Nicholson seeks "legitimacy" amidst a storm of protest
Sir David Nicholson believes his role as NHS Commissioning Board chief executive should be one in which he communicates more regularly and directly with the service and the public.
From 1 April he will no longer, in his words, draw his “legitimacy from an elected politician”, but run an organisation which justifies its work though “its connection with patients and the public.”
Sir David dealt forthrightly with a wide range of subjects during his HSJ interview including an eyebrow-raising interventionist approach to service redesign, the board’s management style, care integration and the problems experienced by those whose jobs are being affected by NHS reform.
However, it was his comments on Robert Francis’ Mid Staffs inquiry which understandably drew the most attention when published online.
Like many healthcare leaders he was genuinely shocked by the findings of the first inquiry and, as he revealed to HSJ, he considered resigning after reading the patient stories in the report. But Sir David is proud of his record as NHS chief executive and believes he has “unfinished business” in “giving patients more clout” through the board’s actions.
The credibility for this aspiration is strengthened by his continued support for central “grip” where necessary. Few would take him seriously if he switched horses entirely in mid-stream. This is still a man who believes that leading from the centre works best in times of danger for the service, with some aspects of poor performance or when something needs to be fixed on a regional scale.
He would argue that the robustness of the service’s performance in tough times is evidence that his approach works. Indeed many leading figures who feared the reforms would fragment NHS services have privately expressed the belief that while Sir David is in charge the service is “safe”.
There will be a clamour for “heads to roll” following the publication of the Francis inquiry. But when considering Sir David’s position, Jeremy Hunt will have to think hard about the impact on a rapidly developing system of pushing for removal of the board chief. The answer to the question: “If not Nicholson, who?” is very far from obvious.
Much of the criticism directed at Sir David by HSJ readers is connected to a belief that he let a culture of management “bullying” develop. No doubt, Mr Francis will have something to say on that emotive subject, but HSJ suspects the NHS chief executive is often simply a convenient scapegoat for the, mostly successful, target culture of the last decade and for those who have had – justified and unjustified – bruising encounters as a result.
HSJ is more concerned with Sir David’s claim that the new commissioning structures are “undoubtedly” already better able to spot quality problems. His belief is based on the emerging system of quality summits and the idea that GPs involved in clinical commissioning groups have a feel for service quality through long experience of “referring and hearing feedback from patients”.
There is no reason why CCGs should not develop a more sensitive approach to quality monitoring. But to say that, during the turmoil of reorganisation, commissioners’ quality radar is better “now”, opens him up to accusations of naivety – something he was accused of during his cross-examination at the Mid Staffs inquiry. It also worth remembering that, as Andrew Lansley pointed out, local GPs should have blown the whistle on Mid Staffs but did not.
Sir David, of course, does not have a naïve bone in his body when it comes to how the NHS works – so his claim is likely to be an attempt to bolster the standing of his new CCG “partners”. However, he will do them little benefit by over claiming their capabilities at this early stage in their development.
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Readers' comments (6)
Diana Smith | 15-Jan-2013 6:35 pm
Well done to those people who chose to use their names. Always better when attacking someone who cannot really answer back.
I agree with the writers who say that the best course of action is to read the report - thoroughly - maybe several times - before entering into judgement on anyone.
Also agree with the writers who suggest that we should be careful what we wish for. Thise who are attacking Sir David are often doing so for completely different reasons, and with a different idea of what they might like to see in his place. The chances of everyone magically being satisfied by a change are slim.
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Kenneth Lownds | 16-Jan-2013 9:41 am
Better start reading Nicholson's evidence, Alastair!
Of course he wasn't "genuinely shocked". He was closely involved in the appointment of failed Mid Staffs chief exec Martin Yeates and acted as a mentor to him.
During his frenetic tenure as boss of all SHAs in the region and to get appointed as NHS chief exec in 2005 he set out to impress Patsy Hewitt by removing the entire board at UHNS and sending in Antony Sumara plus a Deloitte 'turnround' team; UHNS problem? Big deficit.
What did he do for Mid Staffs in 2005 also struggling with years of deficits and already also struggling with serious safety issues (read Dr Peter Daggett's evidence)? Started them on the path to FT status because he needed at least one on his patch or Patsy wouldn't be impressed! Within a month of Mid Staffs becoming an FT the Healthcare Commission were starting to uncover the horror of that sad institution! Brilliant judgement by Nicholson wouldn't you say, Alastair?
Of course Nicholson did what Burnham, Johnson, Hewitt, Reid, Milburn all wanted, but his own day-by-day 'command and control' crushed the culture of care across the NHS. Our members suffered harm and death from this regime. From 2006 Nicholson was the faithful political tool in Richmond House. "Scapegoat"? Is that what he told you? Never.
In May 2008 when Ian Kennedy told Nicholson about the Healthcare Commission investigation into Mid Staffs what action did Nicholson take to prevent further harm and death? Utterly and absolutely nothing.
What did Cynthia Bower his successor in the SHA do to prevent further harm and death at Mid Staffs? She and her team worked hard to undermine the investigation and set out to undermine Dr Foster's HSMRs; read the evidence of all Healthcare Commission witnesses. Hence an obvious choice for CQC boss.
Under Nicholson and his predecessors from Mid Staffs 'zero star day' in 2004 self-assessment rather than inspection turned this part of the regulation of all healthcare into a sham and a charade.
Now the nonsense in this interview. Another year of Nicholson counting the bedpans in the big teaching hospitals (including UHNS, soon to swallow Mid Staffs?) and the NHS will be finished.
Solution? After Nicholson's departure frontline NHS staff themselves rebuilding the culture of care on the wards and throughout the NHS. Nicholson's plan is clearly to keep them and every single NHS staff member under his thumb.
Cure the NHS - Stafford
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Patrick Newman | 17-Jan-2013 11:21 am
If as reports suggest that Nicholson is fingered by Francis it is difficult to see how he will survive and if he does will it be in the form of a disabled duck. To get a 'grip' whoever is in charge of the NHSCB will have to renationalise the FT's who are now considered as subject to OFT regulation as if they are players in a free market - the nadir of the NHS. Which brings us back to Mid Staffs who were going through the throes of becoming an FT and (subject to Francis) may not have been entirely in touch with the inconvenience of having to deal with those pesky patients who were being 'slaughtered in their hundreds' Nicholson is the devil we know. I dont want to think what Hunt will give us in his place.
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Andrew Craig | 17-Jan-2013 1:36 pm
Forget "grip", this is about "blood and iron" but sealed with a Glasgow kiss. But Bismarck got dropped too don't forget.
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Anonymous | 18-Jan-2013 9:27 pm
I agree with all of the above but with one key qualifier. The bullying culture is not solely down to targets of the last decade and Nicholson isn't entirely the scapegoat. I have spent half my career in the NHS and the rest in the private sector. I have never experienced the degree of institutional racism, prejudice and just downright ignorance of our diverse population as in the NHS. I loved working in the NHS despite that, and I still miss many of the people, but I could no longer work in it. Constant reorganisations have just resulted in a self serving clique of elites who protect their salaries and their friends but do and say what they please. Blatantly bullying behaviour is rampant but never challenged partly through fear but also because some of the perpetrators don't even realise - or care - that what they say or do is inappropriate. I won't give examples for fear of being identified but this reform has just been a free for all for all kinds of nastiness. As CEOs of organisations are expected to fall on their swords in a crisis, even one they've not presided over, why should the NHS be any different? Surely we can't have gone through all this just to reshuffle people into new posts, like old wine into new bottles?
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Anonymous | 21-Jan-2013 12:33 pm
'HSJ suspects the NHS chief executive is often simply a convenient scapegoat'
Well perhaps he is to a degree as Sir David Nicolson is very much the figurehead of NHS management. As such he is seen by managers as presiding over -and reinforcing -a bullying culture and even if that were not the case the point is that is how he is perceived. As such he has lost the confidence and support of a great swathe of NHS management. Moreover he is personally linked with the failings at Mid Staffs and he should take responsibility for his part in it and resign.
The notion that he should stay because there is no-one else in the country who can do the job doesn’t stand up to any serious scrutiny. If it were true it would be the best argument yet for changing the role ...and the person in it.
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