It should be fairly obvious that you can’t appoint your daughter’s boyfriend to a senior post even if you are the chief executive.

What about employing your wife’s company to deliver the equal opportunity training or placing the outsourcing contract for support services with an organisation in which a family friend is a director?

Is anyone connected with you automatically barred from applying for senior posts or bidding for contracts? Is it enough if you declare an interest when the matter is discussed by the board? Is it ok as long as you’re not on the interview panel?

The rules may or may not be clear but chief executives and chairs have HR, legal services and the directors of finance and contracting to advise them, should they chose to accept the advice.

The thing that is influencing decisions is what chief executives and chairs do it is their modus operandi.

They don’t need to be on the interview panel to ensure the “right” person is appointed.

They don’t need to be on the contracting sub committee to ensure a ” trusted” company gets the business. And if the finance director is unhappy or the head of HR has concerns well who are they going to raise this with if the chairs ok with it.

The NHS is not democratically and locally accountable. It certainly is not as open as local government in its dealings. It’s too often left to whistle blowers and the local media to ask the awkward questions.