Health secretary Frank Dobson is the manager's friend - and the prime minister just wants him to keep doing his job, he tells Patrick Butler on the eve of implementing the new NHS reforms
Now let's get this clear. Frank Dobson, the health secretary everyone suspected of having a deeply embedded ideological mistrust of NHS managers, is actually a bit of an admirer of them.
So much so that he wants to create a highly paid, elite management cadre of supermanagers.
Before his advisers phone to complain, it is worth pointing out that Mr Dobson did not use the words 'highly paid', 'elite cadre', or 'supermanagers'.
But he did say that he wants to address management development, so that the 'best' managers are steered to the biggest or toughest jobs, and are 'properly rewarded' for doing them.
'I don't think enough attention is paid to managers in the NHS. We need to put more effort into developing managers.
'I also think we need to have a more planned, controlled progression for some of the more senior managers in relation to some of the more senior posts,' he says.
Look at the Leeds Teaching Hospitals trust, he says by way of example, one of the 'biggest industrial organisations' in Britain.
'It's a hard job managing that (kind of trust). We need to recognise that and we need to develop people with the skills to do that.'
He adds: 'Whether in health authorities or trusts, we need to be helping people plan their careers in a way that's good for their career and good for the NHS. At the moment it's a very random progress.
'Somebody may be chosen as chief executive on the basis of two or three non-executive directors of a particular trust on a particular afternoon when everybody is feeling ratty about something or everyone is feeling dozy because it's nice weather, and I don't think we should leave that upper echelon to such random processes.
'So I think that the NHS Executive and the regional offices should have a bigger role to play in identifying the best managers, identifying their careers and trying to make sure that slots are filled by the best people.'
These managers might act partly as management firefighters, he suggests, being sent to failing or badly run trusts and HAs.
'You ought to be able to say to people: 'Come in, do this job for three or four years and then you can reasonably expect that you go on to an even bigger and better-rewarded job.''
He won't be drawn on whether such managers would get industrial-sized salaries.
'I believe that senior NHS management has some of the biggest, most demanding jobs in the country and we need to make sure they are properly rewarded for carrying out those important tasks.'
The idea that he distrusts NHS management, he suggests, is propaganda put about by 'malignant' people.
'I have reason to believe that you and various other magazines and some of the people in the Institute of Health Services Management devoted innumerable person-hours in order to track down generic attacks by me on NHS managers, and you failed, because I have never made them.
'But if some managers fail, it is perfectly right to identify them, and do something about it...
'My perception of managers has not changed (over the past two years). I have always been in Continued from page 9
favour of good managers who are concerned about delivering services to patients and working in a co-operative way with clinicians to deliver top-quality services. There have always been managers who did that.
'The managers who didn't do it were encouraged by the previous regime. But as I say, I don't blame them. I blame the ministers who encouraged them to do stupid things.'
But what of Mr Dobson's approach to managing the launch of The New NHS reforms? Too hurried, too much guidance, and lacking crucial aspects of financial control? And has the reform process ushered in a new culture of centralised command-and- control management?
'There are two lots of criticisms about the guidance: one has been that there hasn't been enough and it hasn't been as early in the process as some people would have liked; and more recently there's been criticism that there's too much,' he says.
'What we were determined to do was issue guidance which was incremental; we took a deliberate decision not to issue comprehensive guidance right at the start because it was a learning process for everybody.
'So there was some initial guidance, and then some further guidance and then some further guidance.
'And the later guidance reflected people's experience of what was going on, and had dealt with problems that might not have even been addressed if the guidance had come out all at once.
'It's not a command-and-control arrangement, but we certainly envisage the NHS Executive and the regional offices playing a bigger role than they did in the past.'
He adds: 'People can't reasonably complain that they are confined by what we are proposing because it's entirely up to people in the locality how far their primary care group progresses.'
He emphasises this last point. 'If they want to stay as PCGs, fine, and the HA should help them do it.
'If they want to progress to be a primary care trust and take on additional responsibilities, then the HA should see it as their job to facilitate them doing that.'
This could lead to 'different arrangements' in neighbouring areas, he admits, but he rejects the idea that it could also lead to inequalities.
'Community and primary services are capable of being delivered in different ways to meet different geographic and demographic circumstances, and the different desires of the people in the NHS in that area.'
He is relaxed about the progress of the reforms - although he admits: 'We live in a wicked, sinful world and there will be things that go wrong,' and is satisfied with Labour's progress, particularly what he sees as the change of attitude in the NHS - 'people working together in a way they haven't been doing before'.
What has Mr Dobson learned in the past two years? 'My principal concern is that things that have been decided take a long time to get implemented. Maybe we need to adjust our timescales.
'Possibly we need to lengthen our timescales a little. On the other hand, some of the people who are supposed to be implementing things need to be shortening their timescales.'
In many ways Mr Dobson is right to be relaxed. Having been targeted early on as an Old Labour dinosaur ripe for extinction, he now basks in the common perception that he is one of the great successes of Tony Blair's Cabinet, and a potential mayor of London.
So what about the future? 'I look forward to doing this job as long as the prime minister wants me to do it,' he says, poker-faced. 'Confident in the knowledge that he does. As I was at the outset.'
At this point he and his advisers collapse in gales of laughter. Against all the odds, Frank Dobson is a New Labour success story. And they know it.