Homa on the range

He may need a prodigious gift for the last as he embarks on two of the most demanding jobs in healthcare management.

In a legendary year for the health service, it falls to Mr Homa to play super-hero twice - to save health secretary Frank Dobson's skin as NHS 'waiting list-buster', and to rescue the flagging fortunes of the Institute of Health Services Manage-ment as its new president. One wonders where the fun will come from.

After all, the health secretary has effectively staked his future on fulfilling Labour's pledge to cut waiting lists by at least 100,000 by next April.

Mr Homa says unflappably: 'I readily accept that a performance indicator, as far as I'm concerned, will be the extent to which that objective is achieved. But it will depend upon a lot of hard work from a lot of people.'

Leicester Royal Infirmary's chief executive is being seconded for two years to the NHS Executive for the task. He says his priority is to put together a team of experts and draw up a schedule of work, including a programme of visits to hospitals and health authorities. The team will provide 'support' over waiting list management where needed, help to 'redesign' elective care, and identify and spread good practice.

The health secretary has reportedly warned non-executive directors they face the sack for failing to meet their target reductions.

But Mr Homa will not play a part in replacing managers whose organisations aren't doing well or taking over the management of waiting list programmes. 'I would characterise our role genuinely as helpful and supportive.'

He is confident the government's objective will be met. On the vexed issue of resources, he says: 'What is important is to avoid the stop-go characteristics of many of the previous waiting list initiatives. For the improvements which I'm confident will be achieved to be recurrent, it will require recurrent additional money. That clearly is a discussion which is taking place between NHS cheif executive Alan Langlands, the secretary of state and the Treasury.'

Mr Homa says his colleagues 'know the pressures staff are under and what can be achieved'.

He discovered these pressures early. After graduating in economics, he worked as a porter for six months in 1979 at the former St James's Hospital, Balham.

'I learned a lot about good and bad management and the difficulties that staff often have to contend with in order to do their jobs,' he recalls. 'It was very useful management training, although I didn't go into it on that basis.'

In 1981, Mr Homa joined the national administrative training scheme in the-then South West Thames regional health authority. He later had spells at St George's Hospital, London; Bristol Children's and Maternity hospitals; and Alexandra Hospital, Redditch, as well as an overseas posting in Canada. He joined LRI in 1989, becoming general manager at 32. He was made chief executive after leading a successful trust application.

'I found myself having a very senior position very early on. I think that taught me the importance of a very strong team. I have always been appreciative of individuals who had confidence in me.'

Now 41 and IHSM president, his job will be to boost the confidence of managers and the institute.

According to latest annual figures, the IHSM crashed to a pounds 180,000 operating loss last year. Turnover fell below pounds 2m, and membership declined to 8,234 at the end of 1997. Mr Homa accepts that in some activities performance has been disappointing. 'The IHSM has had to address a number of really quite profound financial issues - which it has addressed. There's a lot of work to be done, but we're in the process of completing that.'

He adds: 'I think it's fair to say there's been a very substantial piece of work in the past two or three years to enable the institute to enter a period of renaissance.' He cites the sale of the IHSM's Euston HQ and move to rented offices in Cavendish Square that are 'more appropriate to our requirements'. But he adds: 'I would not want to see us in any way reducing the scale of headquarters because the demand placed on it in order to respond to members' requirements is substantial.'

Mr Homa says the IHSM's recovery programme in-cludes investment - more than pounds 50,000 - in regional development. He sees the institute focusing more on providing 'material' benefits to members, developing new services, supporting their professional development and reflecting the changing nature of their roles.

Asked about the extent of worries over the government's white paper changes, Mr Homa says some members who work in primary care have expressed some concerns about their personal security. 'Without having effective primary care management, the promise of primary care groups is unlikely to be fulfilled.'

Mr Homa, who confesses 'no political allegiance', sees the white paper as a 'most encouraging statement of ambition'. The real issue 'is to translate that into practice on the ground. That's the next stage the government and those of us in healthcare must focus on'.

Critics have in the past accused the IHSM of failing to exert sufficient influence on ministers over policy. Mr Homa says the institute has made it an 'explicit commitment' to develop policy work, investing extra resources.

'We have good relationships and lines of communications with ministers. It's now incumbent on us to make sure we make the best use of those to improve the way in which the managerial contribution is played out.'