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.