HSJ50 2006 supplement - Health Service Journal

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ED MAYNARD, RALPH HODGSONNIGEL EDWARDSDIRECTOR OF POLICY, NHS CONFEDERATION41Not every influentialperson is a figurehead;some, like NigelEdwards, haveestablished themselves through thesheer quality of their contribution todebate. Mr Edwards’ job is toestablish the organisation’s positionon NHS policy in relation to members’best interests — as such, his ideasbear considerable weight.On Commissioning a Patient-ledTIM KELSEYCHIEF EXECUTIVE, DOCTOR FOSTER42The former SundayTimes news editor cofoundedhealthcareinformation providerDr Foster in 2000 – the idea originallyborn out of his own frustration as amember of the public when trying tocompare performance betweenhospitals. Since then he has proved atireless networker, co-opting some ofthe most influential figures inhealthcare in both social and formal43General HealthcareGroup chief executiveIan Smith hassucceeded insignificantly raising his profile inrecent months.His name appeared on the shortlistfor the job of NHS chief executive andalthough he was beaten by DavidNicholson (3), he is also largelycredited with steering General44Before his move to theAudit Commission inSeptember 2003 (afterhitting a glass ceilingin the DoH, some would speculate),Andy McKeon had been DoH directorof policy, responsible for the reformagenda, where his influence was seenacross target-setting (the old starratings,when the DoH was in charge),payment by results, patient choice and45Achieving a totalsmoking ban in publicplaces is perhaps themost notableachievement of Kevin Barron, whohas been Labour MP for Rother Valleysince 1983. He was dismayed when thehealth secretary accepted a bill withexemptions, but he reacted by tablingan amendment in January calling fora total ban, and removing exclusionsNHS his comment to HSJ thatforbidding PCTs from providingservices was ‘intellectuallyincoherent’ gave voice to what wasthen largely a silent protest againstthe most vilified policy announcementof recent years. It went on to lead theintroduction to the health selectcommittee’s damning report.Mr Edwards has also been criticalof the view that competitionnecessarily creates more innovativesettings. He was close to healthsecretary Alan Milburn in thecompany’s early days and can countSouth Central SHA chief executiveMark Britnell (20) among Dr Foster’snon-executives.The company was viewed withsome suspicion in the early days, andthe robustness of its data in its GoodHospital Guides was criticised.However, the quality of its products isnow generally well accepted.IAN SMITHCHIEF EXECUTIVE, GENERAL HEALTHCARE GROUPHealthcare through choppy watersand into a successful merger withSouth Africa-based private healthcareprovider Netcare.Mr Smith was originally appointedchief executive of General HealthcareGroup in September 2004 and sincethen has led a number of successfulbids into the DoH’s independenttreatment centre programme.Most recently he has helped toANDY McKEONMANAGING DIRECTOR OF HEALTH, AUDIT COMMISSIONintroducing private-sector provision.Audit Commission reports attractconsiderable political and mediainterest: they are seen as a very honestbroker. Recently, Mr McKeonintervened in the debate over deficits,arguing that the DoH should returnpart of the £504m 2005-06 overspenddeducted under resource accountingand budgeting (RAB). He compared itto ‘trying to treat a business as anKEVIN BARRONCHAIR, COMMONS HEALTH SELECT COMMITTEEfor private members’ clubs and pubsthat do not serve food. And he wasable to persuade the prime minister togive all Labour MPs a free vote.When a 200 majority voted for acomprehensive ban, Mr Barronclaimed it as an important stepchangein public health. He is alsoproud of his involvement in thepassage of a government bill to bantobacco advertising and promotion,practice. Indeed, his most consistenttheme is that a collection of policieswhich of themselves may be sensibleand workable have failed to cometogether to form a compellingnarrative. An infectiously enthusiasticconference speaker, Mr Edwards’intellectual curiosity is a huge serviceto the NHS, but a more ‘political’ rolemight be too much of a bind.● As a judge Nigel Edwards wasexcluded from deciding his inclusion.The company’s joint venture withthe DoH Information Centre forhealth and social care last year, toform Dr Foster Intelligence, marked amajor step forward for the company.It now has access to a powerful set ofpublic sector data which it hopes topackage for purchase by trusts. Thedeal was controversial enough toprompt a National Audit Officeinvestigation, expected to report laterthis year.secure preferred bidder status on twoof the seven national ITC diagnosticsschemes for Netcare and InHealth.At the time of the merger withNetcare, Mr Smith said: ‘We are clearthat we have a significant role to playin supporting the government’spatient choice and quality agendas atvalue-for-money prices to the taxpayer.’Before joining the group, he waschief executive of logistics firm Exel.individual with a credit card bill’, andwarned of RAB’s ‘double whammy’effect, where obligation to generate acompensatory surplus in the mediumtermeffectively means losing moneyfrom budgets twice over. Mr McKeonsuggested that the system should bephased out this financial year, anddeductions repaid. It is an argumentmany would agree with, but will bedifficult to win.after he promoted a private member’sbill in 1993.Mr Barron was made chair of thehealth select committee after the 2005general election. His first major reportwas a blistering attack on primarycare trust configuration, whichcriticised the government for the lackof consultation. The committee alsolaunched an inquiry into the cause ofthe NHS’s financial troubles this spring.14 Health Service Journal supplement 14 September 2006 hsj.co.uk
RICHARD DOUGLASDIRECTOR OF FINANCE AND INVESTMENT, DoH46Among their manyself-confessed virtues,Yorkshiremen seethemselves assurvivors. By this yardstick, RichardDouglas is a nonpareil: still standingas DoH director of finance andinvestment, despite the departure ofalmost all the DoH’s old board, chiefexecutive Sir Nigel Crisp and NHSfinancial improvidence.His survival in the face of the47The Foundation TrustNetwork began life asan off-shoot of the NHSConfederation, a quietrelation to the much more vocalpresence of regulator Monitor.This year that has changed, withthe network increasingly to theforefront of representing foundationtrust interests – a shift in large partdown to the energy of director SueSlipman. When Tony Blair brought48Throughout the fastpacedreforms in thehealth service, NHSAppointmentsCommission chair Sir William Wellshas fought for clarity in the roles andresponsibilities of chairs and nonexecutives,whom he says will ultimatelycarry the can in the new NHS.Last year he publicly attacked thegovernment’s approach to49Mr Selbie inherits oneof the trickiestchallenges in NHSmanagement.Colleagues praise his ability toretain focus and to concentrate on theright things. Leading doctors speakhighly of him and he seems to be wellregarded by politicians of all colours.Mr Selbie joined the DoH inNovember 2003 as the director ofDR RICHARD HORTONEDITOR-IN-CHIEF, THE LANCET50Dr Richard Horton is aman who speaks hismind aboutcontroversial issues,regardless of how many feathers willbe ruffled.In 1998 he famously defended hisdecision to publish the controversialresearch by Dr Andrew Wakefield andcolleagues about the MMR jab andautism. He openly and repeatedlyfinancial and political fall-out speaksof a high level of indispensability, orperhaps a role as the organisation’smemory – a vital quality when tryingto resolve a financial mess such as theNHS’s current one.Appointed director of finance andinvestment in May 2001 (his secondstint at the DoH), his role was todevelop effective financial andinvestment support for the DoH.Going forward, Mr Douglas will needSUE SLIPMANDIRECTOR, FOUNDATION TRUST NETWORKtogether the network, Monitor,foundation trusts and FTSE 100companies earlier this year, it was MsSlipman who led the discussion. Asthe 2008 deadline for all trusts tobecome foundations approaches, herinfluence is sure to grow.Like Monitor’s Bill Moyes (11) sheis essentially an outsider. Beforejoining the network two years ago, shehad previously been chair of theFinancial Ombudsman Service andSIR WILLIAM WELLSCHAIR, NHS APPOINTMENTS COMMISSIONreorganising PCTs, saying theproposed reforms offered ‘no clarity’on the future for PCTs and NHSboards.His concerns were nailed downwhen the DoH forgot to send copies ofCommissioning a Patient-Led NHS toPCT chairs.Sir William dug his heels in andsaid he was not prepared to start onthe changes until there was moreDUNCAN SELBIEDIRECTOR GENERAL OF COMMISSIONING, DoHhsj.co.ukprogrammes and performance.During this time, he developed the‘Selbie Six’ priority areas for PCTs:health inequalities, cancer waitingtargets (31 and 62 days); the 18-weektarget; MRSA; sexual health and GUMservices; and patient choice andbooking. He is clearly able to handle afairly full plate.Like Richard Douglas (46), MrSelbie has survived his associationdefended professor Roy Meadow, thepaediatrician accused of givingmisleading evidence in the criminalproceedings against Sally Clark in1999, who was alleged to havemurdered her two sons.The verdict of serious professionalmisconduct given by the GeneralMedical Council against ProfessorMeadow was ‘unjust’, he said, andwould ‘profoundly damage the futureall of his undoubted shrewdness andexperience, as the top challenges forthe NHS are all financial: fromcommissioning to unbundling thetariff to payment by results to creatinga real NHS Bank.None of these are easy challenges:all involve pitfalls, risks and tacklingvested interests. Being seen to getthrough all of these successfullywould be an enormous – and verynoticeable – feather in his cap.before that worked at the CamelotGroup, the Gas Consumer Counciland the National Council for OneParent Families. Like a number of thehealth service’s most powerful figuresshe is a former communist as well as afounder member of the SocialDemocratic Party.Ms Slipman combines a direct stylewith sharp political nous. She willneed both to manage some fraughtrelationships between her membersclarification from the centre on theroles and responsibilities of boards.He was concerned about the successof the new PCT boards, which wouldbe central to any future judgements onthe quality of healthcare.Recruitment of non-executives hasbeen another crusade, as rapid policychanges, greater scrutiny onperformance and poor pay meantnon-executives were in short supply.with the Crisp era. The infamousMonth 10 finances letter (also knownas the ‘we know where you live’letter), which promised that ‘Sir Nigelis taking a close and personal interest’in trusts’ compliance with cuts wentout in Mr Selbie’s name. This surprisedinsiders, who say this letter wasintended to go out under Sir Nigel’sname. Whatever happened, Mr Selbiehas not been blamed by colleagues.of child protection services in Britain’.He criticised the GMC for sacrificingthe reputation of one person to saveits own hide, and called on thegovernment to urgently create a RoyalCommission to make recommendationsabout the use of experts by the courts.Away from controversy thedecisions he makes every week aboutwhat doctors read mean he has deepinfluence on their thinking. ●14 September 2006 Health Service Journal supplement 15
Page 6 and 7: NICK DAWE, ED MAYNARDDAVID NICHOLSO
Page 9 and 10: PROFESSOR SIR IAN KENNEDYCHAIR, HEA
Page 11 and 12: KEN ANDERSONCOMMERCIAL DIRECTOR, Do
Page 13 and 14: PROFESSOR MIKE RICHARDSNATIONAL CAN
Page 15: ANNA WALKERCHIEF EXECUTIVE, HEALTHC
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