Published: 02/06/2005, Volume II5, No. 5958 Page 18

Roger Moore, chief executive, NHS Appointments Commission

Janice Turner implies that the Appointments Commission acts arbitrarily and unfairly when terminating nonexecutive appointments (Speak Out, page 23, 12 May).

In fact the procedures which the commission follows in the tiny number of cases where appointments have been terminated (seven in 2004-05) comply fully with the principles of natural justice. And if we get it wrong we can be subject to judicial review.

That is why the terms and conditions - accepted by every non-executive when they are appointed - explain in detail how we will interpret 'the interests of the health service' in the unlikely event that we need to terminate the appointment.

There is a clear reason why NHS non-executives, just like their private sector counterparts, are not employees. An employee may have more rights but they also have more obligations to their employer.

Non-executive status gives a freedom to challenge and an independent perspective that is essential to the role, and which an employee can never enjoy.

And while non-executives, as office-holders, do not have the protection of employment law, they are now protected under discrimination law. So allegations of discrimination can go to an employment tribunal.

It would be unfortunate if non-executives were the first to be scapegoated when things go wrong. The commission has made clear that the 'football manager syndrome' has no place in the way we treat non-executives. But there have been particular occasions when non-executives have not been able to provide the leadership needed by their organisation.

In those circumstances they usually realise where the buck stops, and often stand down voluntarily in the best traditions of public service.

The ever-rising expectations of the NHS ask a lot from boards and place skilled non-executives at a premium. We do everything in our power to recruit, train, nurture and retain this valuable asset.

Janice Turner, recently 'resigned' non-executivee director, Surrey and Sussex Healthcare trust So Kensington and Chelsea primary care trust sees its deficit projections rise by£9m in one month and the chair stands down, but the chief executive gets transferred to the strategic health authority ('Deficit projections rose by£9m in one month', news, page 7, 19 May). What is happening to the director of finance?

And should the non-executives be asked to resign?

Are the scapegoats - sorry accountable board members - for the projected£32m debt at South Tees going to fall on their swords ('Debt could hit£32m', news, page 9, 19 May)? And then [by contrast] There is Shrewsbury and Telford, where the deputy chief executive and finance director were suspended ('Suspension at troubled trust', news, page 11, 19 May).

It is funny how SHAs, charged with performance management, seem to escape accountability altogether ('Surrey and Sussex SHA to report£29m deficit', news, page 12, 19 May).

We need a proper debate about corporate governance, whole-board accountability and SHAs' role in the context of the entire health economy.

Otherwise we will just carry on sacking some, suspending others, moving some and leaving some unaffected by decisions that do not appear to be based on any sort of transparency or accountability.

I am waiting to see how many non-executive directors go at these troubled trusts - they are so much easier to get rid of!