Published: 13/05/2004, Volume II4, No. 5905 Page 12 13

Health service managers who fancy running another arm of the public services might soon get a chance.Ministers are believed to be keen on a form of musical chairs among senior public sector managers.

The Office of the Deputy Prime Minister is already looking at a system of public service boards, stretching the current model of local strategic partnerships. This is one of a number of initiatives led by local authorities designed to genuinely integrate public services.

Some non-Department of Health ministers are keen to take this kind of work further still.

For instance, one asks, why do you need to be a 'police person' to run a police service? The Home Office is believed to be particularly interested in sharing top management skills in this way.

And talking of running things, who is actually in charge of the NHS these days on a day-to-day basis?

A senior DoH source was asked about the apparent incongruity of Sir Nigel Crisp acting as both NHS chief executive and DoH permanent secretary. After all, devolution of power from the centre is being trumpeted as the future of the service.

Since the two roles were merged with the yet-to-be-knighted Mr Crisp's appointment in October 2000, a concerted effort has been made to 'shift the balance of power', the source contends.

So where does Sir Nigel direct his efforts? The source suggests Sir Nigel's successor as London regional director, John Bacon, now DoH group director of health and social care delivery, is the de facto chief executive, while Sir Nigel concentrates on his role as permanent secretary.