Nigel Crisp steps down from top NHS job amid financial pressures
London

Rebecca Coombes

The chief executive of the NHS and permanent secretary at the Department of Health, Nigel Crisp, is to step down at the end of this month after acknowledging accountability for the health service�s financial problems.

Sir Nigel said his decision to enter early retirement at the age of 54 was taken with "sadness."

Despite overseeing huge increases in spending and waiting list reductions he admitted in a frank statement that "not everything had gone well."

"I am particularly saddened by the difficulties we have had over the last few months and the financial problems we are grappling with. As chief executive I wish to acknowledge my accountability for problems, just as I may take some credit for achievements," he said.

Although lasting more than five years in one of the most challenging jobs in Whitehall, during which he oversaw the implementation of the first half of the 10 year NHS plan, Sir Nigel has come under huge pressure as the health service�s overspend heads towards a record �620m (�904m; $1080m) for 2005-6.

The secretary of state for health, Patricia Hewitt, supported Sir Nigel�s decision to go, saying that he had been responsible for huge improvements in the care of patients. She said, "As a result of Sir Nigel�s efforts, the department has become a role model for the successful delivery of public services. On a personal level I regret his decision announced today, but I respect his integrity and wish him well for the future."

Commenting on the news of Sir Nigel�s departure, the chairman of the BMA, James Johnson, said: "It is not for us to comment on individuals at the Department of Health. There are clearly problems in the NHS, and we look forward to working with his successors to help tackle these problems in the most appropriate way."

Gill Morgan, chief executive of the NHS Confederation, the body that represents NHS organisations, said that Sir Nigel had steered the NHS through "five turbulent years."

"He led the service through a time of record change which saw unprecedented levels of investment, waiting lists slashed, and the introduction of an enormous reform programme."

Sir Nigel has been criticised for driving through further reorganisation of strategic health authorities and primary care trusts at a time when managers were struggling with the governments� ambitious targets on waiting times.

The chief executive of the Institute of Healthcare Management, Jeremy Millar, said, "History will judge whether the pace of change has been accelerated beyond the capacity of the system to cope. Many institute members have been forced to make cuts in an effort to balance the books. Many have had to leave the service themselves."

Sir Nigel was appointed to his current post in November 2000, becoming the first civil servant to combine the previously separate roles of head of the Department of Health and head of the NHS.

Interim arrangements to replace Sir Nigel will see the roles once again separated.

Ian Carruthers will become acting chief executive of the NHS (in charge of operational issues), and Hugh Taylor will become acting permanent secretary of the Department of Health. Sir Ian, an experienced NHS manager, was recently appointed to the department�s board as acting director of commissioning. Mr Taylor, a career civil servant, is currently group director of strategy and business development at the department.