A major problem is structural. The appearance is of boards of directors as in industry. The reality is that the chairmen are appointed from above and hold their positions not by dint of gaining the support and respect of their members, but by satisfying demands from on high. The members have little power: they, too, are appointed and have no constituency, but more importantly they lack the power to sack their chairman.
The Commons Public Accounts Committee criticism of the Wessex Regional Health Authority was not that the members acted improperly but that they allowed themselves to remain in ignorance. In a management style that was originated by Henry II, chief executives and chairs seek to please their political masters. The politicians, in their enthusiasm for results, become impatient of Parliament and wish to move more quickly than the legislative process. The safeguards in the system are taken lightly or ignored altogether.
Such a system where power and money flow from above is essentially flawed. The integrity of our public life then depends on individuals who will question and criticise. However, without any power or tenure, they are likely to have little influence.
I have been an NHS board member for seven years and am not a supporter of any political party. I realise how little power the board, let alone the individual members, has when higher powers want something done.
Alton, HampshireReuse content