The controversial figure of Roger Thayne has been snapping at heels - and not for the first time.
Some believe he has gone too far. Patrick Butler reports
Is Staffordshire Ambulance trust chief executive Roger Thayne a principled, outspoken critic of institutional pig-headedness? Or is he just a man embittered by the apparent failure of others to recognise his achievements.
The former army colonel has pushed many a nose out of joint since he took up the reins at the trust six years ago and single-mindedly set about transforming it.
Fellow ambulance managers, unions and the Department of Health have all had cause to bridle at his direct manner.
His latest foray - last week's attack on DoH statisticians - was in many ways typical: a dig at the way statistics are collected, which meant his success was not acknowledged, coupled with hints that this injustice was an establishment conspiracy.
The DoH played a straight bat. It defended its presentation of 999 response times 'without wanting to take away from his achievement'. Yet on the ambulance service grapevine it is murmured that officials consider this an outburst too far and that Mr Thayne's job is on the line.
There is no doubt some of his critics would like to see Mr Thayne - who they consider arrogant and self-aggrandising - take a tumble. 'His grievance is that everybody has not fallen at his feet and hailed Staffordshire as the best thing since sliced bread,' says one.
Unfortunately for his critics, Staffordshire is doing well in the sliced bread stakes. In 1997-98 it topped the 999 response time league tables for the third year in a row. Last year it was runner-up in the HSJ acute provider management awards.
Such plaudits, he claims, show that the 999 despatch system he has pioneered, Systems Status Management, is superior to other NHS priority despatch systems, which he says are far from failsafe.
There is an emperor's new clothes aspect to his critique. Priority despatch is most services' system of choice. It has government support and is regarded as the best way of combating the eternal problem of rising demand and diminishing resources.
But it is not only Mr Thayne's critique of the prevailing orthodoxy that has irritated colleagues. The frank, dismissive manner in which it is delivered also raises hackles. 'It's difficult for others to swallow that there's a better way of doing things,' he says.
Mr Thayne argues that his trust's success undermines the assumption that more money should be invested to improve response times. 'There's a difficulty in the NHS if you are successful, because it challenges the view that we are all underfunded.'
Ambulance Service Association director Roy Saunders denies that there is an attempt to freeze out the maverick Mr Thayne.
'There may well be other things (about Staffordshire) for others to learn from. But ultimately services must decide, taking into account local demands and resources.'
But despite a glut of fact-finding visits to his trust by colleagues in search of the holy grail of good practice, Staffordshire's methods have failed to catch on elsewhere.
Local Unison officer Frank Knox offers an insight into why Staffordshire's methods have not been adopted elsewhere. 'He keeps trying to sell his system to other services. But the moment they talk to us the interest dies.'
Unison locally has campaigned fiercely against SSM - which involves a radical, highly unpopular overhaul of work practices - and has twice passed no confidence votes in him. Last week it called for an investigation into staff claims that the trust was fiddling its response times.
Mr Thayne dismisses the allegations. There is no fiddling going on, he says. Change always generates opposition among some staff. And the votes of no confidence? 'If I thought it was genuine I would have resigned.'
He resents the implication that he is on an ego-fuelled crusade. 'It's not Roger Thayne's system. It's a system that is used in supermarkets, in the military, and that is proven in the US... I would be happy that my name was not mentioned at all but instead that the system was mentioned.'
The Audit Commission is due to report on ambulance services in the autumn, and Mr Thayne believes it will prove him right. By then, if the whispers about regional officials sharpening their axe are true, he may have departed. Not that this bothers him overly.
'The message we get is that chief executives are not there to put their heads above the parapet. But if senior managers cannot speak out and discuss these things, mistakes are going to be swept under the carpet and good practice is not going to be disseminated.'
Mr Thayne's self-belief is unlikely to waver despite the veiled threats. 'Look, I'm either a charlatan or there's something to be seen here at Staffordshire.'
In 1992, a year after he joined the NHS Mr Thayne published a radical critique of the UK ambulance service in which he lambasted its lack of direction, poor management, inadequate performance monitoring and wasted resources. It was dubbed 'superficial' by an irate Gron Roberts, chief executive of Essex Ambulance trust.
In 1994, he inflamed colleagues by warning that the loss of a pounds1m contract to West Midlands Ambulance trust could lead to his staff's wages being slashed by 20 per cent. He said he would set an example by taking an pounds8,000 pay cut. Fuming West Midlands chief executive Barry Johns suggested Mr Thayne's army pension meant his sacrifice was not as selfless as it appeared.
Recently he claimed that he had to bypass the Ambulance Service Association regional council to forward his proposals to ASA headquarters because his views on priority despatch 'only serve to cause offence to our regional colleagues'.