Magazine article Public Finance

Crisp Quits amid 'Confusion' at the Top of DoH

Magazine article Public Finance

Crisp Quits amid 'Confusion' at the Top of DoH

Article excerpt

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 DoHs 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. …

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