ABSTRACT
Prime Ministerial health advisers, such as Simon Stevens, Julian le Grand and Paul Corrigan, have been the policy champions for health reform, in some cases providing a bridge to the Department of Health (DoH) given their origin as political advisers to Health Secretaries. Independent advice to Ministers in the DoH from career civil servants, already waning due to the relative marginalisation of the Permanent Secretary (PS) following the Griffiths reforms, was diminished further by unifying the roles of Permanent Secretary to the DoH and Chief Executive (CE) of the National Health Service (NHS), in Autumn when Nigel Crisp was appointed. For the scale of the deficit as Financial Year progressed was a major surprise on an increasing scale as it was reported up the line from individual Trusts, to Strategic Health Authorities (SHAs), to the Department of Health management team, to health Ministers and finally to the Prime Minister.
