Sir David Varney, who has resigned from the post of chair of the Barking, Havering and Redbridge University Hospitals NHS Trust, is not a man to shrink from a challenge.
The former manager of a whole raft of private companies, from British Gas to O2, former permanent secretary of HM Revenue and Customs, and writer of a seminal report on the need to join up government services, Varney was senior adviser to the former prime minister Tony Blair on service transformation.
His resignation comes as trusts such as Barking face what Varney calls an "incredibly tough" challenge.
Until last year, Varney was working as the government's unpaid adviser in services transformation. Some observers were surprised when he took on the position at Barking, deep in the heart of Romford, but Varney himself was keen to take on a position in the NHS.
"I'd been there [on the Civil Service steering board] for five years. I felt I'd learned a lot; I hope I'd contributed something," he says, rather modestly for a man who has not just reports but conferences named after him.
If Varney wanted a challenge, he certainly got it. The trust he was chairing until the end of June was rated the worst-performing NHS trust in England last October by local watchdog the Audit Commission and has a financial deficit of more than £35m.
It is in the middle of consultation on its future shape and strategy in the light of the Darzi review of London's medical services.
Varney acknowledges that whatever the organisation, there are certain aspects of chairing that are similar, including "establishing contact with the organisation, engaging with it and ensuring that the leadership group is as big and as active as it can be".
On the vexed question of targets, Varney acknowledges that there are still too many targets, which are "not knitted together", but defends the use of targets in the NHS. "A lot of the targetry we've got comes out of clinicians' best practice or are about hospital hygiene standards of infection control, where there is best practice," he says.
Looking across the wider public sector at progress towards the aims set out in his 2006 report on how the channels through which public services are delivered can be made more efficient and responsive to the needs of citizens and businesses, Varney says some things have gone very well, but adds: "That's not to say they can't go better."
He approves of the way government websites have been centralised into Directgov, for citizens, and Business Links, for businesses and says more public managers now understand the need for more joined-up services. "You've got more people who understand what it means to put yourself in the shoes of the citizen."
But more change is still needed, not just to make government more efficient but also to cut costs. "It's clear that the scale of the financial problems and difficulties that are going to hit the public sector are more severe and therefore we need to find better ways of doing things," he says.
He also wants any new government to reassess the need for greater structural change in government, to make public bodies work together more efficiently. "Collaboration is always difficult," he acknowledges.
"I always think about St Paul's Way in Tower Hamlets. It's this street that Andrew Mawson first brought to my attention where the public sector was putting investment in schools, in council buildings, in housing. It was a huge amount of investment, all being managed separately by separate organisations, by finance directors in those separate organisations, all using separate IT. And you just thought to yourself there must be a huge opportunity here."
The answer may be an initiative like Total Place, where local areas are adding up all the public money being spent, to try and avoid wasteful duplication, or greater use of shared services, using centralised IT systems.
But this appetite for change does not mean Varney approves of what he calls the present "avalanche" of criticism of Whitehall.
"I don't think this continual pulling bits up by the root is helpful." Again, he'd like any incoming government to take a long, hard look at the workings of the civil service, perhaps through a 12-month commission.
"Some of the issues have proved quite difficult, like what are the limits and roles and responsibilities of accounting officers, particularly when it comes to collaboration."
Some of the mechanisms introduced to try and make government departments work more closer together, such as the Public Service Agreements - policy targets set not just for single departments, but for several different departments - have done less well precisely because of the difficulties such departments still have in working with one another. "I think a lot of progress has been made in the leadership teams in the civil service - what we need to do is now put some meat on the bones," he says.
Varney also harbours another innovative proposal to shake up hardened leadership thinking: jesters. "There was a firm in California that provided jesters - not to make fun, but to talk truth. There's no uniform. You don't have to wear a hat. But the idea is how to contend, without being contentious, and humour is the way we often do that. The second idea is how to increase your vulnerability to feedback."
From Bubb's Blog
From Flip Chart Fairy Tales
