Former Department of Health planning director who helped shape the modern NHS
Alasdair Liddell, who has died suddenly aged 63, following an aneurysm, helped to shape the modern National Health Service. He was one of a small band of leaders who understood the significance of the move in the 1980s from NHS administration to NHS management, and the responsibility that came with it. Many of the ideas he pioneered, such as an emphasis on outcomes rather than activity, are now regarded as mainstream.
Born in Pitlochry, Perthshire, Alasdair was educated at Fettes college, Edinburgh, and Balliol College, Oxford, graduating in jurisprudence in 1970. He joined the health service as an administrator in London, rising in the 1980s to become the district general manager in Bloomsbury, where he presided over a major reconfiguration of services, including the creation of what is now University College Hospital Trust.
However, it was as manager of the East Anglian regional health authority between 1988 and 1994 that he began to put into practice the idea that healthcare needed a strategic purpose based on clear and explicit values. Today, discussions about access, equity and effectiveness are commonplace, but at the time this was new ground, as was his determination to ensure that healthcare was not merely about treating the sick, but about health gain for all.
In the Conservative internal market reforms of 1990 he saw potential and dangers, and unlike many others realised that making the new system work demanded more than central commands and a change of rules; it needed changed behaviours. He was also determined to roadtest the reforms, which ran against government policy at the time.
Working with Laurie McMahon and Greg Parston of the Office for Public Management, in 1990 Liddell commissioned a major simulation exercise known as the Rubber Windmill, which attempted to see how the reforms might work in practice. It enabled managers and clinicians to test mechanisms and behaviours, and develop practices to ensure the new system worked. It achieved national notoriety following press reports that the new NHS market had crashed, although in reality it had been deliberately tested to destruction by withdrawing funding to the point where services could not be sustained.
But the Windmill exercise, repeated in following years, did more than make the obvious point that the health service suffers when money is tight – it showed the weakness of purchasing (later called commissioning), the potential of GP fund holding (now reborn as clinical commissioning) and the need to take all clinicians, especially those in the acute sector, with you. It was also evident at the outset that the voice of the patient was not being heard.
Questions were asked in the House and it was said that Margaret Thatcher, then prime minister, was not best pleased with the "war games" in East Anglia. But the Windmill proved very influential and the testing went on – as a result, the reforms were introduced more gradually and with greater care than otherwise they might have been.
Alasdair's ability to see the wider picture was recognised in 1994 when he was brought into the Department of Health as director of planning. While there, he was responsible for what some regard as the best white paper on health the department has produced. Drafted in the dying days of the Conservative administration, A Service with Ambitions (1996) was an attempt to ease the transition to what most expected to be a new government. It introduced the notion that services needed to be much more responsive to patients and stressed the importance of active patient involvement. It was also a successful move to bind the Conservatives to a service that was free to all and based on clinical need.
In 1997 Alasdair was appointed CBE. The enthusiasm that greeted the new Labour ministers that May did not last long – after many years in opposition they were suspicious of officialdom and keen to bring in their own people. However, Alasdair continued to deliver. He was the brains behind the NHS Direct advice and information service, and oversaw the successful 50th anniversary celebrations of the NHS in 1998, characteristically placing the emphasis on local activity.
By 2000, many of the team that had been around during the previous government were moving on and there were tensions with ministers – Alasdair went to the private sector, working for, among others, the public relations agency Bell Pottinger and the recruitment firm Healthcare Locums. He also became a senior associate at the healthcare thinktank the King's Fund. During my time at the fund, with Alasdair's help we revived the Windmill simulation (Windmill 2007) and again sought to understand the impact of and refine Labour's latest set of reforms, which combined greater autonomy for providers with greater clinical accountability for quality and access.
Alasdair was one of very few leaders in healthcare who recognised the potential of technology to drive change – and his original blueprint for IT in the NHS in the 1990s championed the idea that a bottom up, rather than a top down, approach would deliver best results. Sadly, that was one of his ideas that was not followed through.
He was also one of the first to recognise the potential of telehealth – where technology is used to diagnose, manage or treat patients remotely – and continued to champion better uptake of technology throughout his career. Most recently he chaired the expert panel judging the NHS Innovation Challenge Prizes scheme and contributed to the Prime Minister's Dementia Challenge, launched in March 2012.
Alasdair chose his words carefully, but what he did say was invariably worth listening to. He married Jenny Abramsky in 1976, and together they made a formidable couple. She survives him, as do their son, Rob, and daughter, Maia.
• Alasdair Donald MacDuff Liddell, healthcare consultant, born 15 January 1949; died 31 December 2012