guide officers and managers of authorities and trusts in providing the service mix most suited to their locality? I am sorry that we have not devoted more time to that important issue, instead of having a slightly cheap knockabout.

12.7 pm

Mr. Philip Hammond (Runnymede and Weybridge)

I cannot agree with the final remark made by the hon. Member for Isle of Wight (Dr. Brand). My hon. Friend the Member for Altrincham and Sale, West (Mr. Brady) highlighted two important issues: the damning conclusions of Dame Rennie Fritchie's report and the Government's contemptuous treatment of those conclusions.

I congratulate my hon. Friend on securing the debate and on his interest in the subject. I know that his interest was originally stimulated by particularly nasty examples in his constituency of the practices that he described. My hon. Friend has done Parliament and the health service a great favour with his persistence in bringing such matters to wider attention, culminating in today's debate, which has forced the Minister to make a response, however interim.

It is somewhat ironic that although the Government came to office claiming that they would clean up public life, remove suspicions of impropriety and sleaze, and depoliticise the appointments process, they have presided over a massive increase in the politicisation of that process. They have introduced a culture of cronyism into the national health service and elsewhere. The Minister's interventions on my hon. Friend seemed dangerously close to displays of complacency. She appeared to suggest that there was no problem; that Dame Rennie got it wrong and that there is nothing to worry about.

My hon. Friends the Members for Altrincham and Sale, West and for Chichester (Mr. Tyrie) recited many of the findings of Dame Rennie's report. I shall summarise the most important points. The report concluded that the process of appointments to national health service bodies had been politicised in a systematic way and that the code of practice, which is supposed to govern those appointments, had been ignored. It said that there were clear examples of a candidate's political association acting as the decisive factor in his or her early selection and appointment and found evidence of the parachuting in of candidates at the instigation of Ministers at a late stage in the process as a result of lobbying by Members of Parliament.

Those practices meant, as my hon. Friends said, that 83 per cent. of councillors who were appointed during the first three years of the Government's term in office spent the first two and a half years as Labour councillors. It is important to recognise that that is against the backdrop of a significant decline in the number of Labour councillors. Four or five years ago, the Labour party had great plurality in the total number of local councillors, but the number of councillors from the two main parties is now almost equal. That makes the disproportion in appointments more shocking.

My hon. Friend the Member for Altrincham and Sale, West referred to the Prime Minister's partial quote of Dame Rennie's finding that politicisation of appointments is not new. We know and accept that. The Labour party identified politicisation in NHS appointments before the general election and said that it would do something about it. What it did not say is that it intended to accelerate that process and bias it in favour of one political party. Dame Rennie noted that the process has gained a new momentum since the general election. It has indeed taken a quantum leap. She also noted that, as a result of the process, less successful candidates have been brought forward to replace those already identified on merit on the grounds of promoting equal opportunities.

Real talent has been lost to the national health service. The NHS is too important to be a plaything of political correctness. The boards run one of the largest organisations in the country. They spend a budget which, over the next three years or so, will rise to £68 billion. That is a tremendous sum of money. They face an enormous task. Anyone who has talked to people who are engaged on the boards will know that the work load and demands are significant. My hon. Friend the Member for Macclesfield (Mr. Winterton) made the point that the process has driven many people from providing their expertise to the NHS.

Let me give an example of the way in which the Government, especially in their first year of office, treated people who gave their time to benefit the NHS. People in my constituency who had served on the boards for a long time and whose appointments were due for renewal were sent letters explaining that, because their appointments were coming to an end, they should refrain from participating in significant decisions in the period before their last day.

Mr. Tyrie

Thank you and goodbye.

Mr. Hammond

It was worse than that. They received no further communication, although in one case the retiring chairman of an NHS trust received a letter two weeks after his appointment had terminated informing him that the Secretary of State had decided to reappoint him. His reply was, "Too late, mate; I've already found something else to do"—another valuable talent lost to the national health service as a result of the Government's incredibly incompetent process.

Mrs. Virginia Bottomley

Does my hon. Friend recall the head of a Newcastle trust, Ann Galbraith, who led for the NHS on the citizens charter team? She did not know that she was not to be reappointed until her successor telephoned to ask whether she could make arrangements for handing over.

Mr. Hammond

My right hon. Friend is absolutely right. There are examples from all over the country. I do not want to cite dozens of individual cases because we do not have the time, but I would like to quote an additional global figure, which is telling, that neither my hon. Friend the Member for Altrincham and Sale, West nor my hon. Friend the Member for Chichester gave, although I am sure that both of them are aware of it. The figure was produced by the Library and shows that of the 87 appointees to national health service trusts in the Greater London area from May 1997 to 3 April 2000 who had declared political allegiances, 76 had allegiances to the Labour party. That figure is shocking.

What staggers and worries me so much is that the Secretary of State already has enormous power to direct and to control the national health service, which is a hugely centralised bureaucracy. Yet the Labour party apparently feels it necessary to install a second shadow control network, almost like the system that used to operate in the red army, in which there was a formal command structure and a system of political commissars who shadowed decisions and checked on the political correctness of what was being done. Many chairmen of NHS trusts and health authorities find that it is not unusual for them to be in direct communication with politicians. Two systems of control now operate in the NHS—the formal one and the political one, which operates at a different level. That should give us great cause for concern as we proceed with the plans for the development of the NHS that the Government are to announce shortly.

I want to leave adequate time for the Minister to respond to my hon. Friend the Member for Altrincham and Sale, West, so I will ask just a couple of questions. When will the Government make a full response to the findings of Dame Rennie? Dame Rennie has made it clear that she regards the Minister's letter to her as no more than an interim response. Will the Minister tell us why it has taken so long to deliver even that inadequate interim response? Will she say why the Government were so reticent in talking about the issues after the Fritchie report was published and why they have chosen not to offer Dame Rennie the opportunity to discuss her findings with Ministers?

The Government's behaviour following the publication of the report has been a gross discourtesy to Dame Rennie and to Parliament. A report so damning of the Government has simply been ignored and only now, through the securing of this debate, have we dragged any response from them. We need to hear an assurance today from the Minister that there will be immediate action to implement the report's recommendations and that she will review the appointments that have been made under the flawed process since 1 May 1997. Further, she must ensure that all appointments were appropriate. She must assure us that, where they were not appropriate, and the postholders have not been performing the required function because of the way in which they were appointed, she will take steps to ensure that proper appointments are made in their place.

12.18 pm

The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)

I start by congratulating the hon. Member for Altrincham and Sale, West (Mr. Brady) on securing the debate. Unlike him, I am extremely proud to be in Westminster Hall, which provides us with extra time in which to discuss issues. The hon Gentleman was extremely misguided to treat it as a secondary Chamber—it is as important as the House. I acknowledge the hon. Gentleman's longstanding interest in public appointments and I welcome the opportunity to respond to Dame Rennie Fritchie's comprehensive report. Time is short, but I want to respond to a couple of specific points that have been raised.

The hon. Member for Runnymede and Weybridge (Mr. Hammond) asked when there would be a full response. I am very sorry that the right hon. Member for South-West Surrey (Mrs. Bottomley) regards it as an insult that an Under-Secretary, and not the Secretary of State, wrote to Dame Rennie Fritchie. However, in that letter I made it clear that, as part of the national plan, we are examining the whole process relating to accountability in the national health service. The role of non-executive directors will be extremely important.

I recollect that, in a Select Committee, an Opposition Member who had formerly served in the Department of Health described the appointments process at that time as highly politicised, with civil servants involved at a great distance and outcomes determined by chance, because it was not possible to foresee what would happen. The implication that the world was well, holy and wonderful before 1 May 1997 and has now gone down the drain suggests the need for Opposition Members to get in touch with reality.

Mrs. Virginia Bottomley

The hon. Lady would be well advised to consult the Nolan report. That was favourable about the new procedures for health authority appointments, which have been established in no small measure because of Dame Rennie Fritchie's work. My point was simply that the matter is of such importance that the Secretary of State should have responded to Dame Rennie.

Ms Stuart

As I have said, what we are doing is part of the development of the national plan. Dame Rennie Fritchie's report was extremely helpful to us. In our initial response, we outlined the areas in which implementation has already taken place. We disagree over one or two aspects of the report, but as the national plan developments become clearer, we shall work closely with Dame Rennie Fritchie on further development.

Mr. Brady

Will the Minister give way?

Ms Stuart

I should like to continue. Time is needed for a proper response to a one-and-a-half-hour debate.

To listen to the debate, one would think that serving on an NHS board is some kind of gravy train on to which Labour councillors have jumped, with decisions made in smoke-filled rooms. The record should be put straight. The vast majority of members who serve as non-executive directors are lay people who ensure that the needs of their community are represented. They carry out an extremely important function. There are 3,000 of those public-spirited individuals. I agree with the hon. Member for Isle of Wight (Dr. Brand) about the decline in volunteering to serve in such public capacities. However, I remind Conservative Members that, in the past three years, one in four or one in five of them has responded to requests for nominations. If Conservative Members do not put names forward, they should not be surprised at not having any selected.

Mrs. Bottomley

Every name that I put forward was effectively black-balled. I put forward several names and every time the other individual was chosen. The hon. Lady might want to investigate that. The people whom I suggested were not, as far as I know, Conservatives.

Ms Stuart

That brings me to a useful point made by the hon. Member for Isle of Wight, who said that presenting the choice of two names was a positive step. I am terribly sorry to come across the attitude among Members of Parliament—it has come up in a previous Adjournment debate—that, having made their choice of who should be selected, their wishes have been ignored. The process involves an independent panel and a proper review. On the basis of the assessment, a choice is made. Sometimes those who are involved will not think that the best person has been chosen, but the proper process will have been used.

The achievements in the appointments process since 1997 have been not insignificant, not least because a far greater number of women now serve on NHS boards. That number has increased from 39 per cent. before the general election to 48.9 per cent. Even more dramatically, the number of black people and members of ethnic minorities has increased from 5 to 12 per cent. We should be careful when we use words such as "merit" and "ability". If the definition of merit is having a white, middle-class background, it is hardly surprising—

Mr. Brady

Will the Minister give way?

Ms Stuart

No, I shall not, as I want to make progress.

An equally successful but more important change is the increase since 1997 in the number of appointments of people with a community background. The proportion of people who are appointed from the voluntary sector and who are primarily users or carers has increased to 20 per cent. We do not for one moment deny that our boards still require the skills of business people, but the need for far wider representation remains. Dame Rennie Fritchie's report should be considered with those increases in mind.

I remind hon. Members that an independent auditor's report has been produced by Ernst and Young, which was employed by the commissioner. The report found that in 1999, 75% of applicants for posts on NHS boards in the Northern and Yorkshire and North West Regions had declared "no political activity". It went on to state: The data available suggest that the proportion of candidates declaring political activity at the application stage of the process are similar to the proportions declaring political activity at the appointment stage. Before anybody is appointed or even shortlisted, an independent panel conducts a sifting and assessment process. It would be disingenuous to suggest that anybody is parachuted at the last moment without having gone through that process, as that is not happening.

Mr. Tyrie

I am grateful to the Minister for giving way, as I realise that she does not have much time. She is saying that there is no problem and that we are making all of this up. Will she explain the fact that 284 Labour councillors were appointed between 1 May 1997 and November 1999, while only 23 Conservatives were appointed in that time? Does she believe that that can be described as anything else but political bias?

Ms Stuart

It is important to remember the number of people who put forward their names. I would not be at all surprised if more Labour councillors were prepared to put their names forward and to enter the selection process after May 1997. I would like to hear not merely about disagreements, but about evidence of widespread and systematic abuse of the system in the interview and selection process. The Government are responding to the needs of the whole chain of accountability in the national health service. I deeply reject the notion that everything was fine before 1997. Dame Rennie Fritchie referred to the courtesy with which people who are retiring are treated and to delays in appointment. We have addressed those points and moved forward.

I should like to correct the impression that the previous Secretary of State, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), wrote only to council leaders. An administrative error occurred when the first round of letters was sent, but now all of them go to council chief executives, so the opportunity to put names forward is shared equally among other parties.

Our response to the report lists a number of improvements that we have already put in place and others that we are considering. We agree with Dame Rennie's recommendation that Members of Parliament should no longer be asked to comment on shortlists for chair appointments. We inherited the practice from the previous Government—

Mr. Brady

Will the Minister give way?

Ms Stuart

No, I will not. There are two minutes left, and the hon. Gentleman spoke for 45 minutes. If he wants to hear an honest response, he should listen for a moment.

The practice of allowing Members of Parliament to comment on shortlists gave the impression that the process was politicised. We are happy to change it and are writing to hon. Members about it.

We part company with Dame Rennie on her view of local councillors, whose role we believe to be extremely important. They bring to their posts local knowledge of the community, which our NHS boards are supposed to reflect. There is no presumption, however, that being a councillor is an advantage in the interview and assessment process.

We will proceed with our proposals on the national plan. It is important that the right people are appointed, but we want more people from the regions to come forward as part of the plan. We shall announce further details, but we shall work closely with Dame Rennie to make that process more accountable and open, and to ensure that people see it as such.

Mr. Deputy Speaker (Mr. John McWilliam)

Order. I am sure that the Under-Secretary would not wish to mislead the Chamber. The hon. Member for Altrincham and Sale, West (Mr. Brady) spoke for 52, not 45, minutes.

Mr. Brady

On a point of order, Mr. Deputy Speaker. I did overrun, but only because I gave way generously to all hon. Members, including the Minister.

Mr. Deputy Speaker

That is not a point of order. I call Mr. Livsey.