The outgoing NHS England chief executive has said he regrets not making more progress in increasing the number of black and minority ethnic senior NHS leaders.

Sir David Nicholson said in his final HSJ interview before retirement, that senior NHS management was “too monocultural”, and he described the barriers to improvement as a “systemic problem”.

“You need to nurture and support people in the middle of organisations and help them with their careers, and take them forward in an organised and planned way. People have been very reluctant to cooperate across the NHS in terms of getting talent management and talent planning going. People too often think all they should be interested in is their own organisation,” he said.

Sir David was made NHS chief executive in 2006, becoming chief of the new independent NHS Commissioning Board when it was created in 2012.

Asked about his own leadership style, Sir David argued he was linked to tough, top-down performance management because that was the style most required during his time in very senior posts, but it was not his only approach.

“I’ve always been a much more sophisticated operator,” he said. “You can’t do the job just having one dimension to your leadership.

“But that [direct approach] was of the time. If you think about the challenges we were facing – access, healthcare associated infections, and the idea of government setting goals or targets – that nurtured a particular approach.”

He said today’s priorities – “long term conditions, prevention, integration of services” – encourage “a different set of skills”, although “there are times in any circumstances when you need a more direct approach”.

Sir David said “a whole generation” of senior managers had left “over the last two or three years”, leaving leaders who were “younger, more female, a generation brought up in an era of reform”.

“Using incentives and those kind of things is second nature [to these new leaders], which seems to me to be a good thing,” he said.

He added that it was also positive there were now more clinical leaders in the NHS.

Nicholson exit interview: Rules and structures are blocking change