NHS Greater Glasgow and Clyde was created on April Fools’ Day, 2006. The health board is governed by a board of 30 members. Can you name any of them?

Ultimately it’s accountable to the Health Secretary, but where is the democratic accountability to the people of the communities it serves?

We wouldn’t accept decisions on our schools, or the care our relatives get, being made by a board of people we don’t elect and can’t hold to account, so how has it been accepted that some of the most vital services we rely on have been allowed to be governed at a clear democratic deficit?

Each of the members of the health board receives mare than £8k a year, with the exception of the vice-chair and the chair, the latter receiving over £42k a year.

Despite Inverclyde Royal in my community serving a population area of 125,000, and the multitude of other National Health Services delivered in Inverclyde, we have only one person who is directly democratically accountable to the people that live in Inverclyde.

Democratically elected representatives are the minority on the board. Of course, clinicians should be at the heart of advising what the best clinical decisions should be – but the protection and improvement of our population’s health is everyone’s goal, so the communities our health services serve should have their voice at the decision making table also.

On top of the NHS board there are of course the executive directors. A chief executive who earns around £175k and an executive team of five in total that among them earn over £700k a year.

NHS Scotland consists of 14 regional NHS boards, seven special NHS boards and one public health body which supports the regional NHS boards by providing a range of important specialist and national services. Or in other words, 22 executive teams each servicing hundreds of unaccountable board members.

There is an obvious inconsistency in this approach to the arguments that were made in favour of why one national police service and one national fire service would lead to improved outcomes and a more resilient service.

Successive governments have not addressed that, for too long, communities feel consultations held by health boards are simply exercises that occur shortly before predetermined outcomes are imposed upon them.

Furthermore, for a democratic body to succeed the very people it aims to work on behalf of must have the confidence that they can hold decision makers to account.

As far as health boards go, the out-of-hours service is the latest example that, although they are full of many intelligent and determined individuals, there is a clear disconnect between the communities they aim to serve and the decisions they impose upon them.

I believe only bold reform can fix this.

To address the many challenges health services will face in the decades to come, Scotland needs to transform our outdated health board model, ensuring resilience, ability to address demand, and ensuring communities can democratically hold decision makers to account will be key to meeting this challenge.