Published: 14/04/2005, Volume II5, No. 5951 Page 22

Stephen Davies, lecturer in health services management, department of health and human sciences, Essex University

Hamish Davidson's article on director-level recruitment in the future raises a number of interesting issues that will increasingly come to the fore as the 'inherited' chairs and non-executive directors of foundation trusts come up for reappointment by boards of governors (Opinion, pages 18-19, 24 March).

However, there are two questions the article did not discuss. The first concerns directors' pay in foundation trusts. The perilous life of chief executives is set to become even more insecure under foundation status. Under the legislation, the chief executive is to be appointed by the non-executives, subject to the approval of the board of governors.

In turn, executive directors are appointed by the non-executive directors and the chief executive.

The non-executives are appointed by the board of governors themselves.

The survival of the chief executive, and to a lesser extent other executive directors, depends on the long-term support of the board of governors.

Add to this the draconian powers of independent regulator Monitor to remove directors - and a readiness to use these, as demonstrated at Bradford - and you have a situation of high insecurity.

In the private sector, a level of insecurity at the hands of shareholders is typically invoked as the justification for salaries two to three times those paid for comparable responsibilities in the NHS. How long will it be before foundation trust directors realise this and adjust their expectations accordingly?

The second question is the future of the Department of Health's effective patronage over senior appointments in the NHS. Will the semi-visible system that sees chief executives and other members of the nomenklatura recycled around senior posts in the service wither away as boards of governors take control of director appointments? Or will the DoH and strategic health authorities find means of maintaining their control?

A more open system might be beneficial in recruiting new talent into the NHS but at what price?