A comprehensive study of a fundamental change in the governance of Britain, this text deals with the transfer of power from democratically accountable central and local government to the closed world of quangos. These quasi-governmental bodies, for example health authorities, colleges, training and enterprise councils, housing action trusts and the Low Pay Commission, have boards whose members are appointed rather than elected. Yet the 70,000 appointed men and women are responsible for delivering major public services and spending substantial amounts of public money. This book illustrates how policy and financial decisions are taken behind closed doors and lack accountability to citizens through the democratic process. It draws on the experience of the UK and USA to show how patronage in the appointment of board members enables the government of the day to extend its influence. It includes a detailed analysis of proposals for their reform, including those from the Nolan Committee on Standards in Public Life. Skelcher argues that the problem of quasi-government requires a fundamental reassessment of the British political and governmental system.