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Lewisham Healthcare NHS Trust

Volume 518: debated on Friday 12 November 2010

Motion made, and Question proposed, That this House do now adjourn.—(Mr Randall.)

May I say in passing that I agree totally with the comments of my hon. Friend the Member for Stoke-on-Trent North (Joan Walley)? The private Member’s Bill process in this place is chaotic and we need to overhaul it.

I am grateful to Mr Speaker for giving me the opportunity to raise an important local issue. This is the first time, Mr Deputy Speaker, that I have spoken in the Chamber under your wise and sagacious chairing of our proceedings. I welcome you to the Chair.

I welcome the Minister to his place. We shared a number of experiences—I found them entertaining; I am not sure whether he did—a few years ago on the Health Committee. I suspect that if most members of the Committee had been asked whether they thought he would be occupying his current position, the view might have been that he would not. However, he has got there, and regardless of the Government arrangements, he got there completely on merit. I wish him well in the post that he holds and in his efforts to discharge his duties.

May I point out a mistake on the Order Paper which is entirely of my making? I tabled the title that appears on the Order Paper for the debate, but I have not been keeping up with developments. Lewisham Hospital NHS Trust is now Lewisham Healthcare NHS Trust. It assumed responsibility for primary care functions some 100 days ago and has now expanded to the health care trust. There was supposed to be a celebration yesterday of those first 100 days of responsibility for primary care, but that was cancelled. I am sure there were a number of reasons, but the disruption caused by the events that I am about to describe may well have played a part in that.

University hospital Lewisham has made remarkable progress over the past dozen years or so, the last eight of which have been under the stewardship of the current chair of the trust. For many years previously it was the poor relation in inner south-east London, without the kudos or connections of its much more illustrious neighbouring cathedrals of medicine in the shape of Guy’s, St Thomas’ and King’s College hospitals. In 1990, under the previous Tory Government, it was used as a pawn and a make-weight in the ill-fated attempt to set up the Guy’s and Lewisham self-governing trust. When that ploy failed, it was separated as Guy’s was linked to St Thomas’, and it has prospered ever since as an independent trust.

The notable achievements in recent times and the improvements in services over recent years have included the more than £70 million private finance initiative project at the Riverside block and improved maternity services, including one of the best birthing centres in London and therefore in the country. There have been improvements in paediatrics in the primary care centre. It has achieved some of the lowest hospital acquired infection rates in the country. During a recent stay in King’s College hospital I acquired MRSA, so that has a certain resonance with me. Just 10 days ago, work commenced on the latest stage of building there, which will run through until autumn 2011, including a new urgent care centre, upgraded and refurbished A and E facilities, new and refurbished children’s and adults’ out-patient suites, and a new main entrance and reception.

The financial management of the trust has been outstanding in recent years. Earlier in the year, as part of the Challenge Trust Board funding scheme, KPMG was asked to review the trust and measure its performance against nine domains: good business strategy, financial viability, well governed, capable board to deliver, good service performance, clinical leadership, local health economy, clinical strategy and performance. On a traffic light rating, they were all well into the green, as a net result of which the Challenge Trust Board awarded Lewisham £4 million to pay off historical cash deficits, and KPMG concluded that the

“Trust has rectified the problems that caused the trust to fall into deficit and has a platform for a medium term sustainable position”.

This organisation has not only done well; it continues to do well. It has set its ambition to become a foundation trust within two or three years. It has demonstrated the benefits of strong executive and non-executive leadership. Why then has the chair not been reappointed, or, to put it in plain language, why has he been sacked? He has been a personal acquaintance of mine, colleague and good friend for more than 30 years, and we have served variously on a number of organisations, including Lewisham borough council and Lewisham and North Southwark district health authority before it was abolished by the previous Conservative Government in 1990.

I raise this matter not at the chair’s request—he is a man of such natural modesty and charm that if it was left to him, I am sure that I would not be allowed to raise it at all—but because I want to express my outrage at the way in which he, and by extension, Lewisham Healthcare NHS Trust and the people of Lewisham have been so badly treated by the travesty of a process that has resulted in his not being reappointed. I also have to raise it because although the Appointments Commission has a complaints procedure, under item 8 on remedial action, it says that what shape such remedial action may take will vary from case to case, but in general one of the principles that will apply is that

“where an appointment has been made, this cannot be overturned.”

So clearly the die has been cast and we will have to live with the consequences.

The chair was appointed in 2002, and he was re-appointed, uncontested, in 2006, with the term ending on 31 October this year, just a few weeks ago. The process to find a new chair was implemented in August, and, under the regulations, he could serve a maximum of only two more years in the post before reaching the 10 prescribed. That was well understood by everybody involved in the health care community in Lewisham, by the chair, and by those who encouraged him to stand. Such is his reputation among the stakeholders, partners and others with knowledge of health care provision in Lewisham that many of them encouraged him to stand for those extra couple of years, including Ann Lloyd, the appointments commissioner for London, and Sir Richard Sykes, the then chair of NHS London, to get Lewisham Healthcare NHS Trust to the verge of foundation trust status.

Everybody understood the process. As the regulations said:

“At the end of an individual’s second term of office the post will automatically be the subject of an open competition. The office holder will be free to apply provided they have served less than 10 years in the same post and will be considered alongside other candidates.”

Everybody knew that to be case. However, such is the support for the current chair of the trust that, to my certain knowledge, many other candidates—including a former Member of Parliament—who would have applied had the competition been completely open, did not do so out of respect for, and trust in, the work that the existing chair of the trust had done. Either knowingly or unknowingly, the Appointments Commission and the strategic health authority have between them served to reduce the pool from which a suitable candidate to chair the trust might be found.

Most people understood that the current chair would serve for another two years, and that during that period a completely open competition would be held, in which all those who had any suitability or intention to become the chair could have stood. By skewing the process, as they have, those organisations have denied the people of Lewisham the opportunity to look at the best possible candidates.

My hon. Friend is certainly not alone in his concern about such issues. The west midlands regional health authority has decided not to appoint the chairman of the University hospital of North Staffordshire, Mike Brereton. Today, indeed, is Mike’s last day, yet the authority has not given any reasons either to the public or MPs. It has failed to draw up a shortlist for a successor, and I now learn that it has made a temporary appointment for one year. May I put on the record our appreciation of Mike Brereton’s long record of public service in north Staffordshire, and our deep concerns, like that of my hon. Friend in his area, about the west midlands regional health authority’s secret and unaccountable way of going about the process?

I am grateful to my hon. Friend. Incidentally, I gave way because, if I had not, he might have punched me and I did not want to tempt providence. I accept his point, however. The Appointments Commission will of course be abolished in a couple of years, but unreasonable, undue and improper influence has been exerted over the appointment of people to such positions, and the losers will ultimately be the local communities that they attempt to serve.

I recognise readily that there is no automaticity to reappointments, and nobody should expect there to be. That point was equally well understood by all those involved in the process, and I offer no comment on the ability or personal qualities of the chosen successor. I have met her just the once and formed a mildly favourable impression. The only reason why I met her is that my constituency boundary changed at the last election to include parts of the borough of Bromley, and she is chair of Bromley primary care trust. I have no reason to believe that she is complicit in any of the mishandling and misconduct that I believe has taken place.

At best, there has been incompetence and, at worst, improper interference. A couple of weeks ago, Professor Mike Spyer, the interim chair of NHS London, contacted the existing chair of the Lewisham Healthcare NHS trust to inform him that the Appointments Commission would not be reappointing him as he could be appointed for only two years, which was insufficient time to see the organisation through to foundation trust status. That is complete and utter nonsense. That fact was known before NHS London and the London commissioner, among others, encouraged him to stand for re-adoption as the chair of the trust.

The existing chair then received a letter from the Appointments Commission, which explained that the decision not to reappoint him

“was based on the advice of the interview panel and recommendation of the appointments commissioner and represented the overall best ‘skill mix’ for the board.”

That is complete and utter baloney. It is nothing more than an unconvincing collection of cliché and waffle to hide the fact that the board had clearly made up its mind. Why has the board not had the correct skill mix previously, I wonder? Why has it asked the existing chair to stay on until the end of the year? Because of its incompetence, the new chair cannot take up the post because of her position with Bromley PCT until the end of the year. The board has asked the existing chair to stay on for an extra couple of months, but clearly the skill mix on the board during that time will not be optimum, by definition. It speaks volumes about the character, dignity and integrity of the existing chair—and his dedication to Lewisham hospital and to health care in Lewisham—that he has said that he will stay on to facilitate the changeover to the new chair.

I contacted the Appointments Commission as soon as I heard about this outrage. I sent a letter to its chair, and she replied:

“I am sorry that you have concerns about the manner in which this campaign was conducted and hope to reassure you that it was carried out in line with best practice and in accordance with the Code of Practice issued by the Office of the Commissioner for Public Appointments.”

Well, Ms Anne Watts CBE, chair of the Appointments Commission, you have not reassured me at all. Incidentally, the letter plumbs new depths of disingenuousness by telling me that for “reasons of confidentiality” Ms Watts cannot confirm whether the existing chair was a candidate for the post—how very unco-operative. I had to make my own inquiries into the matter. She went on:

“Seven candidates applied, 3 of whom subsequently progressed to the interview stage…An excellent and experienced candidate with a sound background in NHS leadership locally was identified from among those interviewed, and an announcement regarding an appointment will be made in due course.”

Yes, that candidate was appointed—that candidate was the existing chair, but he was not appointed as the chair of the trust, though.

I received a letter from the incoming chair in her capacity as the chair of Bromley PCT. It is dated 5 November, and says:

“Thanks to the generosity of the outgoing chair…I am able to stay in Bromley until 31 December, which gives me time to ensure that appropriate transition measures are in place. However, I shall start my induction in parallel with working my notice at Bromley.”

That is fine. However, that letter is dated 5 November, and I know for a fact that until 10 November—five days after the letter was written—the existing chair in Lewisham had not made the decision to stay on until 31 December. I do not know who is trying to convince whom of what, but I suspect that there has been a degree of duplicity; as I say, I do not expect the successor chair to have been part of that, but there has been.

The whole process has been chronically mishandled. The strategic health authority, London NHS and the Appointments Commission have completely let down the institution of Lewisham hospital and the people of Lewisham by their abject failure to ensure that the best available candidate was appointed to the post. The new chair might well survive a totally open process in future, but because there has not been one, we shall never know.

Clearly, I will need to establish a working relationship with the trust and its executive and non-executive members—previously, that has been very good—and I will need to establish such a relationship with the new chair as we work for the common purpose of promoting the interests of the people of Lewisham. But that has been made extremely difficult by this astonishing catalogue of failure.

I begin by congratulating the hon. Member for Lewisham West and Penge (Jim Dowd) on securing this debate and thanking him for his kind words of introduction. I, too, have fond memories of those days in the Health Committee, on which we served together, inquiring into a variety of issues.

May I take this opportunity to record the Government’s clear recognition of the hard work and dedication shown by NHS staff in Lewisham and beyond? The hon. Gentleman documented the many successes of the trust over a number of years, and clearly set out his concerns, analysis and interpretation of the events that led him to make these points in the House today.

I have to tell the hon. Gentleman that it is not appropriate for me, as a Minister, to comment on the appointment of the chair of Lewisham Healthcare NHS Trust—or, for that matter, any trust. The process for appointing NHS chairs is very clear and has not changed since May this year. The Secretary of State for Health, whoever they may be, currently delegates powers of appointment to the Appointments Commission. First, all vacancies are advertised publicly through appropriate channels. Selection panels then assess each application, with representations from the organisation and an independent public appointments assessor. The final decision is made by the Health and Social Care Appointments Committee. The Appointments Commission has responsibility for making sure that the process is fair, open and impartial, and that appointments are based on merit alone. It is not a process that politicians, on either side of this House, should seek to influence.

I checked with the trust and the Appointments Commission—I am sure that the hon. Gentleman would expect no less—and they both told me that they have clearly followed the processes laid down. If there are ever any concerns that due process has not been followed, this should be reported to the Commissioner for Public Appointments, who regulates and audits the process. Clearly, the hon. Gentleman needs to look again at the response he has received and consider the matter further. It is not, I am afraid, something for Ministers to intervene in or comment on. However, this debate is on the record, and I will ensure that all parties to the process are aware of the points that he has made. It is an important part of these debates that such matters are drawn to the attention of the relevant authorities.

By way of clarification, I remind the hon. Gentleman that it is, as he said, exceptional for chairs to be appointed beyond two terms. This is not a sacking. As he says, there is no right to automaticity in succession from one term to another when it comes to the end of the second term. In the year ending March 2010, only three chairs across the whole NHS were reappointed for a third term. That is equivalent to only 0.36% of all appointments made that year—fewer than one in 2,500 appointments. Securing a third term as chair is extremely rare, and the decision should not be seen as any judgment on the incumbent’s performance. As the hon. Gentleman rightly observed, the performance of the trust is exemplary.

I should like to take this opportunity to pay tribute to Mr Gnanapragasm for his work and his public service in his role as chair, and for the fact that he is maintaining that role during the ongoing transition. He has served Lewisham Healthcare NHS Trust well for eight years—the hon. Gentleman set out that record very clearly—and I wish him the very best with what he does next.

In the new year, as the hon. Gentleman said, the current chair of Bromley PCT, Ms Butler, will take up the position. I believe that she has an excellent reputation, and I know that she is looking forward to the opportunity that this new role presents. As the hon. Gentleman knows, it is an interesting time in Lewisham in respect of health care. On 1 August this year, the trust merged with Lewisham Community Health Services to create Lewisham Healthcare NHS Trust. This is one of the first integrations of its kind in the country, bringing into the trust 700 people working in the community. That will afford the people of Lewisham a seamless link between primary, community and hospital care. It will therefore be a busy time for the senior managers in building on this and continuing to improve health care for the hon. Gentleman’s constituents. A strong and well-supported chair is a key element in delivering that transformation.

I should like to put on record my best wishes to Ms Butler for every success in this new role. I am encouraged that the hon. Gentleman has been favourably impressed on the occasions he has met her. I am sure that on future occasions he will have the opportunity to develop the important good working relationships that hon. Members in all parts of the House need to have with those charged with managing NHS organisations.

In a debate such as this it would be inappropriate for me to comment on the detailed process. I hope that the hon. Gentleman will accept that I have set out the position as it stands. I undertake to ensure that his concerns are passed to those responsible for the process, and I thank him for raising these matters today.

Question put and agreed to.

House adjourned.