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Ask Sir Duncan Nichol, Bradford-born chief executive of the National Health Service and a lifelong civil servant, if he is something of a grey man and, not surprisingly, he bridles.
That, he counters, sitting sideways across an armchair in his first-floor Whitehall office, is a matter of perspective. 'Compared with a conventional permanent secretary I would not be a grey man, 'he says thoughtfully, the Yorkshire roots still audible in his accent. He has a point. Nichol is no ordinary Sir Humphrey. As boss of Europe's biggest employer and overseeing what must be one of the world's biggest turnovers--L26 billion and rising--his Northern steeliness, plus just a reassuring touch of grey, must come in useful.
Now 52 and nearly five years in the post, Nichol has helped oversee the greatest shake-up in the health service since the war. Out went the old-style consensus management where low-grade administrators charged round trying to keep high-grade doctors happy; in came a whole raft of modern business nostrums: greater pressure on cost-efficiency and customer satisfaction, the introduction of 'internal markets', the separation of key functions like purchasing and service provision, and, of course, the increasing use of snappy titles like chief executive and general manager.
It has not been a smooth transition. Some, both inside and outside the service, are still seething at the enforced changes, arguing that you cannot apply market doctrines to the basic tenets of caring and curing. Others, especially those working in conventional businesses, remain unconvinced that any amount of fancy tinkering will change the nature of the beast. The last few years, they note, have still been dotted with high profile examples of cash squandering on a massive scale.
For the critics, the health service will always be a lumbering, money-gobbling, state-propped leviathan. So few people are happy with things as they are. But it was ever thus: the constant scrutiny of the Press, the incessant wrangling over pay and conditions with a huge labour force, the interminable demands for accountability from politicians, the very life and death nature of the business have all led some to conclude that running the health service, while probably one of the most important managerial jobs in Britain, is also among the most thankless of tasks. If nothing...