NHS Tayside is the latest health board mired in a crisis, and it no doubt won’t be the last. The chairman and chief executive have resigned or been sacked and NHS Scotland has taken over or reallocated powers to others. There were financial challenges, that’s for certain – though Tayside isn’t alone in that – but using charitable funds to plug gaps most certainly crosses a line. It wouldn’t be countenanced in a pub and should never be considered in a public body. The minister was left with no real alternative.

Others though have faced issues, whether financial or in personnel over the years and it is more than a decade since NHS Argyll and Clyde was viewed as terminal and simply dispensed with, its responsibilities split between NHS Highland and NHS Greater Glasgow and Clyde. It raises the questions: why have NHS boards and if there is to be local accountability, which I and almost everyone else would agree with, then why the current model?

There are now 14 such regional boards, though many if not most people might struggle to name them let alone identify with them. There are of course some based on current local authorities, such as the islands and Fife and Dumfries and Galloway. Others though are far harder to define and seem arbitrary in many cases.

Many Glaswegians probably think its NHS Glasgow not stretching “doon the watter” and across, in the form of NHS Greater Glasgow and Clyde. NHS Highland is not simply the council area, but has Argyll and Bute tacked on. Likewise, many in Edinburgh will consider its the capital alone or some even that it replicates the former police constabulary in Lothian and Borders, not simply NHS Lothian.

If the purpose of these boards is to provide local identification and democratic accountability then they’re failing, not just through particular incidents as in Tayside, but more generally through a lack of knowledge and appreciation. For most folk it’s simply the NHS whose loving care embraces and yet whose bureaucracy strangles. They appreciate the care provided, even if they complain about the officialdom that goes with it.

Health boards only seem come to attention when there are major failings or controversial decisions and then they’re lobbied and criticised extensively. Until then they’re just an amorphous mass. An attempt by the First Minister when Health Secretary to instigate elections for them was an unmitigated failure. The organisations are too big for people to identify with and direct elections would simply have been a recipe for pressure groups and particular lobbies. That failure is no more lamented than the passing of the Argyll and Clyde Board.

As a constituency MSP I frequently required to interact with the NHS, whether on individual cases or wider issues of health service policy or plans. My experience was that the staff were very accessible, remarkably open and strived to be helpful, especially with complaints. However, engagement with the wider board on policy was contrived to say the least and based around briefings that were occasionally informative but invariably predicated on plans already decided upon in private.

So, there’s a need for democratic scrutiny and accountability. Moreover, as financial and other challenges mount the time has come to consider the overall structure, not just individual failings within the National Health Service. It is a revered institution and for that reason perhaps it’s sometimes seen as being beyond criticism. But seeking to address its labyrinthine structures isn’t criticism but a requirement for the challenges ahead.

Other public bodies have undergone change, from colleges to police, and they of course haven’t been without significant failings and challenges. However, it has meant that they are better placed to meet the needs of the coming decades and the squeeze on public funds. The difficulty for health has been that the mantra has simply been about more cash, not about using it better. Many other public bodies have justifiably complained that they’ve required to change and become more streamlined, why should health be sacrosanct? Do we need so many boards and chiefs?

Perhaps the clue is in the name – it’s the National Health Service,though it delivers locally. Similar treatment and the absence of a postcode lottery is expected. Some of that now requires not just flexibility within health boards but across them. There can be only so many specialist units in Scotland and the need for a national service ever greater. But, as health and social care integration becomes the issue and requirement locally, why is it boards not councils addressing it?

Surely, it’s time for a review of NHS structures with a national board addressing wider needs not just ministerial direction and local accountability through democratically elected councillors. There’s many models but the current one isn’t working.