Dramatic improvements are needed in the way appointments to NHS boards are made, according to the latest report of the committee on standards in public life.

In a report issued last week, the committee, chaired by Lord Neill of Bladen QC, was unhappy about many aspects of the way more than 3,000 board members are appointed, despite measures already taken by commissioner for public appointments Dame Rennie Fritchie.

The impression we gathered is a cause of considerable disquiet to us, says Lord Neillsreport.

The committee believes the complexity of the appointment procedure should reflect the posts responsibilities - a balance known as proportionality.

But delays in appointment, rather than failure to adhere to the proportionality principle, bothered NHS representatives who gave evidence to the committee.

One trust representative said: The long delay between application and appointment means that some useful people are lost to the NHS because they find other activities to pursue.

A hospital trust chair said: I am aware of several people who have been left waiting months to hear if they have been reappointed or not. They may not be reappointed, are not told why and are often unceremoniously dropped, sometimes after years of valuable service.

NHS Confederation human resources chair Andrew Foster, who gave evidence to the committee, said the situation had improved. Nineteen ninety-nine appointments have been fantastically improved, he told HSJ .

Almost every appointment was made at least a month in advance. So a good deal of what Neill has asked for has begun to be delivered already.

Two unresolved issues have been referred to Dame Rennie - the way reappointments are made and the politicisation of posts.

New NHS rules say candidates for reappointment have to be compared with external ones - a process dubbed the beauty parade .

This has caused an enormous amount of work, and significant distress for candidates, the committee says. It recommends that if a person has been performing satisfactorily, there should be no need to go to external candidates.

It also suggests a change in the central register of potential applicants, which currently prevents them applying for a certain geographical or skill area.