§ Mr. Graham Brady (Altrincham and Sale, West)
I am grateful for the opportunity to raise the matter of political bias in national health service appointments. As the Under-Secretary of State for Health will recall, it is about nine months since we lasted debated the subject in Westminster Hall. It is now more than a year since the Commissioner for Public Appointments published her report on 22 March 2000, in which she made some damning indictments against the Government's record on political appointments in the NHS. I shall quote briefly from her report:I conclude from the evidence…that there are examples where a candidate's political association has been a decisive factor in their early selection and appointment, and that decisions have not always been based on merit … the process itself has been politicised".On 22 March 2000, the Department of Health responded to the report and, in a press statement, promised a fundamental overhaul of the NHS appointment system. That overhaul did not happen, and primary care trust boards were stuffed with Labour party activists in the same way that health authorities and NHS trust boards had been before. Instead of real action to tackle the problem, we had spin and media management.
Ministers repeatedly deny that there is a problem. They even deny that Dame Rennie Fritchie, the Commissioner for Public Appointments, criticised their actions and record. They point frequently to increased numbers of women and ethnic minority candidates who have been appointed. Such outcomes are welcome, but only if they come alongside appointment on merit—appointment of the best possible person for the job—and not instead of it. As Dame Rennie said in her report last year, positive discrimination would be a step too far.
I have been pursuing the matter for some time and, on 31 March 1999, I raised my concerns at Prime Minister's Questions. The Prime Minister's response was very interesting. He baldly stated:An independent system now appoints people."—[Official Report, 31 March 1999; Vol. 328, c. 1087.]That was two years before the independent commissioner for NHS appointments was appointed. A written answer that was given to me by the Under-Secretary about a week ago points out that the independent mechanism has not yet come into action; therefore, in light of the evidence, the Prime Minister stated something two years ago that was hard to support. That, in turn, was a year before Dame Rennie's report, which was so damning.
On 22 March 2000, I again raised the matter with the Prime Minister. In typical fashion, he tried to avoid a straight answer and tried to manipulate facts to his advantage. He quoted part of a sentence from the commissioner's report:The issue of politicisation of appointments 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. 994.]272WH He failed, of course, to conclude the sentence with the phrasebut has gained a new momentum since the last General Election.He went to the heart of the commissioner's report and pulled one sentence to pieces to try to excuse or justify conduct that had been criticised by an independent officer who was appointed to maintain high standards in public life.
Some people have raised the question whether an appropriate political balance has been maintained. I asked the Parliamentary Secretary for the Cabinet Office about that or 21 March 2001, and he replied to the effect that the number of councillors appointed to NHS boards reflected the proportion of councillors on the ground. Again, that is not supported by the evidence—by neither my experiences nor by rigorous scrutiny of evidence taken by the independent Commissioner for Public Appointments. Ministers might wish to ignore the facts and make other claims, but they should not be allowed to get away with it.
I raised my concerns with the Leader of the House on 30 March 2000. She stated thatappointments are undertaken by a panel with an independent assessor".Referring to me, she said:The hon. Gentleman…continues to raise a matter that is erroneous".—[Official Report, 30 March 2000; Vol. 347, c. 508.]That is as though the commissioner's report, which had come out just a week before, had never been published. It also found that people were appointed for reasons other than merit. The commissioner raised doubts about the effectiveness of the independent assessors and said:Not all independent assessors are independent.From 22 March to 5 July 2000, the Department of Health took no action apart from issuing a press release. On 11 April, the Minister confirmed in a written answer:We have no plans to meet the commissionerto discuss the findings of her report. Indeed, no Minister had taken the trouble to meet Dame Rennie before the Department issued its press statement on 22 March. The Minister also promised thata detailed response will be made in due course".—[Official Report, 11 April 2000; Vol. 348, c. 132W.]However, there was nothing until 5 July. As we rehearsed in July's debate in Westminster Hall, that response came a day after I had succeeded in securing a 90-minute debate on the subject.
On 2 May, I asked how many hon. Members had been consulted on appointments, contrary to the recommendations of the Commissioner for Public Appointments. The Minister answered that the selection process had been largely complete when the Fritchie report was published. The implication was clear—that action had been taken but that it had been impossible for that action to impact on appointments already made. When I asked, nearly a year later on 26 April 2001, what representations had been made by hon. Members in connection with appointments to NHS trusts, health authorities and primary care trusts, Ministers avoided the question. The reply stated only thatthe process of consulting hon. Members was discontinued in September 2001".—[Official Report, 26 April 2001; Vol. 367, c. 333W.]273WH I presume that that was a typographical error and that it should have stated September 2000. Even if that consultation of hon. Members was discontinued in September 2000, it would have been six months after the commissioner had criticised the Government on those grounds, six months during which the systematic politicisation of the NHS continued, and six months after the Government promised a radical overhaul of the appointments process.
In a written answer to me on 26 April, the Secretary of State confirmed that he had not met Dame Rennie during the past year. There is a damning report of the Government's record of politicisation in NHS appointments—a critique which suggests that the best person for the job is not appointed—and the Secretary of State has not even bothered to meet the Commissioner for Public Appointments since her report was published a year ago. The only ministerial meeting with the commissioner was on 29 November 2000, when the Under-Secretary of State paid her the courtesy of a visit.
On 26 April, I asked what undertakings had been given to the commissioner in respect of her report's recommendations. It was clear from the response that there was only one: that an NHS appointments commission was to be established, under the chairmanship of Sir William Wells. The body was established on 1 April and I was told in the written answer that it would begin making appointments shortly. That is a year after the Fritchie report was published, a year in which no action whatever was taken and two years after the Prime Minister told me on the Floor of the House that an independent appointments process had already been established.
What is the current position? To find evidence of what the Department of Health is doing, rather than what it says it is doing, I examined the evidence of appointments to primary care trusts. It is significant that the trusts were established on 1 April 2000. They have entirely come into being since Dame Rennie's report on appointments to NHS trusts and health authorities. The Government have had the benefit of the guidance, recommendations and evidence of Dame Rennie since the existence of primary care trusts Yet the evidence is that of all those appointed to primary care trust boards, 20 per cent.—one in five—declare a record of political activity for the Labour party, 6 per cent. for the Conservatives and 5 per cent. for the Liberal Democrats. That is almost exactly the same proportion as in NHS trusts and health authorities. No wonder that a report in The Times on 14 April stated:Dame Rennie Fritchie is said to be furious that Alan Milburn, the Health Secretary, has ignored her advice".She receives as many complaints as she received 18 months ago.
I have pursued the matter for some time, as the Minister knows. I have tried to raise its profile and to ensure that action is taken. I took stock after a year or so and asked myself what was its significance, why it mattered, and whether I should continue my investigations. I concluded that it was a matter of the greatest significance and that I am right to pursue it assiduously; I shall continue to do so. It matters, first, because all parties accepted the basic principle of fairness embodied in the Nolan report and in the steps 274WH taken by the Committee on Standards in Public Life to try to raise the standard of behaviour. All parties pay lip service to those principles, but if they are ignored they are worthless and might as well be swept away.
Secondly, it matters because of the important question of competence. If people have been appointed other than on merit, the best people for the job have not taken the job and these vital posts in our NHS will end up in the hands of people who are not up to the job. That is a serious issue, especially now that primary care trusts are to be given an expanded role and more control over larger budgets. A certain person might have been considered competent when trusts had smaller budgets and a less important role, but the standard will need to be higher in view of the expanded role envisaged for primary care trusts.
Thirdly, it is indicative of a culture of dishonesty among the Government, who have refused to accept Dame Rennie's criticisms. Mr. Anthony Harrison of the King's Fund investigated the Government's record on the NHS prior to a likely general election. In a passage reported in the weekend press, he said:There is a reign of terror in the Department of Health. Nobody is talking to us about these activity figures.A respected independent institution cannot acquire the information on which it depends because of a reign of terror.
Two million people—twice the number when the present Government came into office—are now waiting to see a consultant, and the average waiting time for inpatient treatment is also higher than in 1997. The president of the Royal College of Surgeons described the Government's health policy as unethical and said that patients were suffering as a result. This week has seen GPs adopt an unprecedented work to rule.
It is now more important than ever to have the most able people— not political placements—running the NHS, and to have people who are prepared to speak out when there is evidence of wrong-doing or incompetence. By ignoring the findings of the Commissioner for Public Appointments, the Government have shown contempt not just for Dame Rennie and her office, but for the House of Commons and the Nolan principles. It is a perfect demonstration of the arrogance of power and its ability to corrupt, so well exemplified by the Government.
§ The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)
I congratulate the hon. Member for Altrincham and Sale, West (Mr. Brady) on securing the debate on NHS appointments. One could be forgiven for thinking that it was a debate about the relationship of the Department of Health and the Commissioner for Public Appointments rather than the actual title of the debate— NHS appointments and political bias.
I realise that the subject is close to the hon. Gentleman's heart, but I am taken aback if he believes that repeating the same fact over and over again amounts to evidence. Neither is the quotation of isolated comments from favourable newspaper sources my idea of proper evidence. The hon. Gentleman might benefit from taking note of an old IBM maxim: one should not mistake activity for achievement. The hon. 275WH Gentleman may be right that we have not moved quickly enough, but I shall challenge and refute his allegation that we have not taken any action.
I am happy to affirm that people are appointed to NHS boards on merit and not as a result of political bias. If an NHS non-executive director has a declared political commitment to Labour, the hon. Gentleman seems to equate it with not being up to the job. Just because a Labour sympathiser is appointed, it does not mean that standards are dropping. The hon. Gentleman appears to believe that standards are falling simply because Conservative appointments are not made.
I shall outline what the Government have done. There is no evidence that party affiliation is connected with competence. I want to put it on record that we have the highest regard for our appointments.
§ Ms Stuart
I take the line that we decouple non-political bias. Where is the evidence to support language such as "stuffing with appointees" and saying that they are not up to the job? Those are two different issues, and I should like to make it clear that we have the highest regard for those being appointed.
In a debate last year, I pointed out to the hon. Gentleman the comments of the Commissioner for Public Appointments. Even the commissioner's independent auditors, Ernst and Young, supported many of our arguments that the process is proper. The commissioner's report on NHS appointments stated: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.Almost two-thirds of applicants for primary care trusts declared no political activity. In other words, there was no suggestion that those with a Labour party background were any more likely to be appointed than anyone else. The fact is that if only a small number of Conservative activists come forward, only a proportionally small number are likely to be appointed.
I also pointed out in my response last year that since January 1999 the evidence showed that applicants who had declared political activity on behalf of the Labour party had a 39 per cent. chance of being appointed, whereas Conservative applicants had a 56 per cent. chance. The hon. Gentleman chose to ignore such evidence at the time, and he has done so again today. I have no doubt whatsoever that when Dame Rennie Fritchie concludes her current examination of appointments to primary care trusts, the same picture of a fair process will emerge.
On taking office, we wanted to ensure that NHS boards were firmly rooted in the communities that they serve. We therefore placed a premium on candidates' 276WH records of community service. We wanted people from all walks of life, not only business, so we advertised widely in national newspapers, specialist journals and the minority press to attract people who might otherwise not have come forward. In addition, all appointments to primary care trusts have been advertised locally to ensure a wide field of candidates. Also to widen the pool of candidates, we asked hon. Members and local authorities to make nominations from their local knowledge.
Our changes have been hugely successful in making NHS boards more representative of their communities. The proportion of women on the boards has increased from 39 per cent. before the election to 49 per cent. today. I am proud of that record; I make no apology for it. I resent the hon. Gentleman treating the matter as if it was used as a fig-leaf. It is a good record. We have an even better record on the proportion of black and ethnic minority candidates appointed, which has increased from 5 per cent. to 12 per cent. The proportion of people with disabilities has also more than doubled.
Equally successful has been the increase since 1997 of those appointed with a community background. The number of people from the voluntary sector or who are primarily users or carers has increased to 19 per cent. We have moved away from the domination of NHS boards by white middle-class business men that prevailed under the Conservatives. Perhaps the hon. Gentleman considers that they are the only people who are up to the job; I do not. Of course, our boards still need business skills, and people from that background are still represented, but overall the balance has changed to help boards focus on real local issues.
In planning the way forward, we have responded positively to the recommendations in Dame Rennie Fritchie's useful report. To suggest that the Government have failed to respond to her recommendations or to take them seriously is simply wrong. Dame Rennie herself has not suggested that that is the case. I know that the hon. Gentleman entered the House of Commons only in 1997, just like me, but one thing that we should have learned is that simply because one newspaper report cites sources close to someone does not, never has and never will amount to evidence. Let us just consider the facts.
We have, in fact, gone much further than the commissioner's own recommendations in order to meet her concern about the perception of politicisation. I take issue with the hon. Gentleman's definition of what is independent. He sneeringly refers to independent assessors who are not independent. The process was independent.
§ Mr. Roger Gale (in the Chair)
That is a matter of record, but it is not a point of order for the Chair.
§ Ms Stuart
It has been the practice under successive Governments to involve Members directly in the appointment of trust and health authority chairs. Members' views have been sought at the short-list stage. It was not this Administration who introduced the 277WH process. We put at an end to it. Dame Rennie was critical that this part of the process did not meet her requirement for transparency at all stages. Critics were able to suggest that it introduced an element of political patronage into the process. My right hon. Friend the Secretary of State for Health therefore wrote to all Members advising them that their views would no longer be sought from last autumn's trust appointment round onwards.
We also adopted measures last year to streamline re-appointments. If candidates serving their first term had performed well and had received a satisfactory appraisal report, they were recommended to Ministers as the sole candidate where they wished to be re-appointed. Again those were suggestions that were put forward that we adopted. We accepted Dame Rennie's recommendation that we should continue to give members the opportunity to draw from their local knowledge and nominate candidates. That was always on the understanding that their nominees would be interviewed and treated in exactly the same way as all other candidates.
However, we did not accept the commissioner's recommendation on the issue of councillors on NHS boards. Dame Rennie suggested that we review whetherthe presence of so many councillors on NHS boards is healthy".It should not be a surprise, particularly to hon. Members, that many of those applying for a position on an NHS board also show their public spirit through involvement in local politics. We do not see that as a disadvantage. On the contrary, it can be a positive advantage.
We have been quite open about our wish to see the NHS acting with its local partners so that all the issues that make for a healthy community can be considered together. When one sees how the NHS is working more closely with social services, it is obvious that that is the right way forward. Similarly, it should be noted that the Select Committee on Public Administration, including Conservative Members, also rejected that recommendation from the commissioner.
Most significant of all the Government's measures, however, has been our decision to establish an independent NHS appointments commission for all appointments to NHS trusts, health authorities and primary care trusts. That was not in fact recommended 278WH in Dame Rennie's report, although the Select Committee itself suggested it. We have gone further. We wanted to remove the process entirely from the political domain, going well beyond what is required by Nolan principles and the commissioner's guidance.
The commission came into being on 1 April, and all non-executive and chair appointments will be its responsibility from now on. However, it will continue to be subject to Dame Rennie's guidance, and subject to independent scrutiny and regular audit. The new chair of the appointments commission, Sir William Wells, has already met Dame Rennie and will be working with her closely over the coming months as the commission begins its work. Sir William was appointed as a regional chair under the previous Administration, and they awarded him his knighthood for services to the NHS. He has never been politically active, but has served the NHS in a variety of different positions for more than 30 years. It is for that reason that we made an appointment on merit irrespective of political background. That is now on the record.
There is more harmony between Dame Rennie's office and the Department of Health than the hon. Gentleman would like to believe. We have been able to discuss our proposals for the NHS appointments commission with it during the course of its formation. I know that the first official act of Sir William's term of office as chair has been to meet Dame Rennie. I understand that that meeting was constructive and fruitful. Neither are we ignoring the needs of those whom we appoint. I have recently discussed with the NHS Confederation how we might review the roles of chairs and non-executives. That was another recommendation in the report. Its role has moved on from the quasi-business model introduced to support the ill-conceived internal market. We need to ensure that everyone is clear about the contribution that he or she is expected to make to our new NHS and its development through the NHS plan.
I have agreed with the NHS Confederation that we will build on the extensive consultation that it has recently carried out with its members in setting out its new role. In conclusion, we value our non-executive directors. We draw them from the wider community. We would like to put on record our gratitude for the role that they play. Appointments are made on merit, not as a result of political bias.
I hope that the new system will move beyond even the suspicion of bias.