The article below appeared in this week's Sunday Times News Review. It describes Edwina Currie's experience when she applied to be a Non Executive Director of her local NHS Trust. I don't normally reprint articles in full, but this is worth it. Make sure you read the whole thing.
There’s no dispute that the National Health Service has had a great deal more money since Labour came to power. Spending is up from £65 billion in 2002-03 to £87 billion now, and will reach £105 billion by 2007. But while Patricia Hewitt, the health secretary, claims that waiting times are down and derides “screaming headlines”, a memo from the chief medical officer warns of impending disaster and demands a freeze on all new commitments for this and future years, across all programmes. The deficit, we are told, will soon reach a staggering £7 billion. Most of the extra money has gone on higher pay, higher pensions, changes in contracts and negligence claims. Ministers should have expected this and known that huge hospital building programmes needed watching or budgets spectacularly overrun; they always do. In the next few months those struggling with nasty choices about what to cut and what to save will be the local boards of NHS trusts and their chief executives. But they haven’t a hope in hell, not as long as the system keeps appointing people whose main qualification, it seems to me, is sympathy with the current government. Let me explain.
As a junior minister under Margaret Thatcher, my duties included filling thousands of places on public boards. I took pains to ensure balance of political affiliation, of age and gender, and insisted that appointees’ backgrounds be a fair reflection of the communities they wished to serve. More than once I flung the list back at my civil servants: “Get me more women!” or “Go find a trade unionist,” and the like. It was crude but effective, and we had no complaints whatsoever. When Tony Blair became prime minister the criticisms mounted. Tony’s cronies filled every available position; only card-carrying new Labour enthusiasts stood much chance. In response to official rulings of bias from Dame Rennie Fritchie, the commissioner for public appointments, the government set up a new quango, the NHS Appointments Commission, with offices in Leeds and staff at salaries that would make a hospital porter weep. Its sole purpose is to “vet” applicants and to run the elaborate selection process now required. When I saw that the NHS trust for Surrey and Sussex needed two new non-executive directors, I was curious. I’ve lived in Surrey for five years; East Surrey hospital is our local hospital. In the Healthcare Commission performance ratings for 2005, Surrey and Sussex had zero stars. On a string of targets, especially those concerned with patients, “significantly under-achieved” or “poor” was the verdict. The trust is £68m in debt; non-emergency surgery has been cancelled until March; it’s had half-a-dozen chief executives in recent years. They have £135m to spend every year, which should be sufficient. When a neighbour sat in our kitchen in tears because a much-needed operation on his arm had been postponed, it was time to do my bit. So I put in an application.
When I was the chief selector, had I been informed that a former health minister was interested, I’d have appointed him on the spot, whatever his politics. The NHS needs all the help it can get. The interview was conducted with much formality. I was asked about teamwork and about leadership, which struck me as odd: this is not an interview for employment, but for a public service volunteer. The only qualities needed are a willingness to serve plus the intelligence, integrity and time to do it. At the next question, “Suppose the staff have put down a motion of no confidence in the chief executive, what would be your approach?”, perhaps I should have protested. Instead I replied that in my experience in the Department of Health and as former chairman of the central Birmingham health authority, NHS staff seldom make a fuss unless there is some real grievance. I’d talk to people to find out what was eating them, then ensure it was well aired and dealt with. Chief executives can get on their high horse; board members, as influential outsiders, can help them climb down with their dignity intact. Glances were exchanged across the table. When I asked how the trust planned to deal with its deficits, the chairman barely shrugged. “We can’t,” he said simply. The letter arrived. “On the advice of the interview panel and the recommendations of the regional commissioner . . .” it was decided that other applicants “best demonstrated the qualities required”. Sod off, in other words. Instead they’ve appointed four, not two, non-executive directors: one Labour councillor and three non-aligned, which is weird in a county where every parliamentary seat and most councils are held by the Tories. Indignant, I wrote to a newspaper, only to receive a reply from Dr Roger Moore, chief executive of the NHS Appointments Commission. He spelled my name wrong and sent it to the wrong address, but wrote, “In the information pack (it stated) we were looking for people with particular financial and commercial skills . . .” So how come two of the four were a biologist and a clinical psychologist? In any case, I’m an economist, I’ve taught economics and business studies, and I’ve run my own business and pension fund since 1992. I’ve handled budgets in the millions and staff in their thousands (45,000 people work for the NHS in Surrey and Sussex). I’m a trustee of the Patients Association and a fundraiser for our local hospice. But I’m a member of the Conservative party. And I’m mystified. Why seek financial and commercial skills in the volunteers? This isn’t a business, it’s a public body funded wholly by the taxpayer. It doesn’t have a profit and loss account. It employs accountants, too many perhaps: hence the closure of wards and cuts in cleaning and catering budgets instead of management posts. As for commercial skills — exactly what do they think they are selling? The customers are queuing up and having to wait ages for an over-burdened service. It just doesn’t make sense. Moore, it turns out, knows me well. In Thatcher’s Britain he was one of my officials, doing a vital job with responsibility for the National Blood Service. Maybe I should have asked him for a reference. Perhaps the adverts should make it clear: experienced adults of a right-wing persuasion who care passionately about the quality of service in their local hospital need not apply. Unless, of course, they’re willing to connive in the waste of public money without turning a hair.