10 March 2006
Sir Nigel Crisp's resignation as permanent secretary at the Department of Health followed a breakdown in relations between ministers and senior civil servants, documents obtained by Public Finance reveal.
Crisp has been widely blamed for escalating NHS deficits and a series of policy errors. But a review of the DoH's top management by consultancy McKinsey late last year warned that the working relationship between ministers and senior officials was not 'fit for purpose' and that formal meetings between them were too infrequent.
Copies of the review's recommendations and internal briefing documents were released to PF under the Freedom of Information Act. The recommendations were fully endorsed by Crisp and Health Secretary Patricia Hewitt and led to the recent restructuring of the department's management.
Six out of the seven recommendations were made public on January 20 and focused on moving from a three-division management structure to a single, integrated management board and enhancing financial controls.
A seventh recommendation – to 'further increase the level of collaboration between the board and the secretary of state and ministers' – was not made public.
The documents explain that better collaboration would be achieved through creating new ministerial portfolios – due to be announced 'shortly'; 'more regular' meetings between ministers and lead officials; and by new monthly meetings between Hewitt and the department's management board.
DoH board minutes reveal that no health secretary had attended the board since at least September 2004.
In a memo explaining the changes stemming from the review, Crisp added that Hewitt now also 'plans to chair a weekly meeting with ministers and lead officials on delivery and system reform'.
A separate 'Q&A' paper prepared for DoH staff explained that the changes to ministerial portfolios would enable 'a pattern of more regular meetings [to] be developed between lead ministers and officials'.
The DoH declined to respond to a series of questions based on the documents, saying that 'some of the information may be construed as confidential'.
However, PF has spoken to a source in the DoH's senior management, who said that behind the recommendations lay a department in which senior officials were routinely undermined by ministers and special advisers.
The source said that 'poor relationships' between ministers and civil servants resulted in confusion. 'One part of the department would go out and announce: “This is what we're going to do”, while another part would have no knowledge of what was being announced.'
The review documents state that the new management structure will require 'a new formal sign-off by the finance director for all policies with significant financial implications' and that his 'ability to challenge spending commitments' will be strengthened.
While finance director Richard Douglas's position has been strengthened, Crisp's dual role as permanent secretary and NHS chief executive has been subject to increased speculation since last October when Hewitt retracted an apparent order from Crisp that primary care trusts cease being direct providers of care by 2008.
Asked at a recent select committee meeting whether such a policy 'screw-up' was the fault of ministers or Crisp, former Cabinet secretary Lord Butler appeared to corroborate the view of PF's source when he said: 'Do not blame the mandarins entirely. There are well-documented cases of announcements made by ministers which have come as a surprise to their civil servants… People are just not given the chance to put these things through [a] rigorous process [of evaluation].'
Crisp announced his decision to retire at the end of this month in a letter to Cabinet secretary Sir Gus O'Donnell dated March 7. He said: 'There have been problems in the last months, and it is right that as chief executive I acknowledge my accountability.'
Sir Ian Carruthers – the DoH's acting director of commissioning – will temporarily fill Crisp's chief executive role, while Hugh Taylor, the director of strategy and business development and Crisp's deputy, will become acting permanent secretary.
John Appleby, chief economist at the King's Fund, told PF that it was now likely that the roles would be divided between two – if not three – people.
'When the single post was first introduced it was felt to be a good idea, in that it gave Crisp a higher profile and put a bit of distance between him and the ministers. But maybe it has fudged things a bit, leaving civil servants feeling things aren't going through the proper channels.'
The DoH has not yet confirmed how much it paid for the McKinsey review.
PFmar2006
