Published: 22/07/2004, Volume II4, No. 5915 Page 22 23

Sir Jeremy Beecham (The HSJ Interview, pages 20-21, 8 July) is quite right to be concerned about the problems that might arise if the experiment with elections of public and patient governors to foundation trusts is not handled well.

Local government is dominated by political parties intent on defending national status and by councillors who often take a ward-based perspective rather than a city-wide policy view.

Democracy (based on a simple majority) is one form of representative and responsible government, but it is not the only form. In Churchill's words it just happens to be the 'least worst' that we have devised so far. To compare the numbers who voted for governors the first time around with the giddy heights of participation in local elections seems a bit premature. Far better to wait for three years before making a judgement.

It will only do this if it succeeds in returning a sense of ownership of 'our' hospitals and wresting it away from the national political parties that have tried to micromanage them for the last 20 years while failing to manage strategically in that time.

Who is to say that the mutual, pluralistic model of representation will be worse than the first past the post party-dominated system used now in local elections.

Engaging with the 'constituency' of patients and their carers will be a major challenge for these people. It is one that I am trying to face. I have set up a website to assist me in this (www. sheffieldpatient forum. org. uk). I am sure there will be other more novel attempts to do the same. If any ofthese succeed they might cause the staid, often remote and out-of-touch local councillors to rethink how they should engage with their own electorate.

David Symes Patient governor Sheffield Teaching Hospitals foundation trust