Nicholson’s power is unrivalled – so is his responsibility to lead
This week is expected to see the publication of the revised Health and Social Care Bill. Health secretary Andrew Lansley has written that it will contain more than 150 amendments. It would be only mildly surprising to find one of them enshrining in law Sir David Nicholson’s position as NHS chief executive.
On Monday the government set out the full scope of the proposed changes to its NHS reforms. It included specific mention that Sir David would remain as NHS chief executive until April 2013, before switching to perform the same role at the NHS Commissioning Board.
HSJ cannot remember a similar endorsement of a named individual in such an important Department of Health policy statement. When HSJ interviewed him on the same day, Sir David admitted that neither could he, quickly adding: “and I didn’t write it”.
The question now is what will he do with the power his position gives him?
HSJ asks this week if the NHS reforms can really change their spots. Sir David – the biggest beast in the NHS jungle – is clearly happier, telling HSJ there is now “a much stronger transition path than we had before”. He praises the performance of the NHS during the coalition’s first year, saying it has been “remarkable” given the context and revealing that the DH quarter four report will show that “on all the big measures, healthcare-acquired infections, access to services, cancer waiting times… [performance] has held all pretty well.”
He is keen to “draw a line” under reform controversy and get stuck into building the new system, agreeing with HSJ that risk grows as uncertainty continues.
He echoes the line used by the health secretary in claiming the “intent” of the reforms was misunderstood – although he lays much of the blame for that misunderstanding on “the way” government documents, including the December 2010 command paper, “were drafted”.
He is mindful of accusations of empire building as a result of the accretion of powers around the Commissioning Board and is keen to stress, for example, how commissioning support and back office services for commissioning groups should not be provided by the board.
However, the sheer power of Sir David’s position puts him in a quandary. Last week the NHS chief executive admitted he feared the impact of the original competition proposals. Asked by HSJ when he first raised these concerns with ministers, Sir David said simply: “My job is to give ministers advice and to identify the strengths and weaknesses [of proposals] – and that’s what I’ve been doing throughout all this process.”
A true civil servant’s answer. But people will know that his influence makes him much more than that. He is also chief executive designate of an organisation which was commonly described by Mr Lansley in opposition as an “independent” NHS board.
Sir David declares his “general approach” to NHS reform is “well known”, citing, for example, that he has consistently said that “competition is an important tool to improve quality for patients”.
It is an interesting example, given that he is probably best known by those who have worked closely with him for pointing out the limitations and dangers of competition.
It shows Sir David’s skill that he can avoid being pigeon-holed as either an NHS backwoodsman or rampant reformer intent on liberating the service from public sector monopolies. The fact that he has and is regularly accused of both is another sign of that skill.
But as transition to the new system begins to motor, Sir David’s leadership will need to take on an even higher profile. Everybody knows he is in charge and that will mean being absolutely clear about what is best for the service – and not only to ministers.
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Readers' comments (12)
Robert Bobson | 22-Jun-2011 11:19 pm
"He is keen to “draw a line” under reform controversy"
Yes I should think he is.
"[He] and is keen to stress... how commissioning support and back office services for commissioning groups should not be provided by the board"
Except for communications where he is planning to top-slice the management fee to provide GPs with his own 'on message' comms people.
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Anonymous | 22-Jun-2011 11:26 pm
If the public don't like the way Mr Nicholson is running the NHS, how do they sack him?
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Anonymous | 23-Jun-2011 0:07 am
Well spotted Dr Bobson. Big beast is terrified the docs will tell it like it is, so he is foisting his spin army on them. And the funniest thing is that the GPs will have to pay for the priviledge.
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Anonymous | 23-Jun-2011 10:30 am
Hooray for Robert Bobson - the voice of reason.
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Patrick Newman | 23-Jun-2011 11:15 am
“on all the big measures, healthcare-acquired infections, access to services, cancer waiting times… [performance] has held all pretty well.” I think that means that the NHS has not got worse in the Coalition's first year.
"agreeing with HSJ that risk grows as uncertainty continues." confusion however grows bringing much risk.
"avoid being pigeon-holed as either an NHS backwoodsman or rampant reformer intent on liberating the service from public sector monopolies. The fact that he has and is regularly accused of both is another sign of that skill." - but is this top draw leadership commensurate with exceptional responsibility?
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Anonymous | 23-Jun-2011 11:37 am
When the GPs realise that marketisation of commissioning support has been binned for comms they will not be happy.
When private comms agencies realise they have been frozen out of bidding for work they will not be happy.
When NHS Comms Staff realise they have been set up to be the NHSCB police inside CCGs they will not be happy.
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Anonymous | 23-Jun-2011 2:03 pm
David Nichsolson has the power OF GREYSKULL.
http://www.youtube.com/watch?v=8wl-tQPPm9c
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Gerry Toner | 23-Jun-2011 2:31 pm
Any serious CEO who has overseen the dsasters and about face changes in strategy would have resigned before being binned. This is politics as its greatest stench and the current CEO is a master of survival.
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HARRY CLIBBENS | 23-Jun-2011 3:17 pm
David Nicholson has done a far better job than many of his critics could have done.He deserves credit for keeping the NHS ship afloat under its most critical period since its inception. I have no doubt he will manage the reforms as well if not better than his contemporaries could do from the Private or Public sector.
His performances at select commitee hearings are evidence alone of his knowledge and skills.
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Anonymous | 23-Jun-2011 7:31 pm
I agree with Harry - DN has played a blinder: survived the the end of Labour; implemented AL's sh*t storm; emerged on the other side without a shred of poo on him; got the entire system nicely centralised under him (while talking up localism).... and got the SoS back in the frame as the guy to blame if anything goes wrong. The guy's a genius!
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Anonymous | 24-Jun-2011 8:37 am
With all the emphasis on openness and transparancy to ensure accountability, will the NCB meet in public? Surely the fundamentally important decisions the NCB will make should be opened up and demonstrated to be accountable in the same way as other parts of the sytem.
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Anonymous | 24-Jun-2011 9:25 am
"He praises the performance of the NHS..." vs "lays much of the blame for that misunderstanding on “the way” government documents... “were drafted”. So if you're in DH don't expect a job in the NHSCB!
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