HSJ50 2006 supplement - Health Service Journal

NICK DAWE, ED MAYNARDDAVID NICHOLSONNHS CHIEFEXECUTIVE3Why is the man in charge ofthe NHS not at the top ofthis list? First: the plainspeakingNottinghamnative has only just takenup post. Second, how much powercan even the most senior managerhave in a world of politics? Well, let’slook at his form.Mr Nicholson is an NHS veteran.He has worked in mental healthtrusts, learning disabilities, acutetrusts, and, depending on how youcount it, he has run six differentbodies at interim level.As chief executive of Birminghamand the Black Country strategichealth authority from 2003 untilthis July, he stole a march on policy,introducing a fitness for purposestyleregime for primary care trusts.By July last year, the SHA wasclaiming some of the lowest waitingtimes in England. Mr Nicholson hasadmitted to harnessing a ‘fierce,competitive’ spirit to achieve that, bycomparing figures to those of Dorsetand Somerset SHA, where then chiefexecutive Sir Ian Carruthers wasseen as setting ‘a gold standard’.Before he took the reins of NHSLondon earlier this year he had beengiven two more West MidlandsSHAs to run.He has played a significant part inpolicy-making and implementation.He delivered the human resourcespolicy for the 2002 reorganisation ofthe NHS so well that he was asked toSIR LIAM DONALDSONCHIEF MEDICAL OFFICER4As the most senior medicin the country, Sir LiamDonaldson has been ‘thenation’s doctor’ since 1998.His influence penetrates‘By July lastyear his SHAwas claimingsome of thelowest waitingtimes inEngland’deep into Downing Street.The list of reports bearing hisname is long. He published the firstproper health protection strategybefore the creation of the Healthdo it again, though he handed thetask over when his West Midlandsempire expanded. He is admired forhis straight talking: comparing thehuman resources process for thisreorganisation with the last one hesaid: ‘Doing an HR process for areduction is much more difficult thanfor an expansion, it’s as simple asthat. Last time we were creating lotsof chief exec jobs, this time we’re not.’Apart from being appointed torun three SHAs, the biggestindication of the regard in which MrNicholson was held came in January2004, when he was asked to chair aProtection Agency. His report onpatient safety, An Organisation witha Memory, was similarly influentialin setting up the National PatientSafety Agency (his loss of patiencewas a major reason for its currenttroubles).Sir Liam was also the architect ofclinical governance in the wake ofthe Bristol inquiry. Most recently,his report on medical regulationused strong words to describe theattitudes of managers, accusingmany of being more concerned withpennies than patients.Colleagues adore the energy withwhich he pushes the causes close tohis heart, notably patient safety andhealth inequalities. They are causesbrought to the forefront by hisannual report. His support forpublic health is also evidenced bythe protection the professionenjoyed during the reorganisationof primary care trusts.This support has also broughtcontroversy, such as his backing fornational leadership group coveringpayment by results, new contracts,foundation trusts and patientchoice, although no-one is claimingMr Nicholson solved all the reformills and got home in time for tea.Colleagues speak admiringly ofhis skills: political influence,honesty, leadership, intelligence,numeracy, and compassion all arise.But he is also seen by many as abit of a ‘heavy’: witness his firstweeks at NHS London, when alltrusts that delivered a surplus lastyear found themselves under ordersto do it again.a total ban on smoking in publicplaces when his political masterswere trying to take a more moderatestance. Last year he revealed to thehealth select committee that heconsidered resigning over it; thatthe stance was changed in hisfavour is telling.After working as a doctor inBirmingham and Leicester, he wasappointed regional medical officerand regional director of publichealth for the Northern RegionalHealth Authority in 1986. He wenton to hold teaching and researchposts at Leicester University wherehe also spent time in generalpractice. Eight years later hebecame director for the Northernand Yorkshire region.Knighted in 2002, he has chairedthe WHO’s World Alliance forPatient Safety since 2004.The future? Some see his tendencyto go public with issues as evidenceof a last hurrah before a post-Blairstep-down. But he may surprise.4 Health Service Journal supplement 14 September 2006 hsj.co.uk