Hospitals are often large and complex organisations managing a huge range of services and employing large numbers of staff. A bit like a County Council for example.

They have to work with other health and social care organisations within a complex framework. Often, hospitals are out of step with the system as a whole.

Why? For far too long hospitals have been paid on activity. Crudely, the more patients that pass through the doors the more funding they get. This is against a backdrop of the rest of the health and social care organisations desperately trying to keep people healthy and out of hospital.

It is in the interests of people not to have to go into hospital. Much better that money is spent on prevention rather than cure.

We always seem to talk about hospital beds and patients rather than reminding ourselves that it is people we are referring to. From simple day surgery, to receiving advice on healthy eating, to the long term chronically sick we are lumped together as patients.

Being a patient often creates an unhelpful power imbalance between the person receiving the treatment and those giving it.

So, what has this to do with accountability. Well, hospitals are run by chief execs who are held to account by the Board of Governors who are held to account by ……… No one really.

The Governors are recruited by recruitment agencies and selected by a hospital selection panel. The public has little or no say in who becomes a governor.

This has the real danger of the hospital only selecting people who will maintain the status quo and who won’t rock the boat. I would argue strongly, that some rocking of the NHS hospital boat would be a very good thing for hospital patients and the wider health environment.

Perhaps it is time for the board to be elected in the same way that councillors are. Councillors are accountable to local people and can be got rid of.

Just saying.