Published: 01/12/2005 Volume 115 No. 5984 Page 18

Gary Walker, chief executive, Surrey and Sussex Healthcare trust

I read with interest the 'key policy questions' raised in Mike Farrar's letter to John Bacon (news, page 6, 10 November). It contained many salient points that must be resolved if the new market is to function.

A key point is the proposal to give strategic health authorities the power to remove chief executives and board members if 'the view is taken' that they 'will not pass the Monitor test for foundation trusts'.

SHAs and those organisations that preceded them have, on an informal basis, strongly influenced the appointment and dismissal of chief executives and board members.

So a formalisation of the process must be a good thing.

But one must not overlook the fact that decisions about the appropriate conduct of nonexecutives were passed to the Appointments Commission, in part to avoid such executive action.

Whatever regulations are introduced into the market, it would only be right and proper that they apply to all. In this case, SHAs would need to have the ability to replace chief executives and board members of private companies treating NHS patients.

Another aspect to consider would be how such powers would interfere with the existing governance arrangements of a statutory bodies, such as NHS trusts.