I read with some amazement that trials of elections to trust boards will need to be 'properly evaluated', according to public appointments commissioner Dame Rennie Fritchie's report (news, page 7, 27 July).

This is, of course, sheer nonsense.

The evaluation steam-roller is clearly now out of control.

Probably the most fundamental feature of democracy - choosing people through an electoral process - is its own test of whether we want openness and transparency or something from the darker corners of the appointments cupboard.

In contrast, the electoral process is breathtaking in its simplicity and attractiveness - at least to those who like democratic processes, of course.

All positions of representational privilege in the NHS should be elected.

The time has surely come in modern Britain that electoral processes should be seen as the norm, and that we would have to - as they say - 'properly evaluate' appointments made on the say-so of ministers or in any other non-electoral way.

Mike Tremblay Tremblay Consulting Smarden Kent