The Department of Health looks set to phase out the 14 national czars in a move that will signal a further devolution of NHS power to the front line, HSJ understands.

The Department of Health looks set to phase out the 14 national czars in a move that will signal a further devolution of NHS power to the front line, HSJ understands.

The czars - or national clinical directors - many of whom took up post in 2000 following the publication of the NHS plan, were tasked with helping to implement the waiting-time targets.

But sources say that following the success of major targets, including the four-hour maximum accident and emergency wait and the 31-day diagnosis to treatment referral for all types of cancer, their role is now deemed largely redundant.

Culture shift

One source close to the discussions said: 'The czars were a product of a target-setting culture and the world has moved on from the days of central diktat in these areas.'

National patient and public involvement director Harry Cayton has already resigned his post and it is understood that he will not be replaced. He will become chief executive of the Council for Healthcare Regulatory Excellence.

A spokesman for the DoH said: 'Harry Cayton has worked for the Department of Health for five years and during this time he has made an enormous contribution to making sure patient experience has been put at the heart of policy-making.'

National director for heart disease and stroke Dr Roger Boyle is understood to be in talks with University College London Hospitals foundation trust about the possibility of taking up a senior position.

The czars are employed by the DoH on flexible fixed-term contracts that allow the government to axe the posts and not reappoint past the term of employment.

DoH reshuffle

NHS Confederation policy director Nigel Edwards said the decision to phase out the czars was the result of the reshuffle of senior DoH posts.

Last month former NHS South Central chief executive Mark Britnell was appointed to the DoH as director general for commissioning. and system management and NHS North East chief executive David Flory became director general of finance.

A spokesman for the DoH said that the role of the czars was to give 'clinical advice on national standards'. He indicated that the current policy was to maintain a 'full range of czars'.

The DoH is set to appoint a. new medical director, with Leeds Teaching Hospitals trust medical director Hugo Mascie-Taylor topping the shortlist (see 'Mascie-Taylor tipped to land new NHS medical director role').

Who are the czars?

  • Professor Sir George Alberti - emergency access
  • Professor Louis Appleby - mental health
  • Dr Roger Boyle - heart disease and stroke
  • Harry Cayton - formerly patients and the public
  • Dr David Colin-Thomª - primary care
  • Professor Lindsey Davies - pandemic influenza preparedness
  • Professor Bob Fryer - widening participation in learning
  • Rob Greig - valuing people
  • Nicola Smith - learning disabilities
  • Professor Ian Philp - older people's services
  • Professor Mike Richards - cancer
  • Dr Sheila Shribman - children
  • Donal O'Donoghue - kidney services
  • Dr Sue Roberts - diabetes