Modernisation is about to hit the civil service, long practised at absorbing change without actually changing much. But what will it mean for the DoH and the NHS Executive? Patrick Butler reports

The Department of Health, along with the rest of Whitehall, is in theory about to be reformed.

Under the all-encompassing Blairite rubric of 'modernisation', the civil service has launched itself on a programme of self-improvement entitled 'A civil service for the 21st century'.

From the Whitehall publicity machine comes talk of a new vision and a fresh set of values: promoting responsiveness, openness, leadership and innovation - bold stuff, and perhaps a tacit admission that parts of the civil service are not over-endowed with such qualities.

Whitehall claims the reform is selfgenerated - but there is a general feeling that in the face of Labour's chilly modernising blast the service must change or die.

Devolution and the reform of the House of Lords has served notice to the 'forces of conservatism' that change is inevitable.

Margaret Thatcher took an axe to the civil service in the 1980s in the name of efficiency. Former health secretary Virginia Bottomley tried the same with the DoH in the 1990s. It is debatable whether either led to any fundamental change.

One middle-ranking DoH civil servant says: 'There have been lots of reviews over the years and lots of reorganisations, but no-one really notices the difference. I don't think the culture has changed. As for the latest reforms, it's all good words, but where's it all going?'

The shake-up began with the Cabinet Office white paper Modernising Government earlier this year. This laid down challenges for the civil service: it must become more customer-responsive, more quality focused, more innovative and less risk-averse; it must work collaboratively and strategically.

In September a summit of permanent secretaries met to draw up an action plan that would propose a new vision and set of values for the service which would dovetail with, and ensure delivery of, the white paper challenges.

It says: 'Our aim is to help make the UK a better place for everyone to live in and support its success in the world.'

The values proposed are:

to act with integrity, propriety and political impartiality, and to select on merit;

to put the public's interests first;

to achieve results of high quality and good value;

to show leadership and take personal responsibility;

to value the people we work with and their diversity;

to innovate and learn;

to work in partnership; be professional in all we do;

to be open and communicate well.

Whitehall staff are being consulted on the proposals until March 2000, and there is an unprecedented commitment by the departments and the Cabinet Office to work in partnership with the trade unions.

James Undy, a member of the national executive committee of the Public and Commercial Services Union, which represents many DoH staff, welcomes the proposals as a chance to reform what is in places a frustratingly hierarchical organisation.

But while he applauds the commitment to be more dynamic, he warns there are dangers in compromising traditions of impartiality and public service.

'We would say to ministers, if you want people to be less risk-averse, then you have to back us if we make a mistake. Our members would welcome the opportunity to innovate but the dilemma they have is, if something goes wrong, are we going to be backed or hung out to dry?'

Ray Rowden, visiting professor at York University, who spent two years as a senior civil servant, says senior DoH and NHS Executive staff ought to be more high-profile and accountable for what they do.

'People in the NHS are pig-sick of the double standards of the DoH. On the one hand they are told civil servants are just advisers to ministers; on the other, civil servants dip their fingers into every local decision.'

NHS Confederation chief executive Stephen Thornton agrees. 'It's critically important that the NHS Executive is more high-profile and publicly accountable. It's not a criticism of Alan Langlands, but the NHS chief executive needs to become truly a chief executive.'

The DoH suffers from conflicting priorities and lacks 'a sense of leadership, direction and purpose', he says.

'When the media want to hear about NHS issues, the media come to me - they do not go to the chief executive of the NHS.

'In no other big organisation would that happen.'

Civil servants are past masters at absorbing change without changing.

But the feeling is that having abolished most of the hereditary lords, New Labour means business.

Mr Undy says: 'I genuinely believe that we have a long way to go to persuade our members and some of our more senior managers that Labour is not bluffing.

'There's a presumption among some senior managers that they are secure; that will no longer be true. The threat is of a US-style system, where the incoming government picks its own, highly partial advisers and policy strategists.

'Price Waterhouse and Andersen Consulting would be very happy to give the government confidential policy advice, ' says Mr Undy, who adds that the government might also be happy with such an arrangement.

'I think the civil service is on notice. Its senior figures have got to realise that they cannot patronise the reforms out of existence.'