Is Sir Nigel Crisp- NHS's CEO about to fry?
Speculation is mounting about the future of Sir Nigel Crisp, the National Health Service chief executive and permanent secretary of the Department of Health as ministers appear to lose confidence in him. As the health service heads towards a record £790m overspend, Sir Nigel appears to have lost much of the confidence of health ministers and the support of his top tier of "field management" - many of the 28 chief executives of the strategic health authorities.
A year ago Sir Nigel was persuaded to apply for the cabinet secretary's job to ensure there was competition for Sir Gus O'Donnell, who was eventually appointed.
With the NHS waiting times falling sharply, Sir Nigel's pitch was that, as an experienced manager, he could deliver the government's public service reform agenda.
But, according to one senior Whitehall figure, he has gone in the space of 12 months from being "the blue eyed boy of Whitehall to a member of the fingertips club".
Shortly after that contest, it emerged that the NHS had overspent by £250m last year. That was followed by fury among staff and MPs over a letter at the start of the holiday season telling primary care trusts that they had to divest themselves of services they directly provided. Then in September came the revelation that this year the NHS was heading for a £620m deficit, at the same time as strategic health authorities and PCTs were being pressured into mergers.
Sir Nigel has told the SHA chief executives whom he hand-picked as his top management team in 2002 that barely a handful of them were guaranteed jobs after the mergers. Even among the survivors, that has led to questions over his management judgment.
Evidence of ministers' loss of confidence was their decision, rather than Sir Nigel's, to call in McKinsey, the management consultants, to examine the structure inside the health department as the government moves to a supplier market in healthcare. McKinsey's findings are understood to have been so critical that they have not been committed to paper.
When last month Patricia Hewitt, the health secretary, presented the NHS's key priorities for next year, she was flanked by the department's finance chief and an acting policy director, not her chief executive. Ministers have also expressed surprise in private that Sir Nigel chose to go to the Davos economic forum in the run-up to the government's white paper on healthcare outside hospital.
Asked recently if a new departmental board due to take effect in July was the last word, Ms Hewitt said it would need to evolve further as the NHS did. Asked if Sir Nigel would oversee that, she said: "You will have to ask Nigel that. I think he has made his position clear [that he intends to stay]."
Sir Nigel's supporters point to a string of improvements in the NHS under his tenure that go well beyond merely eliminating the longest waits for treatment. They add that he has "an almost infinite capacity to absorb punishment" and has dealt with some of Labour's toughest ministers including Alan Milburn and John Reid.
Whitehall insiders also note that if and when he goes, decisions will be needed on whether once again to split the permanent secretary and chief executive jobs and possibly divide the chief executive position into a commissioning and providing role. These are decisions that ministers do not yet appear ready to take.
David Hunter, professor of health management at Durham University, said yesterday that "most people didn't expect him to survive last year". But the scale of NHS deficits built up over the years he has been in charge "are making his position increasingly untenable".
In September, Sir Nigel Crisp, the NHS chief executive, told the service it must reduce the overspend to £200m this financial year.
The Department of Health yesterday refused to confirm the figure, but Chris Ham, professor of health service management at Birmingham University, said the fact that the numbers "are going north rather than heading south so late in the financial year is really bad news".
The rising deficit is undermining the position of Sir Nigel, who has presided over six years of record rises in NHS spending but during which underlying problems in finances and structure appear not to have been tackled.
Last week he issued a bulletin warning that the financial position was "serious". Trust and health authority chief executives, many of whom will soon have to reapply for their jobs, were warned he was taking "a direct and personal interest" in their performance. Organisations projecting a break-even were told they must now make a surplus to offset overspending elsewhere.
Prof Ham, a former head of strategy at the health department, said the warning implied "a sense of desperation at the top of the office". "There is real pressure to show that things are being done, even though there is very little NHS organisations can do to turn things round with only five weeks of the financial year to go," he said.
http://news.ft.com/cms/s/5652ff2e-a7ff-11da-85bc-0000779e2340.html
A year ago Sir Nigel was persuaded to apply for the cabinet secretary's job to ensure there was competition for Sir Gus O'Donnell, who was eventually appointed.
With the NHS waiting times falling sharply, Sir Nigel's pitch was that, as an experienced manager, he could deliver the government's public service reform agenda.
But, according to one senior Whitehall figure, he has gone in the space of 12 months from being "the blue eyed boy of Whitehall to a member of the fingertips club".
Shortly after that contest, it emerged that the NHS had overspent by £250m last year. That was followed by fury among staff and MPs over a letter at the start of the holiday season telling primary care trusts that they had to divest themselves of services they directly provided. Then in September came the revelation that this year the NHS was heading for a £620m deficit, at the same time as strategic health authorities and PCTs were being pressured into mergers.
Sir Nigel has told the SHA chief executives whom he hand-picked as his top management team in 2002 that barely a handful of them were guaranteed jobs after the mergers. Even among the survivors, that has led to questions over his management judgment.
Evidence of ministers' loss of confidence was their decision, rather than Sir Nigel's, to call in McKinsey, the management consultants, to examine the structure inside the health department as the government moves to a supplier market in healthcare. McKinsey's findings are understood to have been so critical that they have not been committed to paper.
When last month Patricia Hewitt, the health secretary, presented the NHS's key priorities for next year, she was flanked by the department's finance chief and an acting policy director, not her chief executive. Ministers have also expressed surprise in private that Sir Nigel chose to go to the Davos economic forum in the run-up to the government's white paper on healthcare outside hospital.
Asked recently if a new departmental board due to take effect in July was the last word, Ms Hewitt said it would need to evolve further as the NHS did. Asked if Sir Nigel would oversee that, she said: "You will have to ask Nigel that. I think he has made his position clear [that he intends to stay]."
Sir Nigel's supporters point to a string of improvements in the NHS under his tenure that go well beyond merely eliminating the longest waits for treatment. They add that he has "an almost infinite capacity to absorb punishment" and has dealt with some of Labour's toughest ministers including Alan Milburn and John Reid.
Whitehall insiders also note that if and when he goes, decisions will be needed on whether once again to split the permanent secretary and chief executive jobs and possibly divide the chief executive position into a commissioning and providing role. These are decisions that ministers do not yet appear ready to take.
David Hunter, professor of health management at Durham University, said yesterday that "most people didn't expect him to survive last year". But the scale of NHS deficits built up over the years he has been in charge "are making his position increasingly untenable".
In September, Sir Nigel Crisp, the NHS chief executive, told the service it must reduce the overspend to £200m this financial year.
The Department of Health yesterday refused to confirm the figure, but Chris Ham, professor of health service management at Birmingham University, said the fact that the numbers "are going north rather than heading south so late in the financial year is really bad news".
The rising deficit is undermining the position of Sir Nigel, who has presided over six years of record rises in NHS spending but during which underlying problems in finances and structure appear not to have been tackled.
Last week he issued a bulletin warning that the financial position was "serious". Trust and health authority chief executives, many of whom will soon have to reapply for their jobs, were warned he was taking "a direct and personal interest" in their performance. Organisations projecting a break-even were told they must now make a surplus to offset overspending elsewhere.
Prof Ham, a former head of strategy at the health department, said the warning implied "a sense of desperation at the top of the office". "There is real pressure to show that things are being done, even though there is very little NHS organisations can do to turn things round with only five weeks of the financial year to go," he said.
http://news.ft.com/cms/s/5652ff2e-a7ff-11da-85bc-0000779e2340.html
posted by Drs Search at
9:53 AM
1 Comments:
Does this also mean man overboard for Richard Granger? Everyone from Connecting for Health, through the LSPs and trusts all seem to rally around Granger as the singular blame figure for the NPfIT- a significant feat given the scale of the project and the number/diversity of the actors involved. Any thoughts?
By
anyquestionsquestions, at 10:32 AM
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