To combine his twin NHS roles of permanent secretary and chief executive, Nigel Crisp has to pull off a tricky balancing act. But he is determined to be accessible - and communicative - he tells Laura Donnelly in an exclusive interview

His manner may be quiet, and his demeanour sometimes cautious. But less than one month into his new job at the top of the NHS, Nigel Crisp is determined to deliver - and has already begun to make his mark.

He made a stumbling start.

Claims that Mr Crisp wanted 'a higher profile' backfired when he failed to appear at his very first press conference, called to announce his new job. The meeting was reconvened the next day. But by then an apologetic Mr Crisp had missed his slot. As far as the national media was concerned, the management of the NHS was yesterday's news.

But he meant what he said. In an exclusive interview with HSJ, he set out his plans for the future.

Communication is top of his list.

In his first week, he set up a monthly e-mail bulletin to the service, listing priorities, operational developments and a timetable for the future. The first bulletin also contained a cheery message from the man himself - and a plea for feedback, direct to the dedicated e-mail address mb-nigel-crispnhs@doh. gsi. gov. uk.

Mr Crisp has promised the media monthly briefings. And he insists that although his deputy, Neil McKay, has become NHS chief operating officer with 'day to day' responsibility for operations and performance management, the boss himself won't be hiding in Whitehall.

Before outlining last week's plans for a tour of trusts and health authorities, Mr Crisp says: 'One thing I won't devolve to Neil is getting round the NHS. I need to see what is happening on the ground.'

He shies away from any suggestion that the job he has taken on is too big to handle and he is positive about the benefits of being in charge of social care and public health as well as the NHS: 'You need to be talking to both (health and social care) at once. . . giving the same message.'

He resists suggestions that with his permanent secretary cap comes a hefty dose of political interference, and insists that his job remains one of implementation, not policy. The NHS has 'always sat within a political framework', he adds.

It is a difficult balancing act.Mr Crisp promises to try to be 'more accessible to journalists than either of my predecessors have been'. He suggests that his experience of NHS management - 'knowing what it is really like' - will put him in a strong position to explain issues to the NHS and public. But he quickly adds: 'I am not a politician.'

Mr Crisp points out that the Department of Health is not the first government department to combine the roles of permanent secretary with the chief operational role. He gives as an example the prison service.

But he backtracks at the reminder that the prison service ran into its own difficulties on the split between operational issues and policy decisions.

For the first time he appears flustered, saying: 'That could have happened anyway. I don't think we are on a parallel with the prison service. I certainly can't envisage that sort of problem.'

And Mr Crisp does admit that the Janus-like nature of his new role could bring a few extra strains.

'One [part of the job] is internally faced - looking into Whitehall - the other looks out externally. That does make it a bit more complicated. The only way it will succeed is if I have good, strong people around me. That is why I have made a number of quick decisions.'

These include the new role for Mr McKay and the creation of a new - yet-to-be appointed - head of external and corporate affairs to work across government and with local authorities. The Continued from page 13 successful candidate is likely to be an existing civil servant.

Good people are one of three factors he cites when talking about why now is a great time to take on his new job. The other two are the money - and the NHS plan.

His bulletin promises more information on funding allocations, the planning cycle and a 'clearer map of how the various parts of the new structures - the Modernisation Agency, taskforces and modernisation board - fit together'. Two out of three have already been announced.

Mr Crisp is expecting NHS organisations to work to 'short, sharp' planning cycles this time round; between April and June 2001 they will work to cycles spanning three to five years.

Details on the fit between the new bodies at the top of the NHS are expected by early December.

At the same time a meeting of the NHS modernisation board will examine a draft implementation paper for the NHS plan.

Under the new structure, an operational board will bring together regional directors with colleagues in social care, public health, central management and the Modernisation Agency, meeting fortnightly.

This will replace current monthly executive board meetings and aims to make sure the operational issues get higher up the agenda, looking at issues ranging from fuel crises to winter planning and waiting lists.

As part of plans to bring social care and the NHS together, the new year will see the creation of eight social care regions, coterminous with NHS regional offices, a move which Mr Crisp says will cost just£400,000, largely to be spent on staff recruitment. He expects the new regions to work more closely with the regional offices of government.

The four social services inspectorate regions will remain unchanged. Departmental management meetings will come under a new structure, too.

A 'tightly focused' NHS plan project board will meet monthly to oversee the development and implementation of a project plan, and bring together representatives from the central directorates and regional offices.

A strategy board chaired by Mr Crisp will bring together all directors and some senior managers 'to debate and agree on the key strategic issues'.

As former director of London region, Mr Crisp has strong ideas about the future role for regional offices, too. Again, communication is the key.

'In many ways they are just too far away, ' he adds, later quoting a colleague's suggestion that regional offices spent their time 'setting targets and then we have sat back and marked their homework'. Regional offices need to be more 'supportive and help people deliver'.

'The greatest danger is that we could be a headquarters which is out of touch.'