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Regrets, he's had a few, but former NHS chief executive Sir Duncan Nichol regards the 1991 reforms as a valuable legacy - and he has praise for the Dobson era, too, he reveals to Peter Davies

In the pantheon of demons responsible for the Conservatives' internal market, health secretary Frank Dobson undoubtedly reserves a special place for Sir Duncan Nichol.

As NHS chief executive, he led those reforms from their launch 10 years ago and through their implementation in 1991, before stepping down five years ago this week.

Currently a professor at Manchester University's health services management unit, he has kept silent about that turbulent era and the Labour government's reforms - until now. His views may surprise Mr Dobson.

He is blunt about his regrets - even admitting that the British Medical Association was right on some points - yet defiantly proud of what he sees as his lasting legacy.

But he is also honest about what he admires in Labour's reforms: Mr Dobson may be intrigued to learn that Sir Duncan has been helping develop clinical governance and primary care groups as a consultant.

He readily admits that the government has done a much better job than the Conservatives did in 'cultivating the major players'.

'The work put into articulating what is a very convincing vision has been extremely well done... The clarity and power of that vision has been extremely well communicated.

'It's not divisive. Managers, professionals, patients, communities can see as stakeholders how they can rally round a common cause.'

The passions of the early 1990s are spent. Sir Duncan refers to the Working for Patients white paper not by name but as 'the 1989 publication', and recalls the implementation process as 'putting some flesh on the bones of those - whatever those papers were called at the time - the working papers'.

He dissents from the fashionable view that the internal market was a catastrophe. He is unmoved by ministers' claims that their changes will junk everything the Tory reforms stood for.

'They talk about sweeping away the internal market and replacing it with integrated care. But it's important to remind ourselves of what they have retained.

'What's been kept are some of the key points. What's been rejected are the competitive and fragmentary elements of what was called the market.

'I'm not saying you can't tell the difference, but there is a clear legacy from the past which has been built on, not simply thrown away.'

Chief among those key points Sir Duncan numbers the purchaser-provider split: 'An absolute and fundamental change without which we wouldn't be having the Labour agenda... It put money in the hands of HAs and GPs - and that's a lasting legacy.'

And he is equally proud of instigating the 'performance culture'. Before 1991 that had barely existed. 'I've no doubt at all that we radically transformed the way the NHS thought about efficiency and responsiveness.'

Driving the 1991 reforms, he says, were the need to tackle variations in cost and productivity and a desire to shift power to primary care and stimulate services to respond to local people rather than professionals. 'On all three scores we did make a difference,' Sir Duncan claims, although measuring it is difficult. And he is frank about the failures.

Efficiency was defined too narrowly as acute sector activity; the emphasis on money rather than quality was wrong. 'Current ideas for judging the NHS are much broader, and I applaud that. Ours only gave us part of the picture.

'In that sense the BMA was right to say you're measuring the wrong things. But when pressed to say what the right things were, you didn't get a very fulsome conversation.'

Purchasers 'lost the plot'. Hidebound by the Treasury's efficiency index, they took to working the system rather than changing patterns of care provision. 'Too many were locked into an annual contract paperchase.'

Contracting 'generated costs which with hindsight we should have been careful about'. The extra money which went into developing the finance, human resources and information technology functions was justified in an under-managed service.

'But I separate that from the bureaucracy of contracting, which I think, looking back, is a fair cop. It's not good.'

Sir Duncan regrets, too, the language of competition, and that he had no chance to prepare the public and professions.

'That may sound like a rather weak excuse. But the government's plans were produced in a secret process, and then thrown at me, at the public, the professions as a done deal not for negotiation.

'You wouldn't handle organisational change in companies in that way. You'd want to prepare the ground and explain why.'

So he welcomes the rejuvenated spirit of collaboration in the NHS, although he wonders: 'Will performance ultimately suffer at the altar of partnership? Is it possible to remain partners and friends when the heat is turned up?'

And what chances of a smooth take-off for the new NHS, a condition Sir Duncan set much store by in 1991? 'There's no chance it is going to be smooth. It'll bump along. But the important thing is to learn and persevere.'