Terri Banks, who has died aged 91, was one of a pioneering generation of women admired for fighting their way to senior positions in the civil service. She worked mainly in health finance and later became director of the Office for Population Censuses and Surveys, and with that, registrar general, the first woman to hold the position in its 150-year history.
The main part of her career in the civil service, between 1972 and 1985, was spent in the Department for Health and Social Security (DHSS). She introduced programme budgeting for health finance, an approach that uses routine management information to link costs to measurable results, and gathers services into programmes for different groups of users.
This enabled better planning for changes such as a growing ageing population, as well as transparency in the way priorities were set at national level.
She was proud of her contribution to a consultative document, Priorities for Health and Social Service in England, published in 1976 when Barbara Castle was secretary of state for social services. This provided a basis for moving funding away from hospitals in order to improve prevention and care at community level, as well as towards underfunded areas such as mental health and services for children and elderly people. The report was acclaimed as a model in numerate policymaking.
During the 1980s, the NHS came under attack as too expensive and inefficient. Terri was at the forefront of defending the levels of funding and the funding model. The Conservatives under Margaret Thatcher assumed that private sector involvement would bring lower costs, but a comparative study that Terri contributed to convinced Norman Fowler, then secretary of state for social services, that the tax-based system was the most efficient, and he ensured it continued.
In 1983 the NHS Management Board was established within the DHSS, mirroring the introduction of general managers and lines of accountability throughout the NHS. It allowed the minister to focus on policy rather than day-to-day management. Terri was appointed director of health authority finance, responsible for all the central functions, including public expenditure negotiations, resource allocation and accountability to parliament.
She was proud that members of the board from the private sector were impressed to discover that the NHS, at that time, had lower costs than any comparable western system; was much more equitable than medical care in the US; had improved its performance year on year apart from a dip during the winter of discontent; and also had some of the best clinical practice in the world.
After a long career in health finance, Terri would reflect on her great respect for ministers and how they managed the pressures they were under.
She believed that, during the 70s and 80s, despite changes in government, the NHS was consistently well-run. This resulted from political commitment to maintaining the tax-based system; evidence-based prioritising of funding for services aimed at supporting the most deprived; ensuring there were no costly reorganisations; setting national priorities, but allowing real devolution to local level; minimising ring-fencing of funds by ministers; and realistic expectations of efficiency savings.
In 1986 she was appointed director of the Office for Population Censuses and Surveys. In the face of huge suspicions from her overwhelmingly male colleagues, she oversaw many important changes, such as the inclusion for the first time, in the 1991 census, of a question on ethnicity, and the move to allowing marriages to take place outside register offices.
She was passionate in defending the department’s statistical analysis from political interference, for example arguing that if analysis of health statistics by “social class” showed what a sharp difference material inequality made to health outcomes, this should never be suppressed. Indeed it was an important fact that should be addressed by any government, whatever their political persuasion.
Terri was born and grew up in south London. Her father, Percy Brimblecombe, was a naval architect, and her mother, Beryl (nee Menzies), was head teacher of a school in King’s Cross.
After leaving Walthamstow Hall school, she went to Lady Margaret Hall, Oxford, where she studied philosophy, politics and economics, and then psychology, excelling in both.
In 1960 she married John Banks, also a civil servant, who was soon posted to India, where they had three children. She immersed herself in Indian culture and landscape. She met Jawaharlal Nehru, the Indian prime minister, who taught her the proper way to cut a mango, and together with John, accompanied Clement Attlee, the Labour statesman who oversaw Indian independence, on a tour of the country.
On their return from India, she and John settled in north London, where she resumed her career. Outside work she was a passionate campaigner. She was a co-leader of the successful campaign in the 60s and 70s to stop the Motorway Box, a planned inner London ring road: the only part that was built was the Westway.
After retirement from the civil service in 1990 she took on a number of roles, including serving as vice-chair of the board of trustees of the Royal Free hospital, and from 1990 as director of the Carnegie Inquiry into the Third Age. This was the first national inquiry into life and livelihood for people aged between 50 and 75, and its 1992 report made wide-ranging policy recommendations aimed at supporting this growing group of people to continue to contribute to society.
Terri loved walking in wild places and was interested in literature and in the unanswered questions of science. Later in life she joined the Hampstead Quaker Meeting, where she found a home for her spirituality and became a valued member of the community.
She was a fiercely intellectual and principled person, with great integrity and commitment to those to whom she was close.
Terri and John divorced in 1993. She is survived by their children, Isobel, Sophy and Steve, and two granddaughters, Anna and Tasha.
• Terri (Gillian Theresa) Banks, civil servant, born 7 February 1933; died 5 February 2025
