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Published: 19/09/2002, Volume II2, No. 5823 Page 16

They may be termed 'czars', but at least one would prefer the role of Rasputin.

Carol Harris reports

The government's bright idea of appointing czars was copied from the US, where czars for policy areas such as drugs were thought effective.

Those of us less interested in the ways of US politics, including Harry Cayton, the czar for patient experience and public involvement, immediately think of the dubious examples set by Ivan the Terrible and Nicholas II.

'I think of myself more as the Rasputin for patients, ' he says.

'The patient experience bit means improving the interaction the patient has with the environment, relationships between patients and staff - things like politeness, improving food, cleanliness and so on. These things are pretty obvious generally, but for the NHS - well, they are a challenge.

'The second half of the job is public involvement. It is our health service, we ought to own it and make it accountable to us.

People do not want to go to a dreary hall on a rainy evening, to drink lukewarm coffee from a plastic cup and hear the chief executive say that he has already made his decision.'

Much of the czars'work is linked to national service frameworks.

Czar for older people Professor Ian Philp was one of the first to be appointed and then produced the framework for older people. A year on from that, a joint report from Age Concern and the British Geriatric Society criticised the slow pace of change. BGS president Dr Cameron Swift says they were 'worried by the apparent gap between the excellent rhetorical aims of the framework and the lack of local procedures, safeguards and resources'.

Professor Philp shares some of those concerns, but is optimistic. 'We know we are going to win, even though we still have work to do.'

Since the BGS and Age Concern report, he says, 'we have achieved a stable political and planning environment'.

Government cash and a culture of collaboration between agencies are making a difference.

'One area I have concerns about still is the issue of dignity on the wards. Significant progress has been made, but we are still having a lot of anecdotal evidence about people's dignity being undermined.'

Coronary care, whose czar is Dr Roger Boyle, is also making slow but steady progress. British Heart Foundation medical director Professor Sir Charles George says: 'From our perspective, good progress is being made in the implementation of the framework. Plans for expansion of cardiac services are progressing reasonably well and all of these achievements are in no small measure due to the work of Dr Boyle and other members of the heart team. There do, of course, remain some areas to be tackled.'

He mentions smoking cessation rates and physical inactivity.

An area of concern for all czars, highlighted by Cancer Research Campaign director of corporate affairs Jenny Grey, is funding. She says: '[Cancer czar] Mike Richards has been very successful.

'But the money announced to support the plans for services has not been transparent.

'We are concerned that new money will just go to paying off deficits.'

Professor Sir George Alberti is one of the latest to be added to the growing list of czars, officially known as the national clinical director for emergency access (the government stopped using the term czar when it fell out with Keith Hellawell, the erstwhile high-profile drugs czar).

'My first job is to wander round and listen, ' Sir George says.He will therefore be touring the country to find good practice to disseminate nationally.

He stresses that the czars work as a group, though no-one has yet come up with a collective noun for them.

'We are an outspoken bunch, and that is what you want, ' says Sir George.

'Hats off to the government for finally, after decades, seeing that this is needed - though I think it is also very astute of the politicians. I said to [health secretary] Alan Milburn: 'If this goes pear-shaped we will be blamed, and if it works you will all take the credit'.'

Look on the bright side, Sir George.

At least they will not take you down to the cellar and shoot you.