At the end of last week, Andrew Lansley announced his preferred choice for Chair of the NHS Commissioning Board. Who the post would go to has been the subject of some speculation – a new post in a new organisation, working with the powerful figure of David Nicholson, and overseeing one of the largest organisations in the country in as few as four days a month. Not an easy find, perhaps evidenced by the fact that the job description and scope had to be amended.
The Secretary of State’s preferred candidate for the post, Professor Malcolm Grant, will face an appearance before the Health Select Committee tomorrow – one of the first such US-style confirmation hearings to take place for an NHS appointee. The Committee will be keen to assess his suitability for the job – so how should Professor Grant approach his date with Dorrell & Co?
First, he will need to show how his background equips him for one of the highest profile jobs in public service. Born in New Zealand and a lawyer by training, he has a reputation as an advocate of university reform, dating back to his time as Pro-Vice Chancellor at Cambridge. During his time at UCL he has gained a reputation as a vigorous fundraiser, channelling much of the fruits of his efforts towards medical research. His time at UCL means that he is no stranger to controversies over medical science. He faced a backlash when, in response to threats of libel, he required Professor David Colquhoun to remove the website ‘Improbable Science,’ which lambasted herbal medicine, from UCL’s servers. Following student outcry – and some vetting from lawyers – the website was allowed to reappear. Perhaps more relevant to the NHS’ aspiration to be a research leader, Professor Grant also chaired the UK Independent Steering Board for the Public Debate on GM foods from 2002–2003. He will understand all about controversy, something which will come as a regular part of the job in his new role.
Second, he will need to show that he has a strong enough personality (and thick enough skin) to withstand the egos with which he will be buffeted. Part of a chair’s role is to protect his/her executive from unnecessary outside interference or pressure. In an area as highly politicised as the NHS (and one which is more used to political interference than it is to ‘independence’), this will be intense. He will also have to deal with – and provide a counterweight to – an unusually powerful chief executive. Sir David Nicholson’s name has become synonymous with control in the NHS. His appointment as Chief Executive of the NHS Commissioning Board in December came as a surprise to many, and meant that any future Chair of the Board would have to work alongside the man who has been in charge of the NHS for years. How they work together will be fundamental to the successful running of the Board. That Professor Grant’s experience comes in a different field may be helpful here. David Nicholson brings the experience of the NHS, while Professor Grant has experience and success elsewhere – with UCL rising up the ranking of universities under his leadership. The top team at the NHS Commissioning Board does not need to be a battleground for power, and Grant’s differing background to Nicholson should help in this respect.
Third, he will need to convince the Committee (and the NHS) that he can do the job in the time allowed him. A time commitment of two to three days a week in the early months, dropping to as few as four days per month, will seem to many as a little light touch for running a £100 billion organisation which will have been in the midst of extreme budgetary pressures and unsettling reorganisation. Alongside his new position, Professor Grant will retain his current role as President and Provost at University College London (for which he currently earns over £370,000). He will need to demonstrate to the Committee that his experience and ongoing involvement at UCL will add to his ability to undertake the role rather than detract from it. The fact that UCL has a strong reputation in health research – and was one of the UK’s first Academic Health Science Centres – should help him here, although he may need to explain how conflicts of interest will be avoided between the Board’s duty to promote research and his own duty to promote UCL as a centre of research excellence.
Fourth, he will need to give some indication (but not too much) of where he would like to take the NHS. Little is on the record about Professor Grant’s ideology on the NHS – and he may like to keep it this way, not wanting to appear in conflict with the Secretary of State or his Chief Executive. However, as a man who has held a series of public roles, there will be an array of old speeches and quotes that committee members can use to draw conclusions on his likely approach. Andy Cowper of Health Policy Insight has given the busy MPs a helping hand and identified a few here. Professor Grant has made the case for reform in the NHS, while still arguing that “we have one of the best health services in the world” – he’s not likely to find many opponents on the committee on this. However, there are other aspects of Grant’s ideology that may provoke more questioning – he has, when discussing universities, made the case that elite institutions should be funded while their lower-quality institutions should be cut. How this view will apply to the NHS could have implications for reconfiguration in the NHS, a topic that does not look set to go away as the number of financially struggling hospitals continues to rise.
Confirmation hearings are as much about not creating the wrong impression as they are about making your mark. Committee members will want to probe his background, his approach to handling (inevitable) conflict, his ideology and whether he is able to devote sufficient time to make the job a success.
How well prepared he is to address these questions will likely decide how comfortable a session he has tomorrow.