To put this brief debate in context, I must refer to the current discussions in the Nolan committee and the evidence that has been given to that committee. I can best illustrate the significance of the health appointments by quoting from an article by Mr. Simon Jenkins in The Times last Wednesday, entitled "Is Nolan just a paper tiger?" Mr. Jenkins is a former editor of that paper and he is scarcely a dangerous radical, so his recommendation that the Nolan committee should ask for an independent royal commission on appointments deserves the attention of all hon. Members.
Mr. Jenkins wrote:
If ministers protest hand on heart that no thought of party gain ever crosses their minds when it comes to jobs or honours, a way is open to them to set the public's mind instantly to rest. They can divest themselves of these powers. Ministers should continue to propose appointments, but to the new commission, not to Downing Street. The commission would be expected to listen and act reasonably. Some 42,000 posts in executive quangos are now available for public appointment. More Britons are appointed in a lay capacity to oversee such services as hospitals, schools, the police and social services than are chosen at elections.
He goes on:
As for the 15,000 health authority posts that had to be filled in 1991, it was that most undignified case of catch-as-catch-can in the history of public patronage. On seeing his list, one health administrator paraphrased Wellington and hoped they would 'terrify the consultants as much as they terrify me.'
In the south-west, we have had a number of terrifying incidents in the way in which health trusts have performed their duties. We had, first, for example, the collapse of confidence in the Westcountry Ambulance Service trust, which resulted, after pressure from hon. Members on both sides of the House, in the exit of the chief executive. Secondly, we have had the suspension of Sister Cooksley at the Plymouth Hospitals NHS trust; again, a U-turn and reinstatement resulted. Thirdly, we have had a series of important and worrying incidents at Treliske hospital, run by the Royal Cornwall Hospitals NHS trust. With the latter, of course, a number of inquiries are going on.
The questions that all hon. Members will wish to have answered are: who is in charge, who is answerable and to whom? Who says, "Out you go," if a trust fails? A crisis of confidence exists in the trust leadership. Why? One reason is that the public, the patients and their elected representatives feel that they have no significant role in the appointments procedure.
There was a perceptive series of articles in the Western Morning News at the end of last year entitled, "Who really runs the west?" I wish to quote briefly from an important article, headed "Why Tories tend to be picked to serve on health quangos." The article starts:
A glance down the list of Westcountry health quangos shows a distinct bias towards Conservative chairmen and board members.
At the top of the health pyramid is the South West Regional Health Authority, which nominates chairmen of local hospital trusts and passes names on to health secretary Virginia Bottomley.
One of the SWRHA's six board members is Dame Margaret Fry, a leading Conservative grandee who chaired the annual party conference three years ago.
The article then takes a number of examples of people who, in recent months or years, have been appointed to health trusts. For example, Mrs. Sylvia Russell is described as
a frank speaking former Tory councillor who was given the £17,000-a-year job of running the Exeter and District Community Health NHS Trust.
Mrs. Russell is reported as saying:
Mrs. Bottomley has been very keen indeed to promote women into management. Rennie Fritchie (SWRHA chairwoman) is keen to promote women.
The article gives another example of Mr. Graham Andrews, a former North Devon Conservative councillor, who again was appointed as a director of the Northern Devon Healthcare trust.
The main body of the article concerns the curious saga of the appointment of Mrs. Abigail Kirby-Harris, who is described as follows:
once chairman of the St. Mabyn Conservative Association in North Cornwall, who said that it was not the slightest bit surprising that the Government should choose Tories to push through health reforms.
She added that it was natural for Ministers to pick allies to run NHS trusts ahead of people who wanted the reforms to fall flat on their face.
It was Mrs. Kirby-Harris's appointment, in the face of outspoken opposition from local Members of Parliament and some members of the NHS trust itself, which focused Westcountry attention on the way people are chosen for key quango jobs.
She was nominated by a member of another quango—Dame Margaret Fry—and rubber-stamped by the Secretary of State for Health, who was determined to put more women into top NHS jobs.
I shall not give way, because I want to leave time for one of the hon. Gentleman's hon. Friends, who told me in advance that he wished to take part in the debate, as is the normal convention.
As the Western Morning News correctly pointed out, Mrs. Kirby-Harris's appointment was controversial. First, Sir Godfrey Milton-Thompson, who was the chairman in situ, was expected to continue. Having had a distinguished career in the services, rising to surgeon vice-admiral, he clearly had great expertise. Secondly, when consulted, all five Cornwall Members said that they were happy for him to continue. The hon. Member for St. Ives (Mr. Harris) said:
I don't see any reason why he should not have been reappointed. I thought it was Virginia Bottomley with her obsession with every post going to a woman.
The hon. Member for Cornwall, South-East (Mr. Hicks) asked if he might take part in the debate and I hope that he will catch your eye, Mr. Deputy Speaker. As a parliamentary neighbour and former sparring partner, I welcome him to the debate.
Thirdly, in December 1992, before the appointment was confirmed and publicised, other Cornwall Members and I corresponded with the then Minister for Health, the right hon. Member for Peterborough (Dr. Mawhinney). I wrote a fairly quiet letter. The hon. Member for Cornwall,
South-East wrote in more robust terms. The Minister's answer shows what had happened. The Minister wrote to me:
When my office passed on to me your further message about the appointment of the Chairman of the Cornwall Healthcare NHS trust, I instituted an urgent enquiry into the handling of the information you conveyed to South Western Regional Health Authority in your telephone call.
I can confirm that your message was received by the Region after the submission being sent to me by my Appointments Unit. Your views on Sir Godfrey and Mrs. Kirby-Harris were, therefore, not expressed in that submission.
It appears that, if your views were relayed to the Appointments Unit at the Department, they were not recorded and were certainly not passed on to me at any time. I have made it clear to the staff concerned that this is not acceptable and that our arrangements have got to be tightened up in future. I am extremely sorry that the system did not work on this occasion.
The submission I received did inform me however that Robert Hicks and David Harris both favoured Sir Godfrey being appointed. Having said that, for reasons I sought to explain to you when we spoke and which I have already explained to Robert, the advice I received from a range of other sources strongly recommended that Mrs. Kirby-Harris should be appointed. I felt, therefore, I was not able to accept Robert's and David's and, I now know, your advice on this particular occasion.
I want to get some positive lessons from this unfortunate incident. First, what references were taken up for this appointment? Secondly, what references are today taken up for such appointments? What written reports were available to the Secretary of State for Health? In this case, the person concerned had served from the Army and we now know from the industrial tribunal that has taken place since that the disclosed reports in the Army would have made it clear to the Secretary of State that there was no way in which this candidate should be even considered for half a minute for such an important appointment. The reason why she has been to an industrial tribunal is that she is claiming £500,000 for wrongful dismissal due to pregnancy. Thirdly, what is the point of consulting local Members of Parliament if our advice is then ignored?
Fourthly, there seems to be at least the suspicion of a hidden agenda, some sort of discrimination on grounds of gender, age or political orientation. Fifthly, why not advertise openly and set out the experience and criteria for which the Secretary of State is looking? After all, we are talking about considerable responsibilities—whether on an authority or a trust—and the people appointed exercise considerable control on the public's behalf over huge budgets.
I believe that Mr. Simon Jenkins's suggestion that there should be a royal commission on appointments and that there should be an open and honest process for such appointments is the only credible way forward to regain public confidence in the integrity, objectivity, ability and representative nature of those who run the national health service.
People do not trust the trusts and it is in the Secretary of State's hands to set that right. I hope that the Minister will be able to reassure us at the end of this brief debate.
I am grateful to the hon. Member for North Cornwall (Mr. Tyler), my parliamentary neighbour, and to the Minister for allowing me two or three minutes in which to make a contribution to this important debate, which clearly has national implications as well as implications in Devon and Cornwall.
I would not necessarily go along with all that the hon. Member for North Cornwall said about the importance of political connections in this respect. There may be a political dimension to the examples that I shall cite, but what concerns me more is that some elements of the appointments affecting my constituency have too many characteristics of a Whitehall farce. I shall therefore concentrate on the procedures followed in making such appointments.
I begin by paying tribute to my right hon. Friend the Secretary of State for Transport who, when he was Minister for Health, was most helpful and forthcoming. When I attempted to investigate the procedures followed in such appointments, it was not clear who, under the existing arrangements, was prepared to accept the ultimate responsibility. In the three examples that I shall cite, the Secretary of State played a significant part, whether in her present role or in her previous position in the Department of Health.
It is not clear whether the ultimate responsibility lies with the Department or with the regional health authority. Ministers tend to say that they can act only on what appears on their desks and it is not clear what terms of reference they have issued to the RHAs in the first place. The RHAs themselves say that they have certain parameters within which to work, but one then calls into question the sifting mechanism that they have deployed when names have supposedly come to their attention from the grass roots.
The hon. Member for North Cornwall outlined the sequence of events that accompanied the appointment of the chairman of the Cornwall Community Healthcare trust. I shall not duplicate his comments but wish to refer to the initial appointment of the chairman of the Royal Cornwall Hospitals NHS trust. My right hon. Friend the Secretary of State consulted certain politicians representing the county, although she did not ask the advice of the two then longest serving Members, David Mudd and myself. Perhaps she did not expect to hear the response that she was seeking. In any event, she went ahead—as was her right—and made an appointment.
It is not without significance that, when the time came for a reappointment, the Secretary of State's original appointee was dropped and replaced by the person whom some of us had advocated in the beginning.
There then followed a sequence of events beyond one's imagination, involving the appointment of the chairman of the Plymouth Hospitals NHS trust. My right hon. Friend appointed the late chairman and managing director of Brymon Airways to a trust that had not even been designated at the time. Within a few weeks, he had to resign from the non-existent trust and, as it so happens, the person whom we thought was being groomed locally for the position—then the chairman of the Plymouth health authority—was appointed chairman of the Plymouth Hospitals NHS trust, now that it finally exists. If the procedures had been correct in the first place, I suggest that we should not have reached this farcical situation.
We are talking about the administration and provision of health care for a large number of people, including my constituents. Public confidence in that administration and provision is absolutely essential. When the public read objective reports of what has happened in the three cases that have been mentioned, they understandably feel a little apprehensive.
I measure my words carefully. I believe that, if the litigation involving the former chairman of the Cornwall Community Healthcare trust turns out in a particular way, those responsible at the ministerial level for appointments and those who still hold senior positions within the regional health authority must examine their own positions. It is clear that what has been happening hitherto must not be repeated in the future if we are to retain the public's confidence in the standard of health care in the parts of Cornwall and Plymouth to which reference has been made this afternoon.
I am sorry that we do not have more time to debate the important matter raised by the hon. Member for North Cornwall (Mr. Tyler). I could not help noticing, from the Order Paper, that a pile of earth in south-east Asia is deemed to be so important that it takes up three times as much time as the question of who runs the national health service. Perhaps that is a manifestation of the extent to which we are ruled by the headlines these days. This is an important subject because enormous responsibilities are placed on non-executive members of boards and the chairmen of health authorities and trusts in the health service.
I must correct the impression given—unintentionally, I am sure—that everything was wrong with the appointments that have been made. There are cases with which hon. Members are dissatisfied but some splendid people have become chairmen and non-executive members of trusts and health authorities. I visit a great many trusts—acute trusts, community trusts, ambulance services and health authorities—and meet many non-executive and executive directors who are extraordinarily committed to the health service. Many would die for the hospital with which they are involved, which is very rewarding. Indeed, the level of accountability and responsibility that they feel is one of the reasons that there have been some remarkable successes.
Since the hon. Member for North Cornwall (Mr. Tyler) started his speech by saying that he was referring to the whole of the south-west, does my hon. Friend agree that the Taunton and Somerset hospital trust in my constituency, among others, has been remarkably successful, that on its board there are members of all parties and of none, and that its success is despite the vigorous opposition of the Labour party and the Liberal Democrats before it was set up?
I could not agree more. Taunton and Somerset is a good example of a trust that knows where it is going and is well led, which is exactly what we have been trying to achieve.
Obviously, one can find problems in a huge organisation such as the health service, with some 8 million in-patients, another 35 million out-patient contacts and nearly 1 million employees. There is room for many things to go wrong. I am not quite sure of the connection between the three examples with which the hon. Member for North Cornwall began his speech—the Westcountry Ambulance Service trust, Sister Cooksley and two incidents in the press recently about Treliske—and non-executive appointments. Therefore, we need to be careful about using the material provided by headline writers, serious though some of those incidents may be, to make a wider point.
I have paid tribute to the non-executives of our trusts and health authorities because under them there has been remarkable progress. Many, many more people have been treated. Over 120 patients are treated today for every 100 treated before the reforms came into place. That is a tribute not only to the boards but to the staff generally for taking on an extraordinarily larger work load, albeit with some additional resources. Hospitals have become much more efficient—they have had to cope with the rising demand for health care.
Waiting lists and waiting times are much in the news. Under the reforms, in hospitals and authorities on which those non-executives serve, we have found that the average waiting time for operations has fallen from nine to five months and that the time people wait for a first consultant appointment has fallen radically. Many health authorities, before we set any national standards, were demanding that people should not wait more than a certain number of months, usually in single figures in good cases, for their first consultant appointment. So much progress has been made.
Partly, the chairmen and non-executives have been driving that progress, sometimes with not much encouragement from medical staff who have said that to think constantly about waiting lists distorts priorities and medical staff should have total control over the priorities of any hospital. However, we know, from our constituents and from everything that we find, that waiting times are important to patients, however lacking in urgency their conditions, and they should not be told that they will have to wait two years to see a consultant. Certainly, they should not discover that they need certain treatment and be made to wait years for it.
We are bringing those times down to 18 months, to 12 months and to less, so that people will not be able to say that they do not know when they will be treated. That will become a thing of the past. Under the leadership of some of our chairmen and chief executives, that has happened. However, I agree that there is a lack of uniformity in the appointment system, although it has thrown up thousands of good, committed people. Because people have found the opposite in some cases, we have sought to find a more formal system which people outside will be able to understand.
The first stage of the process is to require all regional health authorities or regional members of the policy board, as there may be if the Health Authorities Bill reaches the statute book, to advertise all posts or groups of posts—there may be difference in procedure between one area and another. There should be free and open advertising so that people can write in to say that they would like to serve on a trust or health authority.
When that stage is complete, a panel of non-executives, usually from around a region, will sift through those names to decide which of those people would appear on the face of it to be suitable to serve on trusts and health authorities. The panels should do that according to agreed criteria.
I am conscious of the limited time, but could the Minister specifically address the question of short lists in the cases to which the hon. Member for Cornwall, South-East (Mr. Hicks) and I referred? As we all know, there was an unmitigated disaster with one appointment because only two people were on the short list. The person appointed turned out to be totally unsuited to the post, while the person who was, in effect, ejected, was subsequently to take the Department to an industrial tribunal. Again, in the Western Morning News, headlines said:
Payouts settle complaint of jobs for girls",
Bottomley spared appearance in sex discrimination case".
All that could have been avoided if the short lists had not been so short.
I understand why the hon. Gentleman is harping on about that unfortunate case, although I repeat to those hon. Members just arriving in the House that it was totally unrepresentative of the generality of health appointments. However, clearly the hon. Gentleman is quite right: we need a larger pool of names from which those who have the task of sifting can draw candidates. Competition is likely to hot up because, surprising though it may seem given all the difficulties and all that is said about the health service, large numbers of people wish to serve as non-executives on health authorities and trusts.
As I said, having advertised, the candidates must be looked at against published criteria. We shall be dealing with guidelines on that criteria in the near future and it will be open for everyone to see the personal and career criteria that we would like to see for those people who serve in that position in the health service.
There is also of course a code of conduct and accountability, very much along the lines of the Cadbury report, covering all matters of governance of public companies and public organisations. All those who serve and who are appointed will be reminded that they must have very high standards of achievement in those sectors. They must maintain standards of discretion, and in all the areas that one expects of someone who is put in a position of great responsibility in a public organisation. That is important.
I very much regret the cases—some may be quoted—when the system has failed to satisfy or, indeed, has resulted in the appointment of people who turned out to be unsatisfactory. While they are in a minority, we seek to avoid such cases.
I shall deal with the objections put forward by my hon. Friend the Member for Cornwall, South-East (Mr. Hicks), who said that he and local Members of Parliament were consulted on appointments and it appeared that their advice was not taken. We cannot give an absolute guarantee to hon. Members, because, clearly, as the House will understand, views of local Members of Parliament are one source of advice on appointments and there may be many other views from other organisations, from individuals and, indeed, from an interview process that, up to now, has been conducted by regional chairmen or district chairmen. Interviews tended to be conducted by regional chairmen when appointments of chairmen for districts were being made.
We cannot guarantee that the advice of our parliamentary colleagues will be taken in every case, but we can at least say that consultation is taken extremely seriously and that all views, especially those of our parliamentary colleagues, are taken into account and always have been.
My hon. Friend the Member for Cornwall, South-East asked who is responsible in the Department of Health. Clearly my right hon. Friend the Secretary of State is ultimately responsible for all appointments, but there are some divisions of responsibility. She takes advice from different ministerial colleagues within the Department, depending upon which part of the country is involved. An enormous selection process has to take place. It happens mainly at regional level, but it also requires a great deal of work by Ministers, who monitor the recommendations made by the regions. That process is shared out round the country.
There will be a more codified system of appointments in the health service, and it will be open and understood. We value trust boards enormously as a central part of the reforms; they cost the NHS 1p out of every £11 spent by a trust, and we think that that is good value. I pay tribute to all who serve on trusts and health authorities, often in difficult circumstances, for the wonderful job that they do.
It being half-past Two o'clock, the motion for the Adjournment of the House lapsed, pursuant to Order [19 December].