More like Peter the Great than Ivan the Terrible—but only if they have money

In 1999 the Department of Health in England appointed its first health “tsar.”

In doing so it broke with its long tradition that only civil servants worked with ministers to develop and implement policy. Since Mike Richards became the cancer tsar (more properly, the national cancer director) a further eight health tsars and one “champion” have been appointed to shape a variety of services, including primary care, heart disease, mental health, diabetes, and services for children and older people.

Although secondment of practitioners is not new in other departments of British government—the Ministry of Defence relies heavily on advice from serving military officers, and Treasury officials often work with seconded economists—the use of clinicians to direct change at a national level in health was new for England. The initiative has not been without its critics.

Tsars tend to be appointed because they are noisy and attract attention. They are usually outspoken and passionate in advocating change in the way their patients are managed. In this respect they are no different from many others working in the same specialty. Inevitably, when one eminent clinician is given the opportunity to change the face of a specialty, equally eminent …