The Sleazy State: How the web of Patronage works / Day 2: Party activists take lead in NHS trusts

Mr Milburn's analysis of the 376 chairs named shows that trust boards are dominated by men - only 97 are led by women - and by the business community. A total of 152 chairs are past or present company directors, or have their own businesses; 22 have backgrounds in finance while only 13 come from medical careers.

A spokesman for the Department of Health said that candidates from commerce were often selected, regardless of whether they had any health service experience, as they could inject 'fresh thinking and business acumen' into the NHS. He added: 'Political affiliations do not play a part in the appointments.' However, opponents argue that because of the selection process, a background in local politics is unlikely to go unnoticed.

Trust chairs are paid up to pounds 19,285 a year, plus expenses, and are appointed by the Secretary of State for Health from candidates suggested by the regional health authority and the NHS appointments unit in Leeds. Crucially, a place on the short list often depends on being proposed by existing trust executives or health authority members.

Unlike the old-style health authorities whose members included elected local councillors, trust boards have been criticised for their lack of public accountability. A Labour Party survey of 156 first- and second-wave trusts found that of the 122 that responded, fewer than half held board meetings open to the press and public apart from the statutory annual general meeting.

The accountability issue came to the fore again this week with the revelation that spending on cars by NHS trusts has risen by 65 per cent.

Yesterday, Mr Milburn said: 'The Independent's findings are conclusive proof that the trust system is wide open to political abuse. I have no doubt that the pattern of Tory supporters chairing trusts is repeated throughout the country.

'The NHS is becoming a lucrative job centre for Conservative supporters. Ministers are unscrupulously using the appointments system to advance Tory interests inside the NHS. In no sense can trusts claim to be representative of the communities they are supposed to serve.

'Spending more money on executive cars is just the tip of the iceberg. The trust system has become a bureaucratic black hole into which millions of pounds of taxpayers' money is being poured.'

Bob Abberley, head of health for Unison, the public-sector workers' union, said that the study reinforced the union's long-standing concern over trusts' lack of accountability: 'The links between trusts and the Conservative Party are creating a climate of political patronage that is not good for the health service.'

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