Behind the doors of anvambulance, doctor's surgery or hospital ward is a silent army of people making decisions that affect all of our lives. Every NHS organisation is managed by a board of directors who decide how money should be spent. About half are members of the public, recruited to represent the needs of the local community.

“It's not something that enough people know about,” says Andrea Sutcliffe, chief executive of the Appointments Commission. In fact, not many people know about the Appointments Commission. The body set up to recruit 4,000 non-executive directors and chairs to local and national health boards has, remarkably, stayed below the radar.

Yet the commission makes more than 1,000 appointments a year. Many are highly influential and affect almost every major decision made in the health service, from local hospitals deciding what services to promote, to UK bodies such as the National Institute for Clinical Excellence, which decides what drugs should be available. The commission has also started to work with other government departments, including the Home Office and the Ministry of Justice.

“Good boards can make a real difference and improve services,” Sutcliffe says. “Poor boards, conversely, can cause problems.”

Uniform policy won't suit all

HR gurus are dubious that aligning pay and conditions of those doing the same jobs for different public sector employers is a good idea

BACKGROUND

• Why you just can't be too careful these days

• Recruitment is no board game

• Patient dignity gets the elbow

• Economies of wishful thinking

Related Internet Links

• Public sector jobs

• Snakes & Ladders

When boards fail the spotlight shines brightest and hospital boards are no exception: when things go wrong, boards are the first to be blamed. A notorious case is that of Maidstone and Tunbridge Wells NHS Trust, where an outbreak of Clostridium difficile, linked to appalling hygiene lapses, caused 90 deaths. Mismanagement exposed in a commission report led directors to be dubbed the superbug board.

Sutcliffe rejects the Shadow Cabinet claim that the entire board should have been sacked. “The difficulty was that two issues got mixed up: what the board had or had not done and the resignation of the chief executive. The board had been moving [forward] in terms of infection control.” The commission appointed new non-executive directors and is advertising for a chair - again. “We didn't find a suitable candidate the first time. We are quite fussy,” she says.

This “fussiness” has met with a generally positive response. Previously, board jobs were allocated piecemeal via the Department of Health and former regional health authorities. The commission adopts a rigorous, wide-reaching recruitment process. “We have to do it in a way that withstands public scrutiny,” Sutcliffe says. “People feel that the calibre of non-executive directors is improving.”

But is calibre enough? Boards that represent community interests are not always representative of their communities in their make-up. As with corporate executives or charity trustees, they are overwhelmingly white, male and nearing retirement age. The proportion of women on health service boards is falling, while the commission also has difficulty attracting disabled and younger people and those from ethnic minorities. Sutcliffe names diversity as her biggest challenge. “This is not about being politically correct,” she says. “Diverse boards make better decisions.”

She has ambitions for the service to become truly cross-government. Many people appointed to boards do not have experience in the health service. There are overlapping issues in terms of people and opportunities. “It's a different pool that you're fishing in. People are not doing this for money. They're doing it as a public service.” First, she needs to heighten recognition in the general population, she says. “It's an issue for all in the health service to make it clear that these opportunities exist.”

Born: March 22, 1964, in Bradford
Career: Read medieval and modern history at the London School of Economics; trainee accountant, Tower Hamlets Health Authority 1986-89; older people's services, Camden and Islington NHS Trust 1992-95; St George's NHS Trust 1995-99; Camden social services, 1999-2000; deputy chief executive, Nice, 2000-07; chief executive, Appointments Commission, since November 2007.
What she says: “The No1 choice for public appointments is where I'd like us to be.”
Little-known fact: First job in the health service was as a cleaner - has “seen [it] from the toilet bowl upwards”.

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