Beyond Quangocracy: Labour Promises Greater Openness in NHS Appointments. There's Much Work to Be Done

Article excerpt

In the misty world of the quango state there is no area of more longstanding concern than that of appointments to the National Health Service and its related institutions. In a speech to Unison at the end of June FrankDobson, the Health Secretary, vowed that henceforth the boards of health authorities and trusts would be more representative of the communities they serve. "We want boards which ensure the effective stewardship of limited resources," he said. "Some will quite rightly still be recruited from local businesses. But the balance must change."

His initiative is well-timed, because he now has his own department's first Public Appointments Annual Report, produced under pressure from the Nolan Committee and the Commission for Public Appointments. It suggests the new government will have its work cut out in exposing the truth about the political character of NHS appointments, which together cost the taxpayer in excess of [pounds]22.5 million a year in salaries and fees for the 3,436 individuals involved.

First, the good news. One departmental goal was to increase female representation on NHS bodies to 40 per cent by September 1996. This target may not be sufficient, but at least it has been met: the report shows a figure of 39.6 per cent, albeit with considerable regional variation, from 49 per cent in the trusts of the Northern & Yorkshire region to 36 per cent in South Thames. More significantly, the proportion of female chairs also varies, from 62 per cent in the West Midlands health authorities to a mere 18 per cent in the trusts of the South & West. There is a clear pattern of women doing better, relatively, in the "purchaser" health authorities than in the "provider" trusts.

There is also good news on the department's second public target, for ethnic representation of 4 per cent; the figure achieved is 5.3 per cent. Unfortunately the report does not present the data in a way that allows calculation of the gender balance for ethnic minorities or how many have reached the position of chair. It becomes obvious as you go through the report that this is by no means the only, or the most serious, flaw in the information.

For example, on the revealing subject of occupational status, post-holders are sorted into 24 categories, from academic to voluntary sector, and from banker to musician. It includes a 25th "not categorised" (NC) entry, where the occupation does not fit the categories or the data [TABULAR DATA OMITTED] has not been made available. Many of our quangocrats are shown to be extraordinarily reticent, with 433, or 13 per cent, yielding a "not categorised" response. This includes, for example, Sir Brian Hill, the former managing director of the construction company Higgs and Hill.

The range of NC responses varies between an absurd 86 per cent for the executive non-departmental bodies (ENDB) and a highly respectable 4 per cent from Anglia & Oxford's health authorities. This surely raises serious questions about the enthusiasm and consistency with which the department administered the survey.

The most striking fact to emerge is the least surprising. Of those classified, 904, or 26 per cent of the total, are in business management. They are supported by 277 lawyers (8 per cent of the total) and 218 chartered accountants (6 per cent). Will the business-friendly new government want to add to this weighting or to curb it? By contrast there are 240 academics, 151 health professionals, 97 teachers and 89 people who work in social services; not to mention 30 journalists, 28 farmers, 22 engineers and 14 clergymen.

Here we get some inkling of the success of the Tory revolution. It is not that all business managers, lawyers or accountants are Tories, or that the NHS does not benefit from their business acumen. But if we group together the categories into business and related professions, caring professions, and "other", we find that business accounts for 47 per cent of all appointees, as opposed to 22 per cent from the caring professions: a value judgment, to say the least. …