The time has come for a fundamental review of the Institute of Health Services Management, former president Ken Jarrold told its annual general meeting.

'I don't want to see something that's been very important to me fading away,' he said.

After the AGM had heard that the IHSM faced increasing competition for revenue from conferences and publications, and that it had failed to attract large numbers of new members, Mr Jarrold said: 'We should start from the proposition, if the IHSM didn't exist, would we invent it?'

It now had only two unique roles: 'It should be the voice of the NHS manager, able to speak unafraid to ministers about some of the things they are doing... and it should be about standards in management.'

Much of what the IHSM had been concerned with 15 years ago was no longer appropriate, said Mr Jarrold, now chief executive of County Durham health authority.

He called for the review to be conducted by members 'with at least 15 to 20 years to go - not aged ex-presidents'.

He added: 'If the review finds something to do, let's do it with enthusiasm. If not, let's go out with a bang.'

IHSM director Karen Caines responded that the institute's strength was that it went 'right across the health sector'.

'If we can't make that work because people don't want to participate or are too busy, I agree - we can't carry on,' Ms Caines said.

She added: 'I'm not standing here saying it's fine and dandy. Thirty per cent of our income comes from member subscriptions. That's far too low to run a sensible organisation unless we have other solid income streams.

'We don't. But it's up to us collectively to go out and bring new members in.'

Earlier, outgoing president Gill Morgan told the AGM that the IHSM had found current health ministers 'were not an easy set of politicians to deal with'.

'They have a very clear vision of the world. They can at times be very intolerant of debate and discussion. We have found it difficult to position ourselves in an appropriate way, where our voice is listened to but we're not seen as being universally critical,' she said.

'This is a major issue for the IHSM. Reading HSJ you will be aware how personal some of the politicians' views of the IHSM are.'

Ms Caines told the conference: 'Ministers are right to insist on the importance of tackling waiting... I am sure we will all approve the secretary of state's intention to make the NHS into a first-class service.'